16389 POST THIS CARD NEAR FRONT OF BUILDING
' PERMIT NUMBER
CITY OF CUPERTINO 16389
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS_��r« 'y+ wo 1� UNIT#k LOT#
q a�� '� A PERMIT EXPIRES IF WORK
OWNER ( `, ��/.1/G. �-0 . CONTRACTOR HLWCG- IS NOT STARTED WITHIN
INSPECTION TE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND-DRAINAGE SHALL BE INSTALLED
PR EG UNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF - PE.RMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL - SLUG ELECT PLG. MBCR
[:] ❑ o ❑ .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR P+'•r" va LUATIIJ $/FT.
PLUMBING -
MECHANICAL y E1 'fA
PER niIr TO
ELECTRICAL Btt111B?LQ
FRAMING LL Di p
STORIES Tvve comm+
INSULATION
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
sa Pr n.00R AR eA iornL Aa+ear,L
r ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID ,
BUILDING USE
ROOF SHEATHING RBS IND CON PB 011-1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING Q 1W. -F[ ELECT.ENERGY
TRACT No. PARCEL NO
TUBS 8 SHO R PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ncc unrE Acc.F n.E No
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG_SITE NO,
INSULATION PLUMBING �.
GAS TEST GAS
FIRE SPRINK ENERGY i-29
MECHANICAL v N� ❑ N[]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A U C
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. `'❑ N� � ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH TEMPORARY APPROVALS WELrCTRIC
f SCRATCH COAT - ELECTRIC
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR.
ARRANGE FOR INSPECTION BY PHONING 252-4505,
H
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING de
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
z MECHANICAL
1
— SEE PERMIT FOR EXPIRATION DATE —
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
PERMIT NUMBER
'BUILDING PROJECT lDENT[FICATION APPLICATION & PERMIT
ADDRESS A 1 6389
.f^
ADDRESS +`'
/ 4 Y BUILDING —ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S a PLAN CHECK VALIDATION
"� OTY. ELECTRIC PERMIT FEE� c
CONTRACTOR
N E UTLETS-SWITCHES-RECEP 10.00/1.00
f LIG NO 6 LIGHTING FIXTURES 10.00/1.00
CADDR6tlT j ONTRACT R's APPLIANCES-RESIDENTIAL 4.00
—
PHONE, Q PANELS 10,00 DATE OF APPLICATION
RCHrtECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P. .NO.
O
OP
ENGINEER
uc.No. ISIGNS TRANS. 3.00
ADDRESS ENG' SPECIAL CIRCUIT 5.00 �"�It_MIT_ DATION
ADDR,ORESS ,9�/
ZIP TEMP.METER OR POLE INS. 20.00
APPucT
ANS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 (((
O o LICENSED CONTRACTORS DECLARATION
X o U I hereby affirm that 1 um licensed under provisions of Chapter 9 ISSUANCE DATE
H G y (commencing with Section 7000)of Division 3 of file Busincss llrd BLDG. ELECT. PLG. MECH.
H w i Professions Cod, n license is in full Cor n \fcpj ❑ ❑ ❑
Z, o w — License CI��ss_ Lic.Numbe �Oa
o H Uafe IJay`J .v Contractor bJk510y_ ,
x'¢ ¢ I (OWNER-BUILDER DECLARATION BUILDING PERMIT
K o d D MISC.— REFER TO ORD INFORMATION
w LL N 1 hereby affirm that 1 am exempt from the Contractor's License
Law for the following reason,(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 1 uATtON $/FT.
Code:Any city or county which rttµliresa permit to construct,alter,
ac R ¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC,NO, ELEC.
DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
A w he is licensed pursuant to the provisions of the Contr:letor's License `1V \\fie ry
r z i
Law(Chapter 9(commencing with Section 7000)of Division 3ofthe CFE L�G•
a Business and Professions Code)or that he is exempt therefrom and .OTYPLUMBING PERMIT E
r Oo the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ; m by any applicant for a permit subjects the applicant tors civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEV ICE 4.00 OCC.GROUP RES.UNITS
their solei compensation,will do the work,and fire structure is not
intended or offered fir sale (Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 Fi Opt So.FT,PLOOR AREA TOTALACREAGE
himself or through his own employees.provided that such improve-
ments are not intendedoroffered 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 owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
prove for purpose of sale). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pe Other
prove
1,a owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(See.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The CmuncHo s License Law docs not apply
to an owner of property who builds or improves Ihereon.and who iLAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts fur such projects with a comractots)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
D IonicxPRrmundCr SeC. .B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Uatc WATER SYSTEM 5.00
ACC.DATE ACF FILE NO.
WORK GRS'COMPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby allirm that I have a certificate of consent to sell-insure. ZONING ENG.SITE NO.
or a Certificate of Workers'Compensation Incur c,or a cert""'d
copy theism'(Scc.3800, .
Policy No.
O ❑ Cert ed op)'isl reby fumishcd. FIRESPRINK ENERGY T 24
Z Z 7th C,rfi d copy lil,d is the city inspection division. MISC.- REFER TO ORD.
Applicant _ Y ❑ N❑ Y ❑ N❑
Fy PERMIT ISSUANCE FLOOD ZONE A.L.U.C.
ccCIiRi'I -G F P 17 [PION FROM WORKERS
L �_ COhIPENSAIINSURANCE PLG,CONTR. LIC.NO, PLG. Qd Y❑ N❑ Y❑ N❑
iZ a (Iiia section lived not be completed if the permit is for one TOTAL
0 Z hundred dollars IS 100)or less.)
U O '1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
L F mit is issued.I shall not employ any person in any manner so as to
U become subject to file Workers'Cormensalion Laws of California.
a kms Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE '10 APPLICANT: If,aflur making this Certificate of 1!x-
F 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 be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PWC.F.M.) 6.00 SEISMIC FEE
1 hereby w h rin that there is n construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work fur which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 6.00_
Lender's Num° HEATING UNIT(OVER 100,000 B.T.U.0.50 ELECTRIC
Lender's Address
.
1 certify mat 1 have read this application and state thrst the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and countyBOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING 6
ordinances and state 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.
(We) agree to save, hit mnnlfy and keep bar mless the City of MISC,- REFER TO ORD.
ul)<•rtino against liabiliti judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue ainsl said in consequence of the
r filling of t ' per MECH.CONT. LIC.NO. MECH.
. ' TOTAL TOTAL
Signature of Applicant/Con raL or Date
IN OFFICE COPY