16965 POST THIS CARD NEAR FRONT,OF BUILDING
PERMIT
CITY. 'OF ,CUPERTINO' 1UM699
65
INSPECTION DIVISION
•_
JOB INSPECTION RECORD/1
PERMIT,EXPI RATION
19
2-3
W
JOB A <
DDR ESS `
�. 1 N e � � d
UNIT# _LOT# + .—
Lv x PERMIT EXPIRES IF.WORK �,
OWNER f�(YLN CONTRACTOR, �
IS NOT STARTED WITHIN,
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU"
FOUNDATION NOTE:
ANCE OR,180 DAYS.FROM
_ °
LASTCALLED INSPECTION.
UFER ' ALL-GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNI TE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PEHMIT VALIDATION
CUPERTINO STANDARDS. '
- GARAGE SLABS - • �;�r� C`.r�
_ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 6 UNDERGROUND /,SLAB
.. PLUMBINGffR
ELECTRICAL IssunrvcE DATE
MECHANICAL
ArEMECHANICAG RLOG. ryEELLEEEGT. PLG.. , ECH
rI
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED . BUILDING PERMIT
INFORMATION
WOOD FLOOR - - VALUATION s/FT. -
MECHANICAL, - / / °'_ D -
ELECTRICAL - S EtiTReG ' �1nY�'ROI-��Pk�- PERMIT TO
U��
FRAMING - . . OF fs-toRG l z+i I rv've':
INSULATION ' �O NyQ STORIES_ TIPECONSTR.
arc ncaa �iC'Ftli ES r•S
, .. OCC GROUP HES UNITS
- - n i
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 4J Z
SO FT,FLOOR AREA 'TOTAL ACREAGE
ROOF - "NOTE:NO FINAL INSP.SHALL'BE MADE BEFORE r�
DIAPHRAGM THE CONSTRUCTION TAXIS PAID •rZ�s ,
BUILDING USE
ROOF SHEATHINGEs IND CON Pe, 0"", '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑' ❑ ❑ '❑ ❑
ASSESSORS PARCEL NO
ROUGH SANA - -
..a PLUMBING'"" - _ ELECT,ENERGY
I,
TUBS 8 SHOWER PAN . PLUMBING ENERGY TRACT NO, PARCEL NO
MECHANICAL _ - MECH:ENERGY- -
ELECTRICAL BUILDING ENERGY - ACC DATE ACC.FILE No.
FRAMING - EL ECT.FINAL TEST �I
ZONING ENO.SITE NO_.
INSULATION- PLUMBING" ' -'��. - j
GAS TEST . GAS -
MECHANICAL FIRE SPRINK ENERGY T]<
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ Y ❑ NQ
EXTERIOR SHEAR,- ELECTRICAL RELEASE FLOOD ZONE, AL.U.C.
INTERIOR SHEAR - FIRE DEPT. - Y❑ NL Y L N[]'
SHEETROCK' - - GRADE FEE SUMMARY '
EXTERIOR LATH - BUILDING - - -
INTERIOR LATH-" ' ' TEMPORARY APPROVAL BUILDING
- SCRATCHCOAT ELECTRIC PLAN CHECK
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ELECTRIC
LU
ARRANGE FOR INSPECTION BY PHONING 252-4505, .
ONE WORKING DAY BEFORE'REQUIRED INSPECTION. PwMlewc
z PLEASE GIVE JOB ADDRESS WHEN PHONING. h
VT - Y MECHANICAL
— SEE PERMIT,FOR EXPIRATION DATE — , 0
-IMPORTANT! CONST.TAX
PLEASE READ REVERSESIDEBEFORE . TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY 5 FOS"
WPLsCANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
UI .BUILDING PROJECT IDENTIFICATION, -
BAUoIoLDIN
G APPLICATION & PERMIT
Ef ILDING M ',.,., I a'` - • +';" 18965 v[
ECHANICAL PLAN CHECK VALIDATION
r NAM CITY. ELECTRIC PERMIT FEE I '
eWe6Pl 44 97.21775 .1G
CONTRACTOR' - - ,.
NA UTLETS-SWITCHES-RECEP 10.00/1.00 ��, 0
` PLIGHTING FIXTURES., 10.00/1,00 '/B � S� � �� .
19611t-uc.No: ,.
ADDRRess'oRs - ^J APPLIANCES-RESIDENTIAL 4.00 -
�JV PHON ::Z PANELS - _ 10.00x' `D DATE OF APPLICATION -
ARCHITECT - - - I ' PLAN CHECK FEE - PC.NO.µ
on PANELS (OVER 200 AMP) 20.00 n
. ENGINE
z SIGNS TRANS, 3.00 pt DO
ARCA OR Es PERMIT VALIDATION
ADDRESS�rqq' q/ SPECIALCIRCUIT 5.00' -
� (/l/I�k`,v YE Sf7� ✓e Z1, {rye EMP.METER OR POLE INS. ,. 20.00
APPLICANTS - MOTORS SEE FEE SCH. cZ 7/
o
A DREss
d � � si- �11 SERVICE CHANGE 20.00 s = a.� �ATots
Foo LICENSED CONTRACTORS DECLARATION �'1- �,
u vI hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE - -
zw
w Q H (commeomng with Section 7000)of Dlvislon-3 of[he Business and FEB BLDG. ELECT. PLG. MECH. ,
Ha wzJ PofoaCod nd my license is in full t.rim LaseCls- Lic.Numbeo7
om DateConlractor
s �� 'I
" BUILDING PERMIT..
w OWNER-BUILDER DECLARATION - - INFORMATION
w ;a. N 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- - REFER TO ORD
Fu0< Lawforthe following reason.(Sec.7031'.5,Business and Professions PERMIT ISSUANCE 10.00 J_,0V VALUATION $/FT.
w i Code:Any city or county which requires a permit to construct,alter,
¢ 3 0;" improve,demolish,or repair any structure,prim to its issuance,also ELEC.CONTR• " LIC.NO. ELEC. o[l )
DLL requires the applicant for such permit to file a signed Statement that TOTAL
�' PERMIT TO
e. w m he is licensed pursuant to the provisions of the Contractor's License
F z i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe IV17e� \/.ti- 1,---d ve
i o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE �-1'r\ \ r'
Be I- m• the basis for the alleged'exemption.Any violation of Section 7031.5 .STORIES Tv E CONSTR.
a ; � by any applicant lorapermit subjects the applicant too civil penalty
, ALTER-DRAIN&VENT-WATER (EA.) 5.00
ofnotmore than five hundred dollars($5000.): r '
vA
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.,DEVICE 4GROUP RES.UNITS,
.00 '
their sole compensation,will do the work,and the structure is not ' OqCC.
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5,00 6,&D
U ,-Z
Code:The Contractor's License Law does not apply to an owner ofu -
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP - 5.00 .o SO.FT.FLOOR AREA TOTAL ACREAGE
i, 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-11 NC.4 OUTLETS 6.00
or improvement is'sold within one year of completion,the ownery GAS EASYSTEM-OVER 4 IEA) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or int - . .
- RES IND CON PB Other
prove focpurpow of sale.). INDUSTRIAL WASTE INTER. 30.00 '
,C1 I,as,owner of the property,am exclusively contracting with ❑ ❑ . El "❑ ❑
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 aeonlraclons)licensed pursuant to
the Contractors License .�SEWER-SAN ITAR V-STORM'EA.200ft/10.00
TRACT NO. PARCEL NO.
❑ 1.amexemptunderLaw.Sea
reason ,B.&P.C.]orthis WATER HEATER W/VENT'' 6.002.;.00.)
Owner Date WATER SYSTEM ' 5.00
VD ACC.OATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP: 5.00 -
., '.I hereby affirmithat I have a certificate of consent to self-insure. - ZONING. ENG.SITE NO.
or'a certificate of Workers'Compensafion Insurance,or a ce tilled ° „
- copy there
PolicyNo3C0m1
uabnCJ
O "
_
❑ 'Certified copy,is hereby,urnished. FIRESPRINK 'ENERGY T-24
pp Certified-copy is filed with the city inspection division. MISC.- - REFER TO ORD. -• _ c, , Y N❑ y�❑ 'N❑
� tn• CERTIFICATE OF EXEMPTION FROM WORKERS' ' PERMIT ISSUANCE . . 10,001 2L.0 FLOOD ZONE A.L.U.C.
J
CL - COMPENSATION INSURANCE PLG.CI . LIC.NO. .PLG.
1 O (This section need not be completed if the permit is for one " TOTAL p� 'Y'❑ N❑ Y ❑ 1 No
Z hundred dollars IS 100)or less.) . ' ' -
U O 1 certify that in,the performance of the work for which this per- FEE SUMMARY `
LL F mit is issued;1 shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE,
U become subject to the Workers'Compensation Laws of California. /N
y>_
Date - Applicant + - ALTER OR ADD TO MECH. 5.00 BUILDING r DID
>_ W NOTICE TO APPLICANT: If,after making this Certificate of Ex- -
H 2 emption,you should become subject to the Workers'Compensation APPLIANCE - 5.00 t ' PLAN CHECK' •I-
provisions of the Labor Code, you must forthwith comply withV FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.). 4.0 ,r p
CONSTRUCTION LENDING AGENCY - AIR HANDLING VNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE .f T�
Thereby affirm that there is a construction Innding'agency.for EX HAUST'HOOD(WITH DUCT) 5.00
the performance of the work for which this permit'ia issued IS - - MICROFILM n
3097,Civ.0.). �� .A
Lender's Name ILL F HEATING UNIT(OVER 100,000 B.T.U.)9.50 t ELECTRIC �L�
Lender's Addre' T7'
1 certify that I have trail this application and state that the above I VENTILATION FAN (SINGLE) 4.00 kmfonnatipn Is correct I agree to comply with all city.and county MBING' 3 r 0
ordinances:and state laws relating to building construction and BOILER-COMP(3 H.P.or 100,000B.T.U.) 6.00hereby authorize representatives'of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE$CH HANICAL 7.above-mentioned,property for Inspection purposes.
(We) agree to.saveFindemnify and keep harmless lhc.City of MISC.- REFER TO ORD.upertino against liabilities,judgments, costs and expenses which -� ST.TAX ay,accrue'ag.i" said City in consequence of the PERMIT ISSUANCE' - 10.00' etin f ispermit _ MECH.CONT. LIC.NO. MECH. -
TOTAL7OTAL
e of Ap icon[/ on ractor Date P
OFFICE COPY T$�rOS