16836 POST THIS,CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO6836
INSPECTION DIVISION " ,
JOB INSPECTION'RECORD .
,,// /'1 n "Z�6a PERMIT EXPIRATION
JOB ADOR ESS 4OIa,3 N, G(IOL1ra ; I) UNIT# _LOT#
PERMIT EXPIRES IF:WORK
OWNER CONTRACTOR - IS .NOT STARTED WITHIN,
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE: ANCE OR 180 DAYS FROM
LIFER '
ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE - TO COMPLY-WITH THE APPROVED PLANS AND CITY OF _ PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS - -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �r {
UNDERGROUND /SLAB '
PLUMBING
ELECTRICAL -
ISSUANCE DATE
MECHANICAL BLDG ,ELECT PLG, MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR19 INFORMATION
VALUATION �SIF.T.
PLUMBING �ry .
MECHANICAL - - CUp 1L$°e,. L,' = .
ELECTRICAL . To
FRAMING - - - IS/1
- INSULATION - STORIES J PE CONSTR...
'UCC GROUP HES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
. .ROOF NOTE*NO FINAL INSP.SHALL BE MADE BEFORE SGFT FLOORAREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
. BUILDING USE
ROOF SHEATHING .. HES IND CON PB •ou..,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El ❑ El ❑
ASSESSORS PARCEL NO,
ROUGH SAN.4
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH.ENERGY
ELECTRICAL _ BUILDING'ENERGY - ACC DATE ACC_FILE NO ,
FRAMING ELECT.FINAL TEST
INSULATION. PLUMBING - zoNlNc. ENG.SITE Na.
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T.2a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ N❑ Y ❑ N❑
FLOOD20NE PLUG
-EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR - FIRE DEPT. Y❑ N❑ 4 ❑ N❑
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDINGN
INTERIOR LATH TEM RARY APPROVALS, BUILDING
SCRATCH COAT ' ELECTRIC PLAN CHECK
GAS FEE w 7S
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE J�1
OCCUPANCYOF BUILDING ISNOTPERMITTEO UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM !
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC .
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
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. a
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.- USE BALL POINT PEN ONLY
BUILDING PROJECT I D€NTI FICATION -PERMIT NUMBER
_ BUILDING APPLICATION & PERMIT
ADDRESS 9z 11
/d/d3 N BUILDING—ELECTRICAL—PLUMBING=MECHANICAL 1 O
,
OWNER'S PLAN CHECK VALIDATION
NPM�j,
QTY' 'ELECTRIC PERMIT FEE
PHONE e_]:J
CONTRACTOR S
NAME
ONTACTOR°i UTLETS'-SWITCHES-RECEP 10.00/1.00
uC.No. LIGHTING FIXTURES 10.00/1.00
ADD.Ess TORS APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION r
ARCHITECT PLAN CHECK FEE P.C.NO.
on - PANELS (OVER 200 AMP) 20.00 .
ENGINEER
LIC.NO. SIGNS TRANS. 3,00
AARCH.OR DDRESS ErvG, SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 `�
BmH+¢O o LICENSED CONTRACTORS DECLARATION V /' /l7(QO
Fi w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
¢ t (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. -MECH.
H w i Professions Code,and my license is in full force and effect. ❑ ❑ ❑
Z O w— License Class Lic.Number
,a w Data Contractor
a se 2 d 'BUILDING PERMIT
¢ ¢ OWNER-BUILDER DECLARATION "
a ° MISC.— - REFER TO OR _INFORMATION
. w ;w r 1 hereby affirm that I am exempt from the Contractor's License
OVALUATION $/FT.
u• o¢ Law for nycit following county
10.00 /T7T/_�
ca — g PERMIT ISSUANCE
Code:Any city or cor rep which requiresa permit tocol saanc.,jou
'Q W Q improve,demolish,or repair any structure,prior 1n its issuance,also ELEC.GDNTR, LIC.NO. ELEE((,
Ca LL requires the applicant for such permit to file a signed statement that TOTAL PE/RM—IT T/p
IZI
w $ he is licensed pursuant to the provisions of the Contractor's License 1100 �'�E V
H z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the �. 0{ �
z D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT 1 F
B: H $ the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toa civil penalty
of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 -
0 1,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 400
their sole compensation,will do the work,and'lhe structure is not . .
OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's Licease'Law does not apply to an owner of
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-1INC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner. GAS EASYSTEM-OVER 4(EA1 200
builder will have the burden of proving that h - . , .
e did not build or im- BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
I,as owner of.tlm property,am exclusively contracting with
INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
li sed contractors toconstructthe project(Sec. 7044,Busmesv LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO. I
and rofessions 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 u contractors)licensed pursuant to
the Con ac tar's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I exempt ander Sec. - ,B.&PI f I'ur this WATER HEATER W/VENT 6.00
on
owDare — WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPIiNSATION D: ARATION WATER TREATING EQUIP. 5.00
I hereby infirm that I have a certificate of consent to sell'�insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy tlmreof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
ZZ ❑ Certified copy is filed with the city inspection division.
H O Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
cc to CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE - 10.00 FLOOD ZONE A.L.U.C.
L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
1 O (This section need not be completed'if the permit is for one - TOTAL V EJ N❑ V F] N❑
0 Z hundred dollars IS 100)or Ic..)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY -
LL F mit is issued,1 shall not employ any person in any Insurer so as to
U becomesubject to the Workers'Com pensat ion Laws of California.
W Date—Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Certilicate of F.x-
F 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. MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER iO=C.F.M.) 6.00 SEISMIC FEE SD
1 hereby affirm (hut throe is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance
3097, C
oance 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 HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and countyPLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP 0 H.P.or 100,000 B.T.U.) 6.00 '
hereby authorize representatives of (his city n anler upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO.ORD.
uper(ino againsUiabilities,judgments, costs and expenses which CONST.TAX
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ti IS of this permit MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL aei J
Signature of Appli awl/Contracmr Date
OFFICE COPY