16850 POST THIS CARD NEAR FRONT OF BUILDING " PeRmlr NumBEa
1
CITY OF. CUPERTINO` 168"50'
INSPECTION DIVISION
JOB INSPECTION RECORD
.E F• /' /� /� 'S' -~• PERMIT EXPIRATION
JOB AD DRESS-I_�( �--� 1� W 0 /�C' IC UNIT#' , _LOT# - '
1� I PERMIT fXPIR5S-IF WORK.
'OWNER r ("'LASS CONTRACTOR ' CY �✓CI, s( �.�. �' ISNOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - -NOTE: ANCE OR 180 DAYS FROM• UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.'
PR EGUNITE 'TO COMPLY WITH THE APPROVED PLANS AND CIT/OF PERMIT vAUILATION
CUPERTINO STANDARDS.
GARAGE SLABS _
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND /SLAB
PLUMBING '7-1,? Le C. ,
ELECTRICAL + ISSUANCE DATE
MECHANICAL e((Epyo•a�. ELECT I PLG, mecR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOORINFORMATION
PLUMBING' ` VALDATION S+ET.
y
MECHANICAL
ELECTRICAL _ pjUD PERnm TO -
FRAMING
INSULATION NOV 2-11988 STo IE . TYPE CONSTR. I
OCC.GROUP RES UNITS -
City,of,Cupertino
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE so:rr.FLooR nREA TOTAL ACR PACE ,
(•. _ DIAPHRAGM- THE CONSTRUCTION TAX IS PAID
'
ROOF SHEATHING BUILDING USE, . . RES IND CON PB 0,Iq r '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ElEl ❑ IDASSESSORS PANCEL NO
• ' ROUGH SAN.q
PLUMBING' ELECT.ENERGY '
TUBS&SHOWER PAN, PLUMBING ENERGY 'rHACT NO. PARCELN
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY 'Acc,oarE . acc.PILE No i
FRAMING - ELECT.FINAL TEST -
INSULATION PLUMBING zoNlNc .ENc.SITE No. ,
GAS TEST GAS
^ FIRE SPRINK ENERGY.T 24
MECHANICAL v ❑ 'N❑ r EDN❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE ELDDD ZONE A.�.uc.
INTERIOR-SHEAR FIRE DEPT. lly'El N❑ ° ❑ ' N❑
SHEETROCK - ` GRADE FEE SUMMARY
EXTERIOR LATH BUILDING .•z i .9'
INTERIOR LATH - - .'TEMP RARYAPPROVAL BUILDING "
SCRATCH COAT ELECTRIC .PLAN CHECK
GAS - .. FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING'252-4505, ELECTRIC 22:j '00 .
~O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING,
- SEE PERMIT FOR EXPIRATION DATE- MECHANICAL,
IMPORTANT! A CONST.TAX
PLEASE READ REVERSE SIDE BEFORE �
TOTAL
CALLING FOR FINAL'INSPECTION. J o I
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RECLINES - USE BALL.POI NT,PEN'ONLY
_ PERMIT NUMBER
„ UILDING PROJECT IDENTIFICATION 1 ;'', "t
.LDING 0 ae APPLICATION &,PERMIT 1'C O L O
aoDREss / / [ I U O J
. ��(�(2C. o f';Te CY/ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
. NAMERS fin �t'k pr..i L.� I PLAN CHECK VALIDATION'S
C ( DTV. ELECTRIC PERMIT FEE
PHONE
CONTRACTORS - n-'
II rva�mgE UTLETS-SWITCHES-RECEP .10,00/1.00
/7LQW 7t Y/ pE. Ic.NDILIGHTING-FIXTURES 10.00/1.00 t • .
CONTRACTOR'S-
ADDRESS ,µromp Su,N �e+'f'/PSC QS/AIJ�// APPLIANCES-RESIDENTIAL 4.00
.�B B�SSL �� PHONE; G-Ip PANELS 10.00 -"DATE OF APPLICATION
ARCHITECT, - PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMPI , 20.00
ENGINEER '
LIC.No. 'SIGNS TRANS:' 3.00 'V.' s;
ADDRESS ENG, SPECIAL CIRCUIT.. 5.00 - . 'PERMIT VALIDATION
zip TEMP.METER OR POLE INS.: 20.00
APPLICANT'S
ADDRESS MOTORS - �MBE SCH. •�
� .� - '
-
SERVICE CHANGE .20.00
,00 .LICENSED CONTRACTORS DECLARATION
a z i-j I hereby affirm that I em licensed under provisions of Chapter 9 -) `ISSUANCE DATE
I- commencm with Section 7000 of Divlvon 3 of[he Business and
as
( g _ 1 BLDG ELECT.. PLG. MECH. �
y i Professions Code �n qW�� ense is in full for gewL fig,t,,, - ,❑ '
j z o w- License Class_. '_Lic.Number H 07 -Iof cupi
Dan-o Z F w
, m -J+ -t - - BUILDING PERMIT
M M w OWNER-BUILDER DECLARATION " INFORMATION '
S:
u I hereby affirm'thatl am exempt from the Contractor's License MISC.- _ e• REFER TO ORD -
H c o< Law for the fallowing reason.(Sec.7031.5;Business and Professions - 1.. n {:VALUATION $/FT.
w91 Code:An city orcounl which re uiresa PERMIT ISSUANCE- 10.00 V _
y y q permittoconsimcl,etre,;
tic
at Q'� improve,demolish,or repair any structure,prior to its issuance,jabo SLED,CONTR. LIC.N0.' ELEC.
i O a requires the applicant for such permit to file a signed statement that TOTAL U Dt I- PERMIT TO '
w ro' he is licensed pursuant to the provisions of the Contractor's License ..
- r z
as
Law(Chapter 9(commencingwith Section 7000)o'Division 3 ofthe
Q Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE.
¢ F o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES' TYPE CONSTR.
a ;'? by any applicant fora pemrit subjects the applicant foo civil penalty ALTER-DRAIN'&.VENT-WATER 5.00
of not more than five hundred dollars($500).):
O 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 1 -
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law doesnot apply to an owner of -
propertywhobuildsorimproves'thereon,and who does such work FIXTURES-,PER TRAP - - 5.00 SOL PT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees;Provided that such improve- / $
10' ments are not intended or offered for sale.If,however,the building GAS-EA,SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the t h . . .
owner- GAS-EA. -OVER 4(EA.) 200 BUILDING USE
builder will have the burden of proving that
e did not build or im- - RES IND CON PB Other
prove for purpose of sale.). - INDUSTRIALWASTE INTER...' 30.00
❑ I,as owner of the property,am.exclusively contracting with El .❑ El 1-0
licensed contractors to construct the"'pfoject(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of,properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA'.)- 1.00 '
contracts for such projects with a contractots)licensed pursuant to
the Contractor's License Law. , SEWER-SANITARY-STORMiEA.200tt/10.00 TRACT NO. PARCEL NO.
U-l am exempt under Sec. ,B.&P.C.forth's WATER HEATER W/VENT . 6.00
reason
Owner Dole _ WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKF-RS'COMPENSATION DECLARATION WATER TREATING'EOUIP, 5.00 '
I hereby affirm that I have o certificate of consent to self-mome, - - ZONING
or a certificate of Workers Compensation Insurance, r a certified ENG.SITE NO.'
copy thereof(S.0 3800,Lab.CA O� ma 4 - "
Policy No. Company -
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY TQA _
Z Z Y Certif copy Is fdel wll . the city inspection division.. MISC.- REFER TO ORD.
O A_ppiican[ Y ❑ N❑ V ❑ 'N❑
~ rn- PERMIT ISSUANCE-- - ;10.00 ' FLOOD ZONE A.L.0 C.
W ' CF.RTH A E OF'EXEMPTION FROM WORKERS' ' _
Lid _ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
1 O (This section need not be completed if the'pennit is for one ' . 'TOTAL - 'Y❑- N❑ Y ❑ N❑
Z) Z hundred dollars($I00).,less.)
U.O 1 certify that in the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY
UL H " mit is issued,I shall not employ any person in any manner so as to
O become subject to the Workers'Compensation Laws of California.
O i Date Applicant ALTER OR ADD TO MECH.., ''5.00 BUILDING {�
}, to NOTICE TO APPLICANT. II alter making this Certificate of fax- `
enlption,you should become subject to the Workers'Compensation APPLIANCE, j • . 5.00 . PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE (I• Z�
C.7•, ' such provisions or this permit shall be deemed revoked.' AIR HANDLING UNIT(TO 10=C.F.M0 4.00 Sr'n
CONSTRUCTION LENDING AceNCY, , AIR HANDLING UNIT(OVER 10=C.F.M:) 6.00 �. SEISMIC FEE F .tv
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.CA 'HEATING UNIT(TO,100,000 B.T:U.)- 8.00 ,
Lender's Name - - HEATING UNIT(OVER 100,000 BIT.U.)9.50 ELECTRIC
Lender's Address - -
-1 certify that I have read this application and state that the above VENTILATION FAN_(SINGLE) 4.00
Information,Is correct 1 agree to comply with all city and county PLUMBING '
ordinances and'state laws relating to building construction, and BOILER-CDMP(3 H.P.or 100,000 B.T.U.)
�• hereby authonre"representatives of this city to enter upon the '-BOILER-COMP,IOvei 100,000 BTU)SEE FEE SCH MECHANICAL '
above-mentioned property'fonnspection purposes. - -
(we) agree to save, indemnify and keep harmless the City of MISC.' y REFER TO ORD. _ I
Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX
may in any way accrue against said City in consequence of the 'PERMIT ISSUANCE• 10.00
-canting
of this penn�i/�/ 0ECH.CONT. LIC.NO.
.f'\ It
a TQTAI: E,�
Sim tore gtyApp can[/Contractor' ',Date- - -
W'
OFFICE COPY