16682 I
POST THI RD NEAR .FRONT OF BUILDING • PERMIT NUMBER
CIT OF CUPERTINO. 16682
INSPECTION.DIVISION
JOB INSPECTION RECORD -SP Q ( Q
r C PERMIT EXPIRATION
^^
JOB ADDRESS � `� '•Y� (_.(Z'(� UNIT# _LOT# '
• - PERMIT EXPIRES IF WORK-;
OWNER \Yl CONTE CTOA B Ve t\A.C IS NOT. STARTED WITHIN
INSPECTION DAYE I INSPECTOR INSP CT ON RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE:
UFER I ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. -
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB -
PLUMBING
ELECTRICAL- ISSUANCE DATE
MECHANICAL BLDG ELECT PLG. MEC.
❑ ❑ ❑ f
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION SIFT.
PLUMBING_ - _ Gr'
' MECHANICAL �n V � '
,. PEHMIT TO
ELECTRICAL
FRAMING
INSULATION IIU r TYPE CO
EI
' D Op6 IDD OCC;GROUP .RES.UNITS
City.PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• 'ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE $O.FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING ' HES' IN ❑N ED 1-1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. g5SE5BORSPANC EL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TUBS 8-SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO.
MECHANICAL MECR ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO -
FRAMING ELECT.FINAL TEST '
ZONING F.NG,SITE NO.
INSULATION PLUMBING _
GAS TEST GAS
FIRE SPRINK ENERGY T.24
MECHANICAL .
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑ F] N❑'
EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZONE A u,c.
❑ ❑
' INTERIOR SHEAR FIRE DEPT. N❑ Y ❑ N
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING "ti j r T
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS .FEE rL 1
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' SEISMIC FEE v17
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ,
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. . PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERIVIMFOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. '
I
OFFICE COPY
APPLICANT TO FILL IN INF2&MATION WITHIN RED LINES - USE, LL POINT PEN-ONLY
lBUILDING PROJECT I DENTI FI N PERMIT NUMBER
.-., BUILDING
APPLICATION & P .IT
i •C.ton Mod .t � ` � BUILDING- ELECTRICAL-PLUMBING.-MECHANICAL - 166-82
OWNER'S
rT1
- . PLAN CHECK VALIDATION
• QTY. ELECTRIC PERMIT FEE
PHONE
CONTUTLETS-SWITCHES-uc.No. LIGHTING FIXTURESESS PPLIANCES-RESIDENTIAL4.00
ESS /-
ARCHITEC tie, PRO o7 1`,¢/ PANELS 10.00 DATE OF APPLICATION 'I
11 OR
ENGINEER _ PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
' v
OC.RD. SIGNS TRANS.
ARCH.OR ENG, - -
AooREss' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
APPLUANTS ZIP EMP.METER OR POLE INS. 20.00
ADDRESS - MOTORSL`-
SEE FEE SCH.
SERVICE CHANGE 20,00
o 0 2
Foo LICENSED CONTRACTORS DECLARATION AID
Eciav I hereby affirm that 1 am licenud under provisions of Chapter 9
Q w (Commencing with Section 7000)of Division 3 of the Business and 5NA
ATE
H L z Professions Cod�,ran�1 pys license is in full fare�eryl {r� U 8 NAR LG. MECH.
z o w Licenu I' s_S.�"'1-.T_Lic.Numbc0 3 ❑fDale Contractor.a8y� /D¢T�jq¢_ ¢w ¢ OWNER-BUILDER DECLARATION CI Of CII ERMIT`xu ; r 1 hereby athill that I am exempt from the Contractor's License MISC.- REFER TO ORDIONO j Law for the following reason.(Sec.7031.5,Bu ai ,.nd Professions $/FT.mCodrAnycityorcounty which requires a permit to construct,alter, PERMIT ISSUANCE 10.00
Q Q<0. improve,demolish,orrepair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
a- w m a. requires the applicant for such permit to file a signed stal emenI Ilial' TOTAL
he is licensed pursuant to the provisions of the Contractors License - PERMIT T A
Hii
Law(Chapter 9(commencing with Section 7000)o f Division 3 of l It,
g 4 o Business and Professions Code)or that tie is exempt therefrom and EW
UMBING PERMIT FEE
a H $ the basis for the alleged exemption.Any violation of Section 703 1.5 STOW, TYPE CONS
A , by any applicant for a pemtit subjects the applicant to a civil penally '
ofnot more than five hundred dollars(8500).): DRAIN -WATER (EA.I 5.00
❑ [.as owner of the property,or my employees with wages asPROTECT. DEVICE 4.00their sole compensutiun,will do the work,and the structure is not OCCGROUP RES.UNITS
intended or offered 1'or sale (SIC. 7044, Business and ProfessionsOR,ROOF,AREA,COND. 5.00Code:The Contractors License Law does not apply to an owner of
prophumserty r th high hist wn empl yes,provid WhO dsuch im WorkER TRAP. 5.00 5D,FT,FLOOR AREA TOTAL ACREAGE
himselfor through his own employees,provided that such ch Weae-
memsarenolintendedoroReledTa,sale.IE however,the buildingTEM-11NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
' builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
Qprove/1.r purpose ofsale.). 30.00 RES IND CON PB oma,
y� as owner of the property,am exclusively contracting with. INDUSTRIAL WASTE INTER.
'
III.sed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00
and Professions Code:The Contractor's License Law does not apply ASSESSORS PARCEL NO.
^r 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 contmellans)licensed pursuant to
the Contract.,',License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL No.
V ❑ I am exempt under Sec. ,B.&I'.C.1'nr this
reason WATER HEATER W/VENT 6.00
Owner
DateMWATERTREATING'EQUIP.
5 00
�O ACC.DATE ACC.FILE NO.
0. WORKERS'COMPENSATION DECLARATION G�EQUIP, 5.00I hereby affirm that 1 have a certificate ofconsent to mlf-insure,
ificale of Workers'Compensation Insurance,er a certified ZONINGENGSITE NOropy the I'(Sec.3800,Lah.C.1.Q/'ItiC , Polic No. ��'{l�l__ rrw CCrt Ia P1 is1, v urn' h 'z 2 ❑ C� city insection tliviiFIRE SPRINK ENERGY T14
O Applies, _ REFER TO ORD. y C] N� Y E) NE]
CIiRTIPICA iOF IMPTION PROM WORKERS' E 10.00, L.U.C.
W COS . A ONINSURANCI. IC.NO. PLG.CL D (This sedion need not be Completed if the permit is for aneTOTAL Y N Y No
U O hundred dollars IS 100)or less.
I certify that in the performance of the work for which this per- OTA, MECHANICAL PERMIT FEE FEE SUMMARY
'{� F mit is issued,I shall not employ any person in any manner so as to
O W become subject t.fire Workers'Compensation Laws of California.
ED Date AppAPPLICANT;
ALTER OR ADD TO MECH. 5.00 BUILDING 8
} to DateNOTICE TO APPLICANT: IL after making this Certificate of lix-
F ? emptier,you'should become subject to the Workers'Compensation APPLIANCE 5.00
prPLAN CHECK
provisions of the Labor Code, you must forthwith comply with
C.1 such provisions or this pelrmt shall be deemed revoked. AIR HANDLING UNIT(TO 10=1C,F.UAL) 4,00 FEE 6 0
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MCFM,) 6.00 SEISMIC FEE -
I hereby affirm that there is a which this p lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
30979 's Nun. 9MI
UNIT(TO 100,000 B.T.U.) I
.00
Lender's Name
Lender's Address UNIT(0%1=0 100,000 B.T.U.19.50 ELECTRIC
1 certify that I have read this application and state that the aboveTION FAN (SINGLE) 4.00 r
• information is correct. 1 agree to comply with roll city and county PLUMBING
ordinances and state laws relating to building construction, andOWP(3H.P.or100,000B.T.U.) 6.00
hereby im lmi-me representatives of this city to enter upon the
above-mentioned property for inspection purposes. OMP(Over 100,000 BTU)BeE FEE SCH. MECHANICAL
a r nify and keep harmless the City of REFER TO ORD.
. per. ainst Habil'i 1 dgnIn costs and expenses which CONST:TAX
may a y ace, aid i ity in cons,? ence of the PERMIT ISSUANCE 10.00
ra
MECH.CONT. LIC.NO. MECH. -
t
Si TOTAL TOTAL
are of A thwart/ ro
C c r �
oU e '
OFFICE COPY