16747 POST D THIS NEAR FRONT OF BUILDING PERMIT NUMB ER
CITrOF CUPERTINO 16747
INSPECTION DIVISION
• JOB INSPECTION RECORD
6 PE'JRMIT XPI TION
JOB ADDRESS 0 ! Z3 �• -LA0 W�, p� UNIT.# _LOT# •t.� / I �
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR J 4C,, G IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION R ORD 180 DAYS OF PERMIT ISSU -
FOUNDATION - ANCEnOR 180 DAYS FROM,
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF +PERMIT VALIDA n ON
CUPERTINO STANDARDS. t� �•-• ,j
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING - ✓�`4L.P
ELECTRICAL - ftbj�j Of '
U ertin0 ISSUANCE LATE
MECHANICAL BLDG ELECT PLG. MCCR. :
A El E Q .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION $IFT.
,
MECHANICAL - {,. 713 I• (
ELECTRICAL QI-
PERMIT TO
- -��
t
FRAMING
INSULATION STORIES TYPE fONSTR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
-50 IT.FLOOR PVEA TOTAL ACREAGE
ROOF
NOTE:NO FINAL INSP.SHALL BE MADE OEFORE '
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING BUILDING USE
w:S ND CON PB -om,.r
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PACE L NO
ROUGH SAN.q
PLUMBING ELECT.ENERGY
PARCEL NO
TUBS 8 SHOWER PAN pLUMBING;ENERGY TRACT NO. . -
MECHANICAL - MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING - ELECT.FINAL TEST
INSULATION PLUMBING zorvlNc ENG,SITE No.
GAS TEST - GAS
MECHANICAL FIRE SPRINK ENERGY T2
'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ v ❑ N❑
EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD ZONE A L u.c.
INTERIOR SHEAR FIRE DEPT. Y ❑ N❑ Y ❑ N❑
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATHTEMPORARY APPROVAL BUILDING -,Z,.I1U
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE ,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 11
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBYBUILDING INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505,. ELECTRIC
ooONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. '
- SEE PERMIT FOR EXPIRATION DATE- MECHANICAL
IMPORTANT! coNsr.TAX
PLEASE READ REVERSE SIDE BEFORE q
CALLING FOR'FINAL INSPECTION. TOTAL r
OFFICE COPY
APPLICANT TO FILL IN INFO ATION WITHIN RED LINES - USE B POINT PEN ONLY
YP
-BUILDING PROJECT IDENTI FIC ERMIT NUMBER
olsf82APPLICATION SPER aoEsJC 3 " ,f
@,.: 1.6 7 4.7 -
LG G•� � /1O =U(JC -
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
R'S PLAN CHECK VALIDATION
NA
OTV. ELECTRIC PERMIT FEE
PHONE n1
CONTRACTOR OUTLETS-SWITCHES-RECEP 10.00/1.00
LL LIGHTING FIXTURES 10.00/1.00 7� u4 ^ Q U
L�
1 CONTRACTOR'S kA4"A APPLIANCES-RESIDENTIAL 4.00
AOOREss C..r1�
(dq 1 C T PHONE 6b"7Z30 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE
OR PANELS (OVER 200 AMP) 20.00
ENINEEGII r
L4sA)E 5- $&_• LIC..Q ISIGNS TRANS. 3.00
ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
AZIP EMP.METER OR POLE INS. 20.00
ADDRESS
MOTORS SEE FEE SCH.
ADDRESS
I
U,W14 CIIL($ SERVICE CHANGE 20.00
0¢i
F o FoF LICENSED CONTRACTORS DECLARATION
¢ U U I hereby affirm that 1 am licensed under provisions of,Cllapter 9 A ISSUANCE DATE
aiw
y a (commencing with Section 7000)of Division 3 of the Business and B OG. ELECT. PLG. MECH.
0
Professions Code,' m license is in full for��,j'ppyy�xef Tp[( ✓ ❑ ❑ ❑
z o�, License Class � y Lie.Number-' 1_ V I/JVr
9 m H w
Date.Contractor
a x City of Cupertinc BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION
o i O INFORMATION
w1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LL O¢ Law for the following reason,(Sec.703 1.5,Businessand Professions VALUATION /FT.
Code:Any city or county whichrequiresa permit to construct,alter, PERMIT ISSUANCE 10.00
w Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIG NO. ELEC. xt C7
ec O ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w " he is licensed pursuant to the provisions of the Contractor's License '
z i
Law(Chapter 9(commencing with Suction 7000)of Division 3 oftha
P o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ H$ the basis for the alleged exemption.Any violation of Section 7031.5 STO IES TYPE CONSTR.
a, byeny applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(85001.)'.
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their are 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 Conlmnor's License Law does not apply to an owner of
. property who builds of 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- GAS-EA.SVSTEM-11NC.40UTLETS 6.00
mems are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the m . .
owner- GAS-EASYSTEM-OVER 4 IEA) 2.00 BUILDING USE
builder will have the burden of proving that the did not build or int- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 '
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL No.
and Professions Code:The Contractor's License Law dues not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsuch projects with a contractooSl license,[pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-.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
I hereby affirm that I have a certificate of consent to sel Ginsure, 20NING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
1 copy thereof(Sec.3800,Lab.C.).�
7C Policy No. Company_ LTES �ull�
0 ❑ Certified copy,is hereby furnished FIRE SPRINK ENERGY T 24
Z C ❑ Certified copy is fled with the city inspection division, MISC.- REFER TO ORD.
Applicant
❑ V[:] N❑ V ❑ N
CC CERA'IPICATIi OP li%EMPTION FROM WORKERS .L
' ❑
Fy - PERMIT ISSUANCE 10.00 FLOODZONE A .U.C.
LLQ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y ❑ N❑
d O (This section need not be Completed if the permit is for one TOTAL
Z) Z hundred dollars($100)or less)
U O 1 certify mat in the performance of the work for which this per, DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is issued,I shall not employ any person in any moaneror iam 3 O ; D
U become subject m the Workers'Compensation Laws of California d
0 i Date.Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} ro NOTICE 1'0 APPLICANT: If,after making this Certificate of Es-
Z eruption,YOU should became subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U sudh provisions or this permit slhall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.K?0 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
1 hereby affirn thud there is a constr¢tion lauding agency for EXHAUST HOOD(WITH DUCT.) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(70 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address H EATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I ce,ify that 1 have read this application and slate that the above VENTILATION FAN (SINGLET 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 13 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above me oned properly for inspection purposes.
(We) rcc h S c demnify and keep harmless the City of MISC.- REFER TO ORD.
uperC ago' •s,judgments, costs and expenses which CONST.TAX ,
may ny a aga said City in consequence of the PERMIT ISSUANCE 10.00
Ian n o s r t MECH.CONT. LIC.NO. MECH.
44t TOTAL TOTAL 6'Z'S- I
ign re of t/Conrzct r Date
OFFICE COPY