16834 POSTTHIS•CAR'D NEAR FRONT-OF:BUILDING - . eRMIrNUMRER
• CITY OF `CUPERTINO 168.34
INSPECTION DIVISION
JOB INSPECTION RE
ICORD
- �n1ZZ ,'`/ - `O' o PERMIT EXPIRATION
JOB ADDRESS •Ib'LJ . A,^ W
. 01fE I-D UNIT,# - LOT# }
PERMIT EXPIRES IF'WORK.
OWNER 11,x - i..LJ TRACTOa �•'1,.:T rsn,/LyN Y={� IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 188 DAYS OF PERMIT ISSU
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: . LASTCAL'LED INSPECTION. ;
LIFER, - ALL GRADING;AND DRAINAGE SHALL BE INSTALLED'
PR EGUNITE' _ TO COMPLY WITH THE APPROVED PLANS AND CITY OF. PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 4
UNDERGROUND /SLAB.
PLUMBING t
ELECTRICAL ` ���'� , ISSUANCE DATE
MECHANICAL. _F�i �ELecr, PLc. MECH�-I
❑, iJ - ❑ ❑ j .
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Bu VING PERMIT
IN ORMATION
WOOD.FLOOR VALUATION s/FT.
PLUMBING- -
I,
MECHANICAL' . •
PERMIT TO
.ELECTRICAL . - ' r:'t t4 `,?,• ,
- FRAMING - - -'
INSULATION • STORIES TYPE CONSTR ;.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
. - ROOF, NOTE:NO FINAL INSP.SHALL BE 50 FT.FLOOR MADE AREA TOTAL ACREAGE
1
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING • 'RES IND CON . PB., 0,1-
APPLY NO ROOFING,UNTIL ABOVE HAS BEEN SIGNED ,'' . FINALS DATE, INSP: ., ❑ ❑ ❑ - ❑ ❑ I
ROUGH - - - SAN.q ASSESSORSPARCEL NO,
PLUMBING _ ELECT,ENERGY -'
PLUMBING TRACT.No. PARCEL NO tl
' TUB H G ENER
S&S OWER PAN ENERGY - y
MECHANICA-L MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC DATE ACE FILE NO .�
FRAMING ELECT'FINAL TEST
INSULATION - ZONING ENG.SITE NO.
PLU
_ MBING -
GASTEST - GAS
FIRE SPRINK ENERGY T-24
M •-
. ECHAN CA L
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' ❑' "❑` ❑ "❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD zoNE A.L.u.c
INTERIOR SHEAR FIRE DEPT. , .`''❑ "❑ _Y ❑' N❑
SHEETROCK GRADEt ,, FEE SUMMARY
EXTERIOR LATH - BUILDING' '
,INTERIOR LATH TEMPORARY APPROVALS BUILDING '
SCRATCH COAT ELECTRICPLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY , : LZ, I SEISMIC FEE {
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED B Y BUILDING INSPECTOR. MICROFILM
+ d ' ELECTRIC -7
ARRANGE FOR INSPECTION BY PHONING 252-4505 �, +---J
�� ONE WORKING DAY BEFOR ELREQUI'RED INSPECTION PLUNGING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
. • MECHANICAL
SEE,PERMIT FOR EXPIRATION,DATE - I: '
:IMPORTANT! : CONST.TAX!
PLEASE READ REVERSE SIDE BEFORE ": ' TOTAL
CALLING FOR FINAL.INSPECTION.' 17
• OFFICE COPY .
APPLICANT TO FILL IN-INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.PERMIT NUMBER
UILDIN PROJ TI ENTIFIC IQN -. ' APPLICATION I
aulLolrvc AY+s ,� 16834
A10 alV _ ��t ���,6 BUILDING—ELECTRICAL—PLUMBING—MECHANICAL +c.'.
OWNER'S �''1��
NAME QTY. ELECTRIC PERMIT FEEPLAN CHECK VALIDATION
Sh'�, Fury 11.6 ' '
PHONE
CONTRgCTORS
E 1 �y UTLETS-SWITCHES-RECEP 10.00/1.00 �� C
1J 61 LIC.N.S.3-{LI� LIGHTING FIXTURES - 10.00/1.00 0
ADDRE BoRs to
APPLIANCES-REemrmrrgL 4.00 VO3�1S j NPANELS S
HOyP • r
r� ' . DATE OF APPLICATION.+^r*
ARCHITECT g���� PLAN CHECK FEE "P.C.NO.
OR . �""`W 1{'fJ'�p(p PANELS (OVER 200 AMP) -` 20.00 �r
ENGINEER W
uc,NO. . SIGNS TRANS. 3.00
ARCH OR AOORESS ENG. - - SPECIALCIRCUIT 5.00' PERMIT VALIDATION
.
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS Ts - v MOTORS SEE FEE SCH. J A-h1•
SERVICE CHANG 20.00
w
00 . ,LICENSED CONTRACTORS DECLARATION
w
a ° r 1=affirm that 1 am licensed under provisions of Chapter 9
N 0 0 0 �`� ,. ISSUANCE DATE ,
¢ % (Commencing with Section 7000)of Division 3 of the and BLDG:"` ELECT.' PLG. "MECH.
H w i Professions Code,end V icense is in full to El e t v$ �� _ a -
0 H - Li40
cense Clo Lie.Numbe p j �^ p (�
q y'� Dare — — Contractor j6/R�eyr�' S 25 CV 8C� ❑ ❑
¢ 0 w ¢ OWNER-BUILDER DECLARATION
-� �i Ut BUILDING PERMIT.
°A " REFER TO ORD INFORMATION
X ; o I- 1 hereby affirm that I am exempt from ihesicess actors License VALUATIDN S/FT,
u °¢ Law for the following reason(Sec.703 L5,Business and Professions
— mres PERMIT ISSUANCE - .10.00 u°
w Code:Any mulish county it any Strrequcture,prior
permit alter,
E '� ELEC.CONTR. LIC.NO. -
rc m ¢ ° improve,demolish,or repair any structure,prior to its issuance,also ELEC.
Om s requires the applicant for such permit to file a signed statement that w
h w he is licensed pursuant to the povisions of the Contractor 5 License' y` �' �pb TOTAL "{ ,� - PERMIT TO
- r Z
rt Business
9(commencing with Section 7000) dDivision 3 ofthe
4 ° Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
Ii H o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
dam by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN -WATER.IEA.) 5.00
of not mom than five hundred dollars(5500).):
- ❑ I,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: The.Con tractor's License Law does not apply to an owner of -
propertyWhnbnlldSOGimprove,lherem,and who doe,such work FIXTURES,PER TRAP 500. O.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 INC.INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the buNen of proving that he did not build or im- GAS-EA:SYSTEM-OVER 4(EA.) 2.00 - BUILDING USE
Prove far purpose of Sale.). INDUSTRIAL WASTE INTER. 30.00 RES' IND CDN PB Other
❑ I,as owner of the property,am exclusively contracting with 'El ❑ ❑ , C1- El
licensed contmetors: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 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 '
the Contractor's License Law. SEWER-SANITARY-STORM EA.,200ft/10.00 ' TRACT NO. PARCEL NO.
❑ ['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 N0.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 ,
1 hereby affirm that I have a certificate of consent to self-insure, -
or a certificate of Workers'Compensation Insurance,or a certified 20NING ENG.SITE NO.
copy Ihergq[I�SEy. ,pU LaI TT
Policy N npanyny
Z Certified copy is hereby furnished. .
zZ Certi ie cop BleI the city inspection division FIRE SPRIN K" ENERGY T-T4
O Alfplicant MISC.- REFER TO ORD. Y N 'Y ❑ N�
CC.T - CE TIF] E OF EXEMPT ION FROM WORKERS' PERMIT ISSUANCE - 10.00 .f -FLOOD ZONE A.L.U.C.
LU-? COMPENSATION INSURANCE. PLG.CONTR.CL . uD.NO. PLG.
Z (This section need not'he completed if the permit is for one 'Y NEI
DO .hundred dollars($100)or less.) . ' I
I certify that in the performance of the work for which this poo- QTY. MECHANICAL PERMIT' FEE FEE SUMMARY
U_ F -. mit is issued,I shall not employ any person,in any mannerso as to
V become subject to the Workers Compensation Laws of California. -
_ fly' Date Applicant - BUILDING ,
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
F? enlption,you should become subject to the Workers'Compensation APPLIANCE _ - 5.00 PLAN CHECK
provisions of the Labor'Code, you must forthwith comply with FEE
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 100 11F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a constructionlending agency for EXHAUST HOOD (WITH DU—CT), 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T:U'.) .8.00 -
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 77pp
Lender's Address - - ELECTRIC _ 7 tLO
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) a 4.00 -
information is correct:1 agree to comply with all city and county BOILER-OOMP13 H.P.Or 100,000 B.T.U.1 6.00 - PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 106,0008TU15 EEFEE SCH. (MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of _ MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMITISSUANCE 10.00 -CONST.TAX
-
may in any way accrue against said City in consequence of the - d
-
rantingofthispermit. MECITCONT.: LIC.NO, - MECH., qO
TOTAL ;TOTAL i
ignatu Ap resat/ ntraclof ate /
7 `-
OFFICE COPY