16915 M
ow
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF ,'CUPERTINO 16915
INSPECTION DIVISION.
JOB INSPECTION RECOR S ld1
PERMILEXPI RATION
JOB ADDRESS Z� ,V• �P O I'� ._U 1-T- ' _LOT# 1'a ,f •t• + ' Y
Q- •'PERMIT EXPIRES IF WRK
OWNER BUS �1 ` OI� CONTRACTOR n .S BQ ldc�-4 IS NOT STARTED,WITHIN .
INSPECTIO.N DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION - ANCE OR 180 DAYS FROM +
NOTE: - LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED .t.
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF ?ERMn VALIDATION
CUPERTINO STANDARDS.
• GARAGE SLABS � 4
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
.UNDERGROUND /SLAB AN 1 1969
PLUMBING - WL7 /L(.GGL4
ELECTRICAL -
t Cu e�in0 ISSUANCE:DATE.
MECHANICAL 2,— 66 - eLoc ELECT, PLc, MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT
-' INFORMATION
WOOD FLOOR, VALUATION $11T.
PLUMBING - Q&
MECHANICAL .@E!
PERMIT TO
ELECTRICAL -
• FRAMING `v��l, i" -�to �•'�rti..�:.
STORES TIRE CONSTR.
INSULATION
OCC GRO UP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
5
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE ,
GM. F DR AREA roTAL ACREAGE
DIAPHRA
THE CONSTRUCTION TAX IS PAID (r
BUILDING USE
ROOF SHEATHING .,
. RES IND GONPb
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.. ❑ 11 ❑ ❑
ASSESSORS PARCEL NO.,
ROUGH SAN.N - -
PLUMBING ELECT.ENERGY -
TRACT NO. PARCEL NO
I TUBS&SHOWER PAN PLUMBING ENERGY ,
'
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY - - -ACC.DATE ACC FILE NO•
FRAMING ELECT,FINAL TEST -
ZONING ENG.SITE NO.�
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL 2 FIRE SPRINT( ENERGY T-2a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ❑ "❑
EXTERIOR SHEAR ELECTRICAL RELEASE
FLOOOZONE A,L U.C.
' _
INTERIOR SHEAR - FIRE DEPT. I Y El El .Y ❑ ' N❑
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING _
PPROVALS
INTERIOR LATH TEMPORARY ABUILDING
SCRATCH COAT ELECTRIC PLANCHECK
GAS, FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE Lq"'
OCCUPANCY-OF BUILDING IS NOT PERMITTED UNTIL BUILDING F INAL ISSIGNEDBYBUILDINGINSPECTOR. MICROFILM
ELECTRIC
LU ARRANGE FORASPECTION BY PHONING"252,4505,
I- ONE.WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z Q MECHANICAL
= SEE PERMIT FOR EXPIRATION DATE
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
A'P'PLICANT TO FILL.IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY
•901LDIN,GPROJFCTIDENTIFICATION - - PERMITNUMBER ••
APPLICATION'& PERMIT 16915 g�ILDING - ELECTRICAL-PLUMBING-MECHANI/YLOI CAL
OWNER'S
PLAN CHECK VALIDATION
NAM QTY. ELECTRIC PERMIT FEE
..."e� PXONE
'. CNAME S
acra"s - , OUTLET -SWITCHES-RECEP 10.00/1.00
NAME
LIC.NO. LIGHTING FIXTURES 10.00/1.00 _
r-ONTRAcrOR's
aoDRESS APPLIANCES-RESIDENTIAL 4.00
_ •
PHONE PANELS 10.00 DATE OF APPLICATION
ARc"ITE,T PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.,NO.
OR
/I '
ENGINE �I V•�
L SIGNS TRANS.
ARCR0 ENG. SPECIALCIRCUIT 5.00 PERMIT�V ALIDATION
W`/A1/`''�►�1 zIP EMP.METEROR POLE INS. 20.00 _ g
APPuca TS
A a MOTORS SEE FEE SCH.
. �.. p.
SERVICE CHANGE 20.00 /'fT•-I
- o 0 0 LICENSE CONTRACTORS DECLARATION - (/�/�UL�A/ ✓ '�'•
'.Q v .I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and - pG. ELECT. PLG. MECH.
r D z Professions Code,and my license is in full force and effect.
Z O H - License Class Lia Number �, ❑ ❑1 ❑
o Z r w
Data - Contractor
BUILDING PERMIT
s w u OWNER-BUILDER DECLARATION - INFORMATION
. w ;ac y.. I hereby affirm that 1 am exempt from the Contractor's License MISC.- _7 y Rp RBF TO ORD
uoJ Law for the following'reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION -$/FT.
t - Code:Any city or county which requires permit to construct,alter, PA
/�](L�-A
G improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.,NO.' ELEC. I ✓EI0 P
ca - O IS requires the applicant for such permit to file a signed statement that - TOTAL - PERMIT TO
n w $ he is licensed pursuant to the provisions of the Contractor's License
F Z i Law(Chapter9(commencing with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ('�
Z r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES Ty CONSTR.
by any applicant fora permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundrod dollars($50B.):-
- ❑ 1,as owner of the property,or my'employees with wages as BAOK FLOW PROTECT. DEVICE 4.00 OCC.,GROUP RES.UNITE
their sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,,AREA,COND. .5.00
Code:The•Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
GAS-EA.SVSTEM-11NC.40UTLET$ 6.00 3
mems are not intended or offered'for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4112A.) .2.00 .BUILDING USE
builder will have the burden of proving that he did not build or an- 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 1:1 ❑
licensed contractors to construct the project(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 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.
. D 1me exempt under Sea. ,B.&P.C.for this WATER HEATER W/VENT 6.00 '
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. ' - 5.00
I hereby affirm that I have a'certificate of consent to self-insure, ZONING ENG.SITE N0. .
or a certificate of Workers'Compensation Insurance or a certified -
copy thereof(Sec.3800,Lab.C. �v Q. - -
Policy No. cCompony c...V JL
0- ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified 'copy is Ned with the city inspection division. .
O Applicant - .cr MISC.- REFER TO ORD. y❑ - ;N❑ y ❑ 'N❑
w Irl
PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U:C.' _
CC - CERTIFICATE OF EXEMPTION FROM WORKERS'
LU COMPENSATION INSURANCE- PLG.CONTR. LIC.NO.; PLG.
1�0 (This section need not be completed if the permit Is for one - 'TOTAL Y❑ ,",N❑ V C] NEI
'
:D Z 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 F 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. -
0 w Date - Applicant BUILDING 7
} W NOTICE TO APPLICANT: If,,after making this Certificate of F:x- ALTER OR ADD TO MECH. ' 5.00 -
L-- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN,CHECK
U
lin
uchlprovis ons or th sbpermitt shall be deemed revokou must ted comply with AIR HANDLING UNIT(TO 10,000C.F,M.) ,4.00 FEE A
CONSTRUCTION LENDING AGENCY / AIR HANDLING UNIT(OVER 10=C.F.M.) ,6.00 SEISMIC FEE f zS
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of th/Work for which this permit is issued(Sec. MICROFILM
3097,Civ.0-) LNNHEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC-
Lender's Andreae
1 certify that I have read this application and state that thab
e ove VENTILATION FAN (SINGLE) 4.00 -
information is correct.I agree to comply with all city and county BOILER-COMP(3 H.P,or 100,000 B.T.U.),6.00 PLUMBING
ordinances and slate laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
0010 agree to save-indemnify and keep harmless the City of I MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenseswhich "CONST.TAX
ac
may in any way crue ago st said City in consequence of the PERMIT ISSUANCE 10.00
M
tin Ofthispe it,. CH.CONT. ., 777
IL.NO. MECH.
'
M51- 1- q TOTAL TOTAL � Z
kJbignature of Applithant/Conlractor Date
OFFICE COPY