16783 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
" CITY. OF CUPERTINO 16783
ISPECTION DIVISION
JOB INSPECTION RECORD
h�+ � - ? /'' - PERMIT EXPIRATION
JOB ADDRESS �d��-J ✓M0 - �Y� '- UNIT# U�v _LOT#
PERMIT EXPIRES IF WORK I
OWNER ,�,l..Q `:C �/tYV� CONTRACTOR /Lp, lG+,/ IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION '+ ANCE OR 180,DAYS FROM
_ NOTE:' LAST CALLED INSPECTION.,,
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
" CUPERTINO STANDARDS.
• GARAGE SLABS
• POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - ,,Qti
UNDERGROUND /SLAB A fp�p
PLUMBING
ELECTRICAL - \� ISSUANCE DATE
MECHANICAL
'
MECHANICAL BLDG; PLG. MECH.,
0011 Cl
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BuaDwG PERMIT
• WINFORMATION
WOOD FLOOR
VALUATION $/FT.
PLUMBING - _ <) -
MECHANICAL
ELECTRICAL - - PERMIT.TO -
FRAMING SGGs�/i
INSULATION STORIES TYPE CONSTR.
OCC,GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
`sn Fr-aooi+AREA TOTAL ACBeAce
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
./ DIAPHRAGM THE CONSTRUCTION TAX IS PAID .
BUILDING USE
ROOFSHEATHING RES' IND CON PB "I",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS. DATE INSP. ElIf] El ❑' El "
ASSESSORS PARCEL NO
ROUGH SAN.a'
PLUMBING ELECT.ENERGY
TRACT No, PARCEL No
' TUBS 8'SHOWER PAN PLUMBING ENERGY -
MECHANICAL MECR ENERGY '
ELECTRICALAcc.DArE ACC FILE NO
BUILDING ENERGY
FRAMING - ELECT.FINALTEST
ZONING ENG.SITE No. ,
INSULATION PLUMBING
GAS TEST �, GAS
FIRES,PRINK ENERGY T•24
-
MECHANICAL: -, v 0 N❑ v ❑ _rvQ
- COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR - ELECTRICAL RELEASE FLoouzONE A'L-UC, ^
INTERIOR SHEAR FIRE DEPT. -
.Y❑,'. N❑ Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH, BUILDING.
.INTERIOR LATH - TEMPORARY APPROVAL BUILDING
SCRATCH COAT ELECTRIC ,PLAN CHECK �.Jl d,f�
- GAS FEE V _
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY.' sElsMlc FEE'
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
'ARRANGE FOR INSPECTION BY PHONING 252-4505, eLEcrRlc
• Jul- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLunnBwG
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR, EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL '
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
•^ ;Ln LDI NG PROJECT I DENTIFIC TION - ,PERNIT NUMBER
BUILDING T ION . APPLICATION & PERMIT 1 C Q
ADDRESS T In BUILDING 8
-ELECTRICAL-PLUMBING-MECHANICAL "+ 1 U
OWNER'S: {Md 0"IxIatS Vetl, , PLAN CHECK VALIDATION
NA E
`}� �y OTY. ELECTRIC PERMIT FEE
IN J PHONE (q
C NTRACTOR'S
N OUTLETS-SWITCHES-RECEP - 10.00/1.00
Y �/ LIGHTING FIXTURES - 10.00/1.00
uc.No
T.TRAc7oR'sip APPLIANCES-RESIDENTIAL 4.00 `
(® Rf0/NP- Id PANELS I 10.00 DATE OF APPLICATIONARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE PCORENGINEER LIC.No. SIGNS TRANS. 6ARCH.OR ENG. _ SPECIALCIRCUIT S.QQ PERMIT VALIDATION
ADDRESSZIPEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS- � SERVICE'CHANGE 20.00p�o o LICENSED CONTRACTORS DECLARATION ^^ e/w I hereby affirm that I am licensed under provisions of ChaO ISSUANCE SAa 'm commenemg with Se}Sir 7000)of Division 3 of hhq t BLDG. ggg lll{{{GT- PLO. MECH.
F w z, rofesslons C LAyJ license is in full fo �Igth ! .i ❑ - ❑
z O w — License Class Lic.Number T _
o R w Da[c�{, _�,. ` Contractor X -
- - -' // o - - _ `x,O , - BUI LP1G PERMIT
w a OWNGR-BllILUER DEC ATI N • MATION
Wo u r- 1 hereby affirm that I an exempt from the Contractor's License MISC.- REFER TO ORD
3 n,A VALUATION $/FT.
F LL 0 j Law for the following reason.(Sec.7031.5,Business and Professions - PERMIT ISSUANCE
Code:Any city or county which requires a permit to construct,alter,aCE t g0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. qq (�.
ao ¢ requires the applicant for Such permit to file a signed statement that TOTAL�pti. PERMIT TO
K
m" he is licensed pursuant to the provisimis of the Contractor's License
Hii
Law(Chapter 9(mmmencingwlth Section 7000)of Division 3 ofthe �C 6-'�
4 c Business and Professions Cade)or that he is exempt therefrom and. CITY. PLUMBING PERMIT FEE
CE I- a the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a3E by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500)J: -
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 UCC.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 Llccuse Law does not apply to an owner of -
1 property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.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-1 1 NC.4 OUTLETS 6.00 -.
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im -
prove for purpose ofaaleJ. INDUSTRIALWASTE INTER. 30.00 RES IND 'CON P9 ower
❑ I,as owner of the property,am exclusively contracting with ❑ E] 1:3 - El El
licensed coal...triS to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and I'rofeasinna Code:The Contractor's License Law does not apply
to an owner of property who birds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for Such puetmswith amntractorro licensed pursuant to SEW V-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ 11,,exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 "
ACC.GATE ACG FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, .ZONING ENG.SITE NO.
or a certific to of Wor mi,Comps 'on nauance,ora rtlfied
°I l i IM ��
Q ❑ Certifiedcopylsherebyfllrnished. FIRESPRINK ENERGY T 24
Z_ Z •�l"CerbflC y is N dlwith Ih• J'nspectlon difiaion MISC.- REFER TO ORD.
O Applicant Lf fig— Y❑ N❑ Y ❑ N❑
Fy JPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
CH ATG O EXIiMPT10I ROM WORKERS'
LU COMPENSATION INS ANCF- PLG.CON IND. LIC.NO. PLG. Y❑ N❑ Y ❑ N[] ,
d o (This section need not be completed if the permit Is for one _ TOTAL
Z hundred dollars IS 100)or float
U 0 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL•H mit is issued,I shall not employ any person in any manner so as to
O Ed become subject to the Workers'Compensation Laws of California. BUILDING LZe—*-O„ _
y Date Applicant - ALTER OR ADD TO MECH. 5.00
} W NOTICE TO APPLICANT'. If,after making this Certificate of Ex-
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply withFEE
U such provisions or this permit shall be deemed revoked.. . AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 .�
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1<
I 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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address -�'
I certify that I have read this application and state 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-COMPI3H.P.or100,000B.T.U.) 6.00
. hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,00013TU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep handess the City of MISC.- REFER TO ORD.
per apat liabilille 'udgments, costs and expenses which CONST.TAX
ey n a way Imme egal t said 'ty in consequence of he PERMIT ISSUANCE 10.00
rant go lisp n. CH.CONT. LIC.NO. MECH. �� /tel
TOTAL TOTAL -1
Sig to of Applicant/ tractor Dafe -
OFFICE COPY