16656 POST THIS RD'NEAR FRONT OF BUILDING , PERMIT NUMBER
'' CIOF CUPERTINO 6
INSPECTION DIVISION . ."
JOB INSPECTION RECORD
-?lp/.�3 7Y- PERMIT EXPIRATION
JOB ADDRESS ZQ/Q3 /Vi WdL �. �/ 'UNIT# _LOT#
PERMIT EXPIRES IF.WORK i
OWNER', ,LLc S" OU T a CONTE CTOR �[� IS NOT STARTED WITHIN'
INSPECTION DATE . INSPECTOR INSPECTION RECORD 1Bo DAYS OF'PERMITJSSu-
FOUNDATIONANCE OR 180 DAYS FROM:
.NOTE: - LASTCALLED INSPECTION..
UF,ER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - - TO COMPLY WITH THE APPROVED PEANS AND CIN OF PERMIT.VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED i .�
:UNDERGROUND /SLAB
, PLUMBING'
ELECTRICAL - ISSUANCE UA rE
MECHANICAL •• ,_ elOc� ELEcr. Plc. MECH, -
IFf. ® �
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED w BUILDING PERMIT
WOOD FLOOR O+, _ - INFORMATION
PLUMBING - ej1EY D aPB ATION • $IFT.
MECHANICAL
ELECTRICAL' - - , PERMIT TO
FRAMING - -
INSULATION STORIES TYPE CDNSTR.
.00C GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SD.FT FLOOR PR[A TOTAL ALH[PGf 4'
• • ROOF NOTE'NO FINAL'INSP.SHALL BE MADE BEFORE
DIAPHRAGM ..THE CONSTRUCTION TAX IS PAID _
". BUILDING USE
ROOF SHEATHING RES IND CON PB om
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ "❑ ❑ 1:1 El
ROUGH _ $AN.H ASSESSORSPARCELNO,
PLUMBING ELECT.ENERGY
.
TUBS BSHOWER PAN - PLUMBING,ENERGY - ' TRA6T NOPARCELNO
MECHANICAL MECH.ENERGY -
ACC DATE ACC PILE NO.
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST '
INSULATION PLUMBING eoNlNc- END SITE No.
` GAS TEST ' GAS
MECHANICAL FIRE$PRINK ENERGY r"za,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ 0' NE]
FLOOD ZONE A.L,U C.
1� EXTERIOR SHEAR ELECTRICAL RELEASE
• INTERIOR SHEAR FIRE DEPT. - - v:❑ N❑ Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH - - BUILDING - -
NTERIOR' LATH' TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC" ,PLAN CHECK
GAS + -FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCVOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ' "3;' -ELECTRIC 70'
o� ONE WORKING'DAY BEFORE REQUIRED INSPECTION. , PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
` z — SEE PERMIT FOR EXPIRATION DATE = MECHANICAL
IMPORTANT! a corysr.,rnx '
PLEASE READ REVERSE SIDE BEFORE e de ":``
CALLING FOR FINAL INSPECTION. . TOTAL
OFFICE COPY
I .
APPLICANT TO FILL IN INFOATION WITHIN RED LINES - USE B :L POINT PEN ONLY
"-,BUI LDING PROJECT 1 DENTI FIC •'.PERMIT NUMBER
9DPLICATION & PE T
ADN'SIS 4tZ3 Wof�' Dwvp AP
BUILDING -ELECTRICAL-PLUMBING'-MECHANICAL P
' q L+UCo
OWNER'
PLAN CHECK VALIDATION
NAME _ L QTY. ELECTRIC PERMIT FEE ,-
LU I% PMONE
NAMERActoRs 12-OUTLETS-SWITCHES-RECEP 16:98{1.00 I
ZA"6-mv IFIL �/� ��/ LIC.NO,ONI =LIGHTING,FIXTURES 10:0017..00
CONTRACTOR'S
ADORES,. / PPLIANCES-RESIDENTIAL 4.00 '
PHONE>h -yyo4- PANELS - '16-96 v DATE OF APPLICATION' r
ARCHITECT -OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE -P.C..NO.
ENGINEER I - '
LIC.No. SIGNS-TRANS. 3.00
ARCH.OR ENG. - PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT- 5.00
. ZIP EMP.METER OR POLE INS.' 20.00
ADDRESS
A - MOTORS - SEE FEE SCH.
ADDRESS
x
_ SERVICE CHANGE 20.0 - •/
r
09 LICENSED CONI RACTORS DECLARATION -
a i w 1 hereby affirm (hal I am licensed under provisions of Chapter 9 - ., ISSUANCE DATE
y < (commencing with Section 7000)Of Division 3 of the Business and y BLDG.'] ELECT. PLG. MECH.
r y.i Professions Code mid my license is in full tome' Pect
Z o m- License CI ss �"I Lic.Number �•
9 m L,°w Date 1��'LI'� Contractor�+�+a1 041_9494, 61'1100
OI Up BUILDING PERMIT
rc ca OWNER-BUILDER DECLARATION
.
w o INFORMATION
E
; LL I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
c VALUATION. $/FT.
H LL w J Law for the following reason.(Sec.7031.5,Business and Profeaeione PERMIT ISSUANCE -1600 -
cw - Code:Any city oremoty which requires a permit o construct,alter, -
e, ¢ ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEG w1
n .LL requires the applicant for such permit to file a signed statement that TOTAL :6 L O PERMIT TO
E
m he Is licensed pursuant retire provisions of the Contractor's License
Law
nese and
ProcosionsC de)with Section is7000)
exempt
Division of the
EGe�T,'
io' Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5
malty STORIES TYPE CONSTR.
of nanyot applicant fora permit subjects S5001.licam loacivil penalty ALTER-DRAIN -WATER (EA.)' of not more than five hundred dollars($500).): - '
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for Sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF;AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP' 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve. -
�, ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 '
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4.IEA.) 2.00
builder will have the burden of proving that he did nut build or inn- - BUILDING USE
prove for purpose of sale.). INDUSTRIAL'WASTE INTER. 30.00 FRES IND CON PB Other
' El 1:1 1:1 1:1 11' ❑ I,as owner of the properly,am exclusively contracting with
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply ,
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractols)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00 `
the Contractor's License Law. TRACT NO._ PARCEL NO. .
Cl I am exempt under See. ,B.&P.C.for this WATER HEATER W/VENT 6.00 -
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. . 5,00
1 hereby affum that I have a to rtificute of consent to ecl INTa re. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereo ��$$e}} 3800,Lab.C.) st- '
Policy No([ 17lIP :ompany /�� - .
' 0 ❑ edified copy is hereby furnished. '., ', � FIRE$PRINK ENERGY.T.24 '
Z'Z �/Cert7fie coy Is til d v�I(h Btu ylt�, inspection division. -
0 - ApplicantI�i fc.L!_Clf 1. MISC.- - REFER TO ORD. Y�. N� Y ❑ NE]
CC rn PERMIT ISSUANCE 10.00
LU - CERTIFICATEOF ENSATIN INS FROM WORKERS' FLOOD ZONE A.L.U.C. '
W COMPENSATION INSURANCE PLG.CONTR. 'LIC.NO. PLG.'
Z (This section need not be completed if the permil'is for one 'TOTAL V[:] N[] Y NE]
dollars(S 100)orlessI
U 0 . 1 certify that in the performance of the work for which this per- QTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shell not employmny person in any manner so as to
O W become subject to the Workers'Compensation Laws of California
Date Applicant . ALTER OR ADD TO MECH. 5.00 BUILDING
} 0 NOTICE TO APPLICANT:-If,after making this Certificate of Ex-
F 2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK '
provisions of lite Labor Code, you must forthwith comply with AIR HANDLING UNIT FEE
U such provisions or this permit shall be deemed revoked. (TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 'SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name - HEATI NG UN IT(OVER 100, . . . . ELECTRIC
Lender's Address 000 BTU1950 96 7
1 certify thatI have read this application and,lule that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I,agree to comply with all city and county, - PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
�T hereby authorize representatives of this city to enter upon the BOILER-COMP Over 100,000 BTUI SEE FEE SCH. - MECHANICAL
above-mentioned property for inspection purposes.
(We),agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against Babilities„judgments, costs and expenses which - CONST.TAX ,
a it any s ay ace a gainst said City in consequence of the PERMIT ISSUANCE 10.00
ra i got[h perm' . MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
- 0 n of Applic t C ntractor ,Date
` OFFICE COPY