16931 POST THIS CARD NEAR FRONT OF.BUI LDING PERMIT NUMBER
CITY OF CUPERTINO 16931
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
., JOB ADDRESS_f_f�1=_2 WQI. P aD.IOI
S` �r P UNIT# LOT# PERMIT EXPIRES IF WORK
owrvER .� 1 O(' C CONTRACTOR ��psc con IS NOT STARTED WITHIN '
INSPECTION DAT INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: `
UFER � � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERnsrt VA,DATION
• - -CUPERTINO STANDARDS. l�:
GARAGE SLABS - S,.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL "
ISSUANCE DATE
MECHANICAL BLDG ELECT. PLG. MEcv. `
Eiji
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED SLE BUILDING PERMIT
WOOD FLOOR '`'' INFORMATION.
'
PLUMBING VALUATION . S/FT.
MECHANICAL - -
ELECTRICAL - PevM1n r�•yro�
t FRAMING 1 1 ''
INSULATION STORIES - TYPE CONSTR
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE-HAS SIGNED
ROOF _ 50.Ft FLOOR AREA TOTAL ACREAGE '
Fl NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
� ., DIAPHRAGM THE CONSTRUCTION TAX IS PAID
' BUILDING USE
ROOF SHEATHINGNO CON PB 0"".
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSOR S PARCEL NO
ROUGH SAN.q
PLUMBING ELECT.ENERGY
'TRACT NO PARCEL NO
TUBS&SHOWER PAN - PLUMBING ENERGY -
MECHANICAL MECH.ENERGY -
ELECTRICAL Acc.Dare —ACC.FILE No,
BUILDING ENERGY
FRAMING' ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG SITE NO.
GAS TEST- GAS
- -
MECHANICAL FIRE SPRINK ENERGY T-24
❑ ❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y [D NY [:] N
EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD ZONE A.L U.C.
• INTERIOR SHEAR FIRE DEPT. - Y'❑ N❑ '° 0 N
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH• . BUILDING
INTERIOR LATHTEMPORARY APPROVALS BUILDING
SCRATCH COAT -. ELECTRIC PLAN CHECK,•
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE '
OCCUPANCYOF.BUILDING IS NOT PERMITTED UNTIL'BUILDING FINALJSSIGNED BY BUILDING INSPECTOR. MICROFILM
' ARRANGE FOR INSPECTION BY PHONING 252-4505,
PLUMBING
ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
. 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.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN'RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATION+- PERMIT NUMBER
BUDING
ILAPPLICATION & PERMIT
Lt ADDRESS 16931
Z w0IL BUILDING -ELECTRICAL-PLUMBING-MECHANICAL ';; '
OWNER'S - PLAN CHECK VALIDATION
NAME
DTV. ELECTRIC PERMIT FEE
N C• pi PHONE .. 900 -
NOMTRacTOnS - OUTLETS-SWITCHES-RECEP 10.00/1.00
AWIn,YUC.NO. 16 LIGHTING FIXTURES p 110.00/1.00
r-o RACTOR's �s APPLIANCES-RESIDENTIAL 4.00
ADDRESS - - - qq
DePmONE /'�g7 PANELS. " - 10.00 DATE OF APPLICATION
ARCHITECT - - PLAN CHECK FEE P.C.NO.
OR ' PANELS (OVER 200 AMP) r 20.00 5
ENGINEER - -
LIc.NO. ' SIGNS-TRANS. 3.00
ARCH OR ENG. - - 'PERM T VALIDATION
ADDRESS- - SPECIALCIRCUIT 5.00
ZIP-. TEMP.METER OR POLE INS. • t 40:9B
APPLICANTS , MOTORS ' SEE FEE SCH.
ADD -
RESS,
'DDR1p. q C t SERVICE CHANGE 20.00 +
o Mimi . LICENSED CONTRACTORS DECLARATION
.Q u 1 hereby"affirm that I am licensed under provisions oGChapter 9 'D ISSUANCE DATE
(commencing with Section 7000)of Division 3 of[he Business and BLDG. ELECT. PLG. MECH.
'6a Professions Cod nit m license is in(all fo apd '
Z i `Av,o License Class :b Y Lic-Number�`r� T 7-�� r.Prry - ❑ ❑ ❑
O
1- La Dale - Contractor "{rV
y a�t - r BUILDING PERMIT
IS Ic mat :OWNER-BUILDER DECLARATION _ '
MISC.- OOER TO OR
INFORMATION
E
;u y I hereby affirmlhat.l am exemprfrom the Contractor's License - VALUATION $/FT.
r LL w j Law for the following reason.(Sec.7031.5,Business and Professions :'PERMIT ISSUANCE' - r •}990
Code:Any city or county which requires a permit to construct,alter, '
K¢¢p improve,
demolish,or repair any structure,prior to its issuance,also: ELEC.CONTR. LIC.NO. w TE LEC.
O w requires the applicant for such permit to file a Signed statement that TOTAL 2Z PERMIT TO
' w 2,w he is licensed pursuant to the provisions of the Contractor's License M er
H i> Law(Chapter 9(commencing with Section 7000)of Division 3 of the �e1/}1 g /f 1
5
eoBusiness and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE.
,
rc H o the basis for thealleged exemption.Any violation ofSection 7031.5 .STORIES TYPE CONSTR.
by any applicant fort permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5,00
that more than five hundred dollms($500).):
❑ 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 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 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-111NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA:). 2.00 BUILDING USE
builder will have the burden of proving that h .e Aid not build or im- 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 - - F-1 ❑ El [D 1:1
licensed contractors to construct the project(Sec. 7044,Business ILAWN SPRINKLERS-1 INC.5 V.B. -6.00 ASSESSORS PARCELNO.
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 IEA.) 1.00
- contracts for Such projects with a conlraetIms)licensedpursuant to SEWER-SANITARY-STORM EA.200ftI10.00
the Contractor's License Law. - TRACT NO. PARCEL NO.
❑ lam 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.
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 oGWorkers'Compensation Insurance,or a certified
- copy thereof(Sec.3800,LAC.)
Policy No. Company!T !Ere '�6.�.J
Q qq CerIbed' p isherehyfumis�' FIRESPRINK ENERGY T24
Z Z .<g'Certified D s filt ed the city inspection division.
O Applicant L MISC.
REFER TO ORD. Y ❑. N❑ Y'❑ N[]
CCCERTIF L OF-EXEMPTION FROM WORKERS' PERMIT ISSUANCE • 10.00 FLOOD ZONE A.LU.C.
-
LU 0 COMPENSATION INSURANCE PLG.CONTE. LIC.NO. TOTAL Y❑ ,N❑ V E) NJLG ❑
- (This section need not be completed if the permit is for one `
I D Z hundred dollars IS 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 1- mil is issued,I shall not employ any Person in any manner so as to
U'
0'w become subject to the Workers'Compensation Laws of California.
Datc - Applicant - - BUILDING "
Is. RR - ALTER OR ADD TO MECH. , 5.00
Fm NOTICE TO APPLICANT: If,after making this Certificate o6Ex-
�... Z_ emption,you should become subject In the Workers'Compensation APPLIANCE .5.00 PLAN CHECK.
provisions the Labor Code, you must forthwith comply with FEE
V� such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M,) 4.00 '
•CONSTRUCTION LENDING AGENCY - AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 _ SEI SMIC FEE '
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,
HEATING UNIT(TO 100,000'B.T.U.) 8.00 '
Civ Niu.
Lender's ume 6& 14 HEATING UNIT(OVER 100,000 B.T.U.)9.50 •ELECTRIC
' Lender's ress
I certify that l have read this application unit 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-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorizerepresentatives of this city to enter upon the BOILER-COMP,(Over[00,000 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.
upertino against liabilities,j ments, costs and expenses which - CONST.TAX
May
i accrue ag' id City in.consequence of the PERMIT ISSUANCE 10.00
u ng of this p it. MECH.CONT. LIC.NO. MECH. -
TOTAL TOTAL
Signature of
lificanjonircultor D e I29 `
OFFICE COPY