16799 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF. -CUPERTINO 16799
INSPECTION`DISION
JOB
B INSPECTION R
4,E.,,^ -
q3'3 '' PERMIT EXPIRATIONI
JOB ADDRESS (0/ A oe- # _LOT# '
I + PERMIT EXPIRES IF WORK
OWNER ,I( ONTRACTOR .,pC :, aL &cfit 'T/I�,F IS' NOT STARTED WITHIN
INSPECTION DATE I INSECTOR INSPECTION RECORD iso'DAYsOF.PERMIT lssU
FOUNDATION- - ANCE OR 180 DAYS FROM I
NOTE: - LASTCALLED INSPECTION.'
UFER ..ALL GRADING AND'DRAINAGE SHALL BE INSTALLED
PR EGUNITE - _ TO COMPLY WITH THE APPROVED.PLANS AND CIN OF ,PERMIT VALIDATION
CUPERTINO STANDARDS.
- GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
'UNDERGROUND3SLAB- •p , �, `'
PLUMBING
ELECTRICAL: ISSUANCE unrE
MECHANICAL .+ - - BLDG: . ELECT. PLO.
-DO NOT POUR FLOOR UNTIL ABOVE HAS BEENSIC
SIGNED
BUILDING PERMIT
+
. .. , INFORMATION
PLUMBING.
'• WOOD FLOOR " ALUAT+ON $ITT.
-
lm
P
MECHANICAL
ELECTRICAL
FRAMING
INSULATION"" " •V pSEIEYMIES. , TYPE CONSTR.
F .00C,GR0 UP ,RESIUNITS ,
PLACE NO SUBFLOOR UNTIL ABOVE,.HAS BEEN SIGNED '
SO.FT.FLOOD AREA TOTAL ACR E A[.E
,ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE-
THE CONSTRUCTION TAX IS PAID -
• DIAPHRAGM - � +.
BUILDING USE r
ROOF SHEATHING' - - HES . +NO CON PB om.,
+ ' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED -FINALS DATE INSP. ❑ El- - ED ❑
A
ROUGH SSE550.5 PARCEL.NO.
,• SAN.# -
PLUMBING, ELECT.ENERGY T
_ TRACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY +.
MECHANICAL MECH.ENERGY '
BUILDING ENERGY ' ACC.DATE Acc,Pn.E No,
ELECTRICAL S'• - 'T +
FRAMING - - ELECT:;F.INAL TEST
'INSULATION; -
�•ZONING . ENG.SITE NO.,
- - - PLUMBING ,
GAS.TEST",,' GAS
I „ MECHANICAL - FIRE SPRINK ENERGY T@n ,.
I COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING,.,. , ..�- ' ❑..'' "❑ ° 11 NEI
-
EXTERIOR SHEAR ELECTRICAL RELEASE FLoou ZONE AC,U.C.- '
INTERIOR SHEAR' - ' FIRE DEPT.' - `'E] "❑ Y ❑ ' N❑F' SHEETROCK GRADE FEE SUMMARY
EXTERIOR:LATH BUILDING
^' - MPO
INTERIOR LATH. ' TE S BUILDING_
TEMPORARY APPROVAL 1
SCRATCH COAT. ELECTRIC PLAN CHECK
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
'I OCCUPANCY OF BUILDINGIS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BV BUILDING INSPECTOR. 'MICROFILM -"
ARRANGE FOR INSPECTION BY PHONING 252-4505- ELECTRIC '
~
ONE WORKING DAY BEFORE REQUIRED'INSPECTION
P.L'UMBING
z,� i PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! -
, -- ' CONST.TAX
[ PLEASE READ,REVERSE SIDE BEFORE.
` CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
+ APPLICANTTO FIL•L'IN INFORMATION^WITHIN"RED LINES ' USE BALL POINT PENIONLV ,.
` ` PERMIT NUMBER
'BU9 LDI NG.PROJECT 1 DENTI FICATION •': - P 'Ft
BUILDING .�. APPLICATION & PERMIT - �•�+' rn
go�OHESs� ^ IVI , LRCS q3.� BUILDING-ELECTRICAL-'PLUMBING,-MECHANICAL + "� 6799
S
OWNER' d' e _
- PLAN CHECK VALIDATION
NAME
ACITY' ELECTRIC PERMIT
/
CONTR CTOR'S
OUTLETS-SWITCHES'-'RECEP 10.00/100 -•:ems Or
�.VVS/V1$J ►'M/11��' 'uc. �-1�U.� LIGHTING FIXTURES 1 10.0011.00'r-!
+, 'Ory RA oR•5
o Es
APPLIANCES-,R 4.00 a' 1 -
1 PHo PANEL'S' 10.00 1'• 'DATE OF APPLICATION•'
ARCHU T; xu" PLAN CHECK FEE PC-NO q,t,
'r oR 'I�/�\ 11I '1�f1PI/�\ PANELS (OVER 200'AMP) .2000
'! ENGINE '1 V ♦ •i" .. 1 t'•
+ + L No SIGNS TRANS. 3.00
Y ARCH.OR ENG.,• - '
�1�t• SPECIALCIRCUIT - 5.00 -- + PERMIT VALIDATION
I/ 3rrEMP.METER OR POLE INS." 20.004101
I
APPLICANT'S r - - �^
AGED LEE 'MOTORS SEE FEE SCH �,
z ° SERVICE CHANGE 2000 ! --
o o ',LICENSED CONTRACTORS DECLARATION �-
¢ o w 1-hereby aRum.t hat I-am licensed'under provisions of Chap ler 9 -
F 2 _ ISSUANCE DATE
cc (commencing with Section 7000)of Division 0 the 'ness and BLDG. ELECT,. PLG MECH.
4 H i Professions CoQgi my license is in full f
zO0 o, Licen Class V VO ' Lic'Numbr
r w'- Dale�' - Contract
¢ ¢w¢ OWNER-BUILDER DECLARATION G� t. I- BUILDING PERMIT
- D a " - >, .� INFORMATION
K ;ac y'-' 1'li'eneby affirm that]-am exempt from the Contractor's License MISC.-i' ' , REFE_R T
a.o¢ - Lew loathe following reason.(Sec.7031.5,Business and Professions VALUATION $/FT. ,•
- r - PERMIT ISSUANCE
v+• Code `Anycity or county which requvesa permit townstrucNalteA - •`+ °
Improve,demolish,or repair any structure,prior to its issuance also ELEC.CONTR. •,LIC.N0. t ELEC. ±
o 0 requires the applicant for such permit to file a signed slelcment that - . TOTAL 3a
` - -PERMIT TO,
t'
x e. m" he+s licensed pursuant m the provisions of the Contfnctor's License
. r z > ' La'w(Chapter 9(oo r I ncing with Section 7000)of Division 3 of the
_ 'f i3O ; Business sand Professions Cod that ISe is exempt therefrom and QTY. PLUMBING PERMIT `.FEE
w'�"m' the basis for the alleged exemption.Any vi0lnbon of Section 7031.5 _ _ _" _• "' STORIES TYPE CONSTR (
u ; _ by any applicant for a permit subJeds the applicant to a civil penalty
ALTER-DRAIN 8i VENT-WATER (EA.),5.00 .i
oC not mo re t ban five hu nor dollars($500).) i' + '_♦ .
❑ 1,as owner of the property,army employees with wages as ' BACK FLOW'PR OTECT. DEVICE 4.00 .r Oce GROUP REB UNITS '
[heir sole compenwh.n;will do Die work,and the structure is not. ,.
monded:Or offered for sale (See. 7044, Business and Professions' DRAINS-FLOOR,ROOF,AREA,CON•D.+.5.00
Cotle:The Con[racmr's.License Law docs not apply to an owner of
property who builds or improves threon,and who docs such work FIXTURES' PER TRAP •,_,!. 5.00 �I SO FT.FLOOR AflEA TOTALAC
mPEACE
hlmself,or though his own employees provided that such improve -
enuare'non intended.,offered forma.'If,however,the building ' GAS-EA.SYSTEM-11 NC. 16.00
or improvement is:sold within one year of completion,the owner. , •.-
V builder will have the burden of proving that he did not huild or im- 1' GAS-EA.SYSTEM-OVER 4'(EA.) _ 2.00 4 ' BUILDING USE
prove for purpose bf sale.). r RES, IND , CON 'PB Other
INDUSTRIAL WASTE INTER. x,30.00 �' �; „❑" �:
6 ❑ I,is owneNof the property,am,exclo'Nely contracting with 1
licensed contractors to construct the,project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 1 6"00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does.not apply _
to'an owner of property who builds or improves thereon,and,who LAWN SPRINKLERS-OVER 5(EA.) 1.00
' contracts for such projects with a contractors$)licensed pursuant to � -
theContractor'sLicenseLaw. _ SEWER-SANITARY-STORM.EA.200ft/10.00 1 TRACT NO. PARCEL NO.
e ❑ 1 anneaem L under Sec. ,B,&I'U.for this t„ ' y. ;4' P •._
•z "+'•' reason P WATER HEATER W/VENT ♦ 6.00 p
" Owner a Uate'• WATER"SYSTEM ,5:00 '
,1 5 _ ACC.DATE ACC FILE NO. I
WORKF RS COMPENSATION DECLARATION WATER TREATING EQUIP. •5.0.0
I hereby at 4 that I have a certificate of consent to self insure t ° ZONING - ENG.SITE NO.,
,o1. r a certificate of Workers'Compensation Insurance,or a certified „
copy thereof(Sec 3800,Lab C)
.' - - - -I
Policy No:' -Company
(] ❑. Certified copy is hereby furnished' - FIRE SPRINK; ENERGY T24+
Z Z ❑ Certified' copy o fileds ith the 'ity in pection division - - i
'F.O Applicant r t MISC. REFER TO ORD.." Y ❑ N❑ . Y ❑ , N� `
CC LO Cf R'I'IFICATEOF FXEMP11ON FROM WORKERS' 'PERMIT ISSUANCE 10.00 ' -^jF LOOD ZONE q L U c'.
UJ � ', COMPENSATION'INSURANCE 'i PLG.CONTR. LIC,NO: PLO;' - s.
'? Z (This section need not he"complchd'iG the pefmt is Ior one - Y TOTAL ^ V❑ NO' V +., N❑
hundred dollars($100)or'lesS. ' '
- UO' 1 certify'that in the pertormen a of the work for wbreli this Per- QTY, MECHANICAL PERMIT FEE FEE SUMMARY
LLt H ' mit V. is it sh not emp y arson in an man ' so as m '
hLw+ a Works o L o r iu
'> Dare CPAPNiant ALTER ORA TO MECH., 5.00 o- BUILDING
} W - NOTICE TO�APPL CAN'T: If oak n tis Certificate of Ex` -
emption,you hould becomes je f to tl a Workers'Compensation - APPLIANCE "
I-+� - - '5.00 PLAN CHECK
provisions the Labor (ode, mu forthwith comply with -
such provisions or-th+s'permit shall be deemed'revoked. - AIR HANDLING UNIT(TO 100WCF.M.) 4.00 FEE,
CONSTRUCTION LENDING AGENCY r AIR HANDLING UNIT(OVER)O,000C.F.M.) 6.00 SEISM IC FEE v
Ihereby-affirm that,there is a construction lending agency for, EXHAUST HOOD(WITH DUCT)- 5.00
the Performanc ofthe.work for which this permit*'is HEATING�UNIT IT issued(See. a MICROFIL'M'' -
3097 qvC) y100,000 B.T.U.) :8.00
Lender's Name ' , HEATING UNIT(OV ER 100,000 B.T.U.)9.50
Lender's Addre5: + i ELECTRIC . �.•�
I certify that l have read thrs application and state that Die above VENTILATION FAN (SINGLE) 4.00 +
r information is correct I agree to comply with.all city find county - PLUMBING
ordinances and tate'laws relating to building construction, and " BOILER-COMP(3 H.P.O-•.-100,000 B.T.U.) 6.00
Hereby. authorizerepresentatives of this'city to enter upon the BOILER-COMP Over 100,000 BTU) FEE SCH. MECHANICAL �r
above-mentioned property for inspection purposes. -
(We) agree to savc,.indr;nmfy and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments;costs and expenses which" " 'CONST.TAX
1 may it'any way accrue,against said"City,in consequence of the• PERMIT ISSUANCE 10.00
nlip
g f[his i a i MECH.CONT, , LIC.NO. MECH '
ToTAL TOTAL 3 ? 06
Li t of Ftlicanl/Contractor •D'ate
i
9. OFFICE COPY