16906 POST THIS CARD NEAR FRONT OF BUILD.ING
P RNLT NUMBER
CITY OF CUPERTINO A' . 16906
INSPECTION DIVISION'
JOB INSPECTION RECORD ' �� .. � (�
J
PERMIT EXPIRATION
• JOB ADDRESS IZO F11�G UNIT# _LOT#
`I,IIpp � 1�-r ��c PERMIT EXPIRES IF WORK
OWNER WI—tC H 1 corvTRAcroR it-�L,� u IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE:
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLEDINSP ECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PeRNUT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED , , 0 - '
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE LATE
MECHANICAL BLDG ELECT I PIL-GI.. MECH.
El 1:1 9- ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WINFORMATION
WOOD FLOOR
PLUMBING .. [ VALUATION 3/RT.
MECHANICAL' Ff�.� I
ELECTRICAL - PERMIT TO
FRAMING
City of Cupe It t L. I. .I
INSULATION STORIES TYPE CONST14
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF I NOTE:NO FINAL INSP.SHALL BE MADE BEFORE s".FT aooR AReA TorAL.ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
auiLDmc USE
ROOF SHEATHING Res IND CON PB an..
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ L E1 ❑
ASSESSORS PAR CE L NO
.ROUGH SAN.B
PLUMBING ELECT.ENERGY
,
TUBS BSHOWER PAN � PLUMBING ENERGY TRACT.NOPARCEL NO.
MECHANICAL MECH.ENERGY
ELECTRICALACC DATE ACC FILE No
BUILDING ENERGY
FRAMING ELECT.FINAL TEST
ZONING
INSULATION PLUMBING.
ZONING ENG.SITE NO.
GAS TEST GAS
MECHANICAL ' FIRE SPRINK ENERGY T.2<
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N� N❑
ROOD ZONE A L U C
' EXTERIOR SHEAR ELECTRICAL RELEASE
L No Y L NE]SHEAR FIRE DEPT.
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH TEMPORARY AP $ BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
r
LU
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBINGo
Z
PLEASE GIVE-JOB ADDRESS WHEN PHONING.
MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL jt )
CALLING FOR FINAL INSPECTION:
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION •: ,PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADOREss /�O 2 16906
Q( �.J BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
NAME B qQ PLAN CHECK VALIDATION
OTY. ELECTRIC PERMIT FEE
CONTRACTORS I
NA�^E II q UTLETS-SWITCHES-RECEP 10.00/1.00
//-if N LIO.N ULIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS Sol �� /P^�� .
IqZ� / N 7% d PANELS 10.00 GATE OF APPLICATION
CARRCH TELT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C:NO.
ENGINEER
uc.no. SIGNS TRANS. 3.00
noo Ess END' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 T
noo a STs MOTORS SEE FEE SCH. J• ANNNL)fCA
SERVICE CHANGE 20.00
2
0
0 �1
,Foo LICENSED CONTRACTORS DECLARATION
a U w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
a n (commencing with Section 7000)of Division 3 of the Business uad BLDG. ELECT. PLG. MECH.
H w i Professions Cod• and ryY license is in full for J ff c ( '
z o m - License Class_P=; Z Lie'.Numberjmaj F�_
D y-w Date- Contractor. _NA.0-_
a m E V BUILDING PERMIT
¢ as OWNER-BUILDER DECLARATION
A INFORMATION
o i u
y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER
Hu0 J Law for the following reason.(Sec.7031.5,Businessind Professions PERMIT ISSUANCE 10.OD VALUATION
vs Code:Any city or county which requires permit to construct,alter,
ec ¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
a wD¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT70
$ he is licensed pursuant to the provisions of the Contractor's License p(
HiQ Law(Chapter 9(commencing with Section 7000)otTivisirn 3 of the - ' ILIM�IN�
x O Business and I'rol'essions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
e, H $ the basis for file alleged exemption.Any violation of$ection 7031.$ STORIES TYPE ONSTR.
w ; by any applicant IOr a permit Stlb)CCn$the applicant to a CMI pCllally
of not more than five hundred dollars($5000.): ALTER-DRAIN& VENT-WATER (EA.) 5.00
O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES,UNITS
their sale compcnsalion,will do the work,and the structure is not
Mnded nr offered fur sale (Sce, 7044, Business and profession's DRAINS-FLOOR,ROOF,AREA,COND. 5.00
¢ The Contractors License Low does not apply to an owner of
properly who builds or Improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself'or through his own employees,provided that such improve.
marts are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.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 no.
prove for purpose ofsale.). RES IND CON PB Omar
11 1, WASTE INTER. 30.00 ❑ 0 E:1 ❑ El
I,as owner of the propery,.am exclusively contracting with
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I'he Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPR IN KLERS-OVER 5IEA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
tine Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-,BAP.C.for fills WATER HEATER W/VENT
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK FRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm Ihut I have a certificate of consent to mlf-asme,
or a Ger ificate of Workers'Compensation Insuranc ,or a certified ZONING ENG.SITE NO.
Copy tlIt1p�r• f 380 ,Lab.C.)
I'olicySY �is mpany '
O LY/ it ed copy isl e f byf nhflo, FIRE SPRINK ENERGY T 24
z Z C n '•J Lilly is fled with Ne city inspection division.
OPPlicnnt MISC.- REFER TO ORD. v N v N�
CC CE ' ll'ICA'117 OF F X Ii M PIT ON 17 ROM WO R K H RS' PERMIT ISSUANCE W,00rQLf FLOOD ZONE A.L.LLC.
LU COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG. v N Y
(This section need not be completed if the permit is for ones _ TOTAL J r0 N
Z
H
dollars($100)or less.)
U 0 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I• mit is issued, I Shull not employ any person in any manner so as to
O w become subject to the Workers'Compensation Laws of California.
Date Applicant BUILDING
>_ tail NOTICIi TO APPLICANT: If,after making this Certificate of lis- ALTER OR ADD TO MECH. 5.00
2 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 00
AIR HANDLING UNIT(TO 10,0C.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC 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,Cie C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
LenderAddress ddtcss H
's EATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
ICertify that lhave read this application and state I, 'the above VENTILATION FAN (SINGLE) 4.00 /
information n 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 statorre laws relating to building lconstruction,ad co and county
hereby authorize representatives of this city IO enter upon lhn
above-mentioned properly for inspection put BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
poses.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperlino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,00 CONST.TAX
'any any way accrue against said City In consequence of the
rant n 01'this pet nit MECH.CONT. LIC.NO. MECHTOTAL. �
TOTAL
Signa ur of Applicant/Contractor f Date/ /
OFFICE COPY