16941 POST THIS.CARD,NEAR FRONT OF, BUILDING'
- - PERMIT NUMBER
CITY OF CUPERTINO` 16941
INSPECTION DIVISION
JOB INSPECTION RECORD'
t�/� �/' PERMIT EXPIRATION
JOB ADDRESS 1`1`0 -2-'--3 - • �UV A (�2 UNIT# _LOT# � ' .t
r - PERMIT EXPIRES IF WORK
OWNER '. 'S CONTRACTOR 5' �La �•, IS NOT STARTED WITHIN,;
INSPECTION DATE INSPECTOR INSPECT ON RECORD 180'DAYS OF.PER141T ISSU
FOUNDATION - - ANCE OR 180 DAYS FROM.
NOTE: LASTCALLED INSPECTION.'' '
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED d _
PREGUNITE " TO COMPLY WITH THEAPPROVED PLANS AND CITY OF P ERMIT,VALIDATION
• CUPERTINO STANDARDS.
GARAGE SLABS-
FOUR
LABSPOUR NO CONCRETE UNTIL.ABOVEHAS BEEN SIGNED
UNDERGROUND/SL•AB,
(�{%A JlitUr'CiI
PLUMBING' - - • ('
ELECTRICAL .
'� ISSUANCE-0ATE S '
MECHANICAL ♦ BLDG, ELECT. PLC. MECH
DO NOT.POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ti4 C ' BUILDING PERMIT
WOOD FLOOR , ' INFORMATION
VALUATION $SFT
. PLUMBING - - - � ,• .� .'
MECHANICAL -
• .ELECTRICAL , ,ry PERM T TO
FRAMING
INSULATION ' STORIES TYPE CONSTR. d
_ OCC.GROUP ' RES.UNITS f '
PLACE NO SU+BFLOO'R UNTIL ABOVE HAS BEEN SIGNED
•+ - I ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE 5°'Fr ELaoR AREA TOTAL AceEACE
i THE CONSTRUCTION TAX IS PAID °
DIAPH RA GM's � '
ROOF SHEATHING - - BUILDING USE
HES IND CON PEI ' Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ El ❑ `•
. .ROUGH ASSESSORS PARCEL NO
sAN.a
PLUMBING ELECT.:ENERGY
TUBS&SHOWER PAN •_, PLUMBING ENERGY " , .TRACT NO, PARCEL NO f
MECHANICAL 17- �•," MECH.ENERGY '±
ELECTRICAL BUILDING ENERGY - '•• Acc,GATE "Ace.FILE No.
FRAMING — ELECT!FINAL TEST ' {
INSULATION' PLUMBING— ZONING 'ENG.SITE,NO
T/ ✓ -
GAS TEST ' GAS
MECHANICAL FIRE SPRINKL ENERGY T.24 �
I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ✓� Y ❑- N❑ Y ❑ N,❑
EXTERIOR SHEAR - ELECT,RICAC RELEASE FLOOD ZONE A.L.U.C. ,
INTERIOR SHEAR - FIRE DEPT. Y ❑ N❑ Y ❑ N❑',
SHEETROCK' ", GRADE: - FEE SUMMARY
EXTERIOR ,LATH`' BUILDING-4, ..
INTERIOR LATH - , TEMPORARY. APPROVALS ' BuI�DINc
:SCRATCH COAT' ; - • ELECTRIC ". '.+ PLAN CHECK '+
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM '
10
w ARRANGE FOR INSPECTION'BY PHONING 252-4505,. ELECTRIC
1— ONE WORKING DAY BEFORE•REQUIRED INSPECTION.
C'• Q PLUMBING
Z PLEA11 SE GIVE JOB ADDRESS WHEN PHONING. jeP'
='SEE PERMIT FOR EXPIRATION DATE.- MECHANICAL 140
IMPORTANT[ :' CONST.'TAX `
. 'PLEASE READ REVERSE SIDE BEFORE `
CALLING.FOR FINAL INSPECTION. TOTAL
OFFICE COPY" '
, APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY'
-1 t
'} U14PINGPROJECT IDENTIFICATION PERMIT NUMBER
o;.,•'P B no J APPLICATION & PERMIT CO,A'�
�. �y ADDRESS ID�Z�' I W(7 e R _ii /Q `F
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL "
"P 60/ PLAN CHECK VALIDATION
OWNE 'S
NAME y OTV. ELECTRIC PERMIT FEE
corvTRACTOR's UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
• I� S MM?d 2 LIGHTING FIXTURES - 10.00/1.00 -
CONTRACTOR's PPLIANCES-RESIDENTIAL 4.00
ADD Ss -11�/ /`/
O N. M.a,*-ke f PHONE p!( ] -07 PANELS 10.00 ' DATE OF APPLICATION
PANELS (OVER 200 AMP) 20.00 PLAN LHECK FEE P.L.NO.
ARCHITECT -,
OR
ENGINEER 3.BO
' -
LC.NO. SIGNS TRANS.
ARCH,OR ENG. - SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
ZIP EMP.METER OR POLE INS. 20.00
ADDfl �9
Arvra MOTORS SEE FEE SCH.
DRESE55 Y
SERVICE CHANGE 20.00 D� q��InkUCX�
'woo LICENSED CONTRACTORS DECLARATION
u u, I hereby affirm that I am licensed under provisions of Chapter 9 - • N V ' ISSUANCE DATE
I;a i (commencing with Section 7000).of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H7 i Professions C and m license s in full force nd effect - ❑ ❑
o0 L o License Class . - Lie.Number Z 2-
F y R j (late./-?�a� Contractor L
a y s METgL City Of Npe1tIR BUILDING PERMIT
¢ ¢ w OWNER-BUILDER,DECLARATION INFORMATION
w3 LL H 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
u0a Law for the following reason.(Sec.7031.5,Business and Professions VALUATION SIFT.
� - Code:Any city or county which requiresa permit to construct,alter, ' pERMIT ISSUANCE 10.00
2 a Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. '
F. O u requires the applicant for such permit to file a signed statement that TOTAL PERM
T
wTO
$ he is licensed pursuant to the provisions of the Contractor's License y ,
Law(Chapter 9(eommeneingwith Section 7000)o f Division 3 ofthe `L- -
a Business and Professions Code)or that he isexempt therefrom and OTV. PLUMBING PERMIT FEE
1 O STORIES_ TYPE CONSTR.
¢ r $ the basis for the alleged exemption.Any violation of5ection 7031.5
n ;� by any applicant for a pemsit subjects the applicant to a civil penalty , ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than Ove 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 Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and wlm does such work FIXTURES-PER TRAP S.00 SO,FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
pit GAS-EA.SVSTEM-1 INC.40UTLETS 6.00
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 4 (EA.) 2.00 BUILDING USE
builder will have the burden'of proving that he did not build or lm- RESIND ' CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 E:i �..
❑ 1,as owner of the properly,am exclusively contracting with
licensed contractors tD constmet'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 r
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 contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ I am exempt under Sec. .B.&1'.C.in'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
1 hereby affirm that I have a certificate o(consent to self-insure. ZONING ENG.SITE NO.
' or a certificate of Workers'Compensation Insurance,or a certified
copy there S c.3 0,Lab.CI
Policy N ompany /Irl ptr, Q,nn'rP
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z �L Cer i('ed copy Is filed with the cit spection Ision. MISC.- REFER TO ORD. YO ry� y N�
HO Applicant ."ne;y_b� '
Lr W CERT IFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.c.
IyJ > COMPENSATIONINSURANCIi- PLG.CONT.. LIC.NO. PLG. Y[] N� Y.0 N❑
CLO (This section need not he canpleted if the permit is for one TOTAL
D Z hundred dollars IS 100)or loss.)
0 O I Certify that in the performance of the work for which this per- DTV MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
0 W become Subject to tire Workers'Compeamtion Laws of California. BUILDING
0. Date Applicant ALTER OR ADD TO MECH. • 5.00 eQQ
�-
to NOTICE TO.APPLICAN'I': 11,alcor making this Certificate of Ex-
♦- ? emption,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 he deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.NL) 84.00 r
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE
1 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. HEATING UNIT(TO 100,000 B.T.U.) 8.001 MICROFILM
3097,Civ.C.T
Lender's Name HEATING ON IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address '
I certify that l have read this application and state that he above VENTILATION FAN (SINGLE) 0 4.00
. information is correct.1 agree to comply with all city and county BAILER-CQMP(3 H.P. 100,000 B.T.U.) 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 100,000 BTUI 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.
upertiuo against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 �2'QQ CON$T..TAX
ay in any way accrue against said City in consequence of the
tanffngoghis permit. MECH.CONT. LIC.NO. MECH.
TOTAL
TOTAL z. OD
Signature of Applicant Otte
d� ' O D
OFFICE COPY