16823 POST THIS CARD NEAR FRONT OF,BUILDING .
'PERMITNUMBERa
CITY OF CUPERTINO
�� 6A23
INSPECTION DIVISION
JOB INSPECTION RECORD 5�'� b
�rJJ PERMIT EXPIRATION ,I
JOB ADDR ESS r (1�� NQ' UNIT# -_LOT# -
F IJ�IT E�PlES IF WORK
OWNER Cj B \L( .coNTRAcroR .S (Tp.� IS 'NOT�SrYARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RE ORD 180 DAYS OF PERMIT ISSU:
• `
FOUNDATION- NOTE: ANCE OR 180 DAYS FROM
LASTCALLEDINSPECTION.
LIFER ,
ALL,GRADING AND DRAINAGE,SHALL BE INSTALLED t
'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. ,-MECH:,
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABGVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR- INFORMATION
-, PLUMBING
VALUATION $)FT.
MECHANICAL
ELECTRICAL' - - - PERM IT TO
FRAMING Iq VL
p�, ID ..,`
INSULATION - - )RXs - TYPE CONSTR..
NOV L61988
OCC,GROUP - RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED City Of Cupertino
'Sp IT,GLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID .I
BUILDING USE
ROOF SHEATHING '. RES'- IND .)CON PB. 0,,P, ,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El El ED 71
. ASSESSORS PARCEL NO.
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN TRACT NO PARCEL NO
PLUMBING ENERGY
MECHANICAL - MECH.ENERGY
ELECTRICAL - -. BUILDING ENERGY , Acc.,DarE Acc.FILE NO
FRAMING ELECT.FINAL TEST - -
" INSULATION PLUMBING' ZONING ENG.SITE NO.
GAS TEST GAS _
MECHANICAL ' FIRE SPRINK , ENERGY fi44- ,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING y ❑ N❑ Y ❑' m❑
EXTERIOR SHEAR. ELECTRICAL RELEASE FLOOD ZONE AL U c.
INTERIOR SHEAR FIRE DEPT. ,Y❑ N❑ v ❑ -N E]
SHEETROCK GRADE FEE SUMMARY
EXTERIOR CATH - BUILDING M.^.
,INTERIOR LATH TEMPORARYAPPROVAL ,BUILDING
SCRATCH COAT ELECTRIC PLAN CHECKI
' GAS - FEE )
., NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BWBUILOING INSPECTOR. 'MICROFILM'
ARRANGE'FOR INSPECTI,O,N BY PHONING 252-4505, .' ELECTRIC, rya
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
. Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
-SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT! coNsr_TAx
i
PLEASE READ REVERSE SIDE BEFORE
-CALLING FOR FINAL INSPECTION TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION 'PERMIT NUMBER
BUILDING APPLICATION'& PERMIT C 8
aD ss U
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL �� 8
23
OWNER'S PLAN CHECK VALIDATION
NAME
..{�. QTY. ELECTRIC PERMIT FEE
NAMERACTDBs OUTLETS-SWITCHES-RECEP 10.00/1.00
uc.No. LIGHTING FIXTURES 10.00/1.00
ADDRESTOR'sS 1010,
-RESIDENTIAL 4.00 6 -
PHONE t'J PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR �E PANELS (OVER 200 AMP) 20.00
C�
uc.No. '31'3SIGNS TRANS. 3.00 25.00
ADDRESS ENG' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
PPlP EMP.METER OR POLE INS. 20.00
rS
ADDRESS
MOTORS SEE FEE SCH.
REsa
SERVICE CHANGE 20.00
o o LICENSED CON'T'RACTORS DECLARATION PAIDl
a i u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE
N a y (commencing with Section 7000)of Division 3 of the Business and BLOC. ELECT. PLG. MECH.
H D z Professions Code, my license is in full for e s t ❑ El ❑
z o Licen; s ntLia Rumber J�? r
19 L r Date Coractor `_
BUILDING PERMIT
¢ ¢ a OW GR-BUILDIiR DECLARATION
o i v INFORMATION
E
; a_s- I hereby affirm that I ant exempt from the Contractor's License MISC.- RE ER TO ORD
'Fu04 Law forthe followingreaser.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 2i66
VALUATION
Code:Any city or county which requires a permit to cc nstn¢L.1w,,
Be a a a improve,demolish,or repair any strmclure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. T
d y 0, requires the applicant for such permit to file a signed statement(]let TOTAL l •V)u. PERMIT TO
w m m he is licensed pursuant to the provisions of the Contractor's License �� -
Fi>
Law(Chapter 9(commenting with Section 7000)ofDivision 3 ofthe -
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
le H $ the basis for Ilse alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n ' by any applicant for a permit subjects the applicant m a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not mom than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW 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:Tile Contractors License Law does not apply to an owner of
properly 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 In prove-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,lite owner- GAS-EASYSTEM-OVER 4(EA) 200 BUILDING USE
builder will have the burden of proving that h . . .
e did not build or fill. .RES IND CON PB Omer,
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,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:1'he Contractors License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.I 1.00
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am 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.
WORKF-RS'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 certificate of Workers'Compensation Ing¢ance,or a certified
copy thereof(Sec C-00 Lab
ab.C.l
Policy r. '✓sJk�f R'�(�
O ❑ Certiliedc is he ished.
Z Z FIRE SPR INK ENERGY T�24
❑ Certific y, lie ty inspection division. MISC.- REFER TO ORD.
D Applicant_ - V Y ❑ N❑ Y ❑ N[
X LO CER'PIFICATEOI'EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C.
W 2 COMPENSATION INSURANCE: PLG.CONTR. LIC.No. PLG.
Q• O (This section need not be completed if the permit is for one _ TOTAL Y❑ N❑ Y E] N❑
DZ hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit Is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
O i Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} 0 NOTICE TO APPLICANT': If,after making this Certificate of 17 -
Z emption,'you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with AIR HANDLING UNIT(TO 10 FEE
U such provisions or this permit Shall be deemed revoked. =CF.NI) 4.00
.
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the 3097.C'v. ),performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 - MICROFILM
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and ,are 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-CON1P(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOvar 100,000BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(VJ,Twree to Save, indemTA and keep harmless the City of MISC.- REFER TO ORD.
Cu rti against li ifities,j ents, costs and expenses which CONST.TAX
in in y wayTue a• said in consequence of the PERMIT ISSUANCE 10.00
t' li fths pe B MECH.CONT, LIC.NO: MECH. ,
uTOTAL TOTAL pp
t re o AppBcant/ tar Date
iAlw OFFICE COPY