16152 (2) POST THIS CARD NEAR FRONT OF BUILDING
, .. PERMIT NUMBER _ ,✓'•
CITY OF CUPERTINO 1615
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS' 10 '6 D0 ;3U3A Ava UNIT# -LOT#
n - - PERMIT EXPIRES IF WORK '
OWNER CE' C6 4 CONTRACTOR /GO IS NOT STARTED WITHIN I
INSPItdTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE:
ANCE OR 180 DAYS FROM
-
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLEDINSPECTION.
TO COMPLY WITH THE APPROVED PLANS AND•CITY OF PERMI r VALIDATION
PREGUNITE CUPERTINO STANDARDS.
GARAGE SLABS "
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING .I•., -/f/ �Pjb�
ELECTRICAL ISSUANCEDATE
-
MECHANICAL - BLDG, ELECT, PLG, MECR„
❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED -7 BUILDING PERMIT
INFORMATION,
WOOD FLOOR - VALUATION SIFT.
PLUMBING - -
MECHANICAL -
ELECTRICAL, PERMIT TO
FRAMING
hte�
STORIES TYPECONSTR.
INSULATION
OCC GROUP- RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT FLOOR AREA TOTAL ACREAGE
. ROOF NOTE:NO FINAL INSP.SHALL BE EFORF(•.. ?
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
�'tt�� BUILDING USE
• ROOF SHEATHING r .. - fires INO CON PB Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE ❑ 11 ❑ -El ❑
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT No. PARCEL No
MECHANICAL MECH.ENERGY
ACC DATE ACC.FILE NO.,.
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG,SITE Na
INSULATION PLUMBING
GAS TEST GAS -
FIR-] ' R ENERGY T 2
MECHANICAL
'T,�- Y ❑ E] v [3. No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE I'LOOULONE A.L,U C.
INTERIOR SHEAR' FIRE DEPT. v No Y ❑ 'N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING BUI Cf71NG
.INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
v - GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE-HAS SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS'SIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252=4505, ELECTRIC
Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING..
� �(1T1
--SEE PERMIT FOR EXPIRATION DATE -
MECHANICAL 0
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 IDENTIFICATION .PERMIT NUMBER
BUILDING j``�ry APPLICATION & PERMIT
ADDRESS I/'w �N 1 (rye 1
`� IK_/IV/• BUILDING—ELECTRICAL—PLUMBING—MECHANICAL µ. 1 �/ I 5Z
O vIve.. PLAN CHECK VALIDATION
NAME LSO OTY. ELECTRIC PERMIT FEE
AMERncroas v��w�f/ ( • UTLETS-SWITCHES-RECEP 10.00/1.00
igm ��
rT�i LIC. ILIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL -4.00
//4F• PHONr V �- • PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE C.NO.
OR
O
ENGINEER
LIC.No. SIGNS TRANS. 3,00
ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
A 'S MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
wo o LICENSED CONTRACTORS DEC A O
rt U w I hereby affirm that I am licensed andL 9 ISSUANCE GATE
w¢ (commencing w on 7000)of Divisio i BLDG. ELECT. PLG. MECH.
Professions Celtlicense is in full
License Class Lic.Num _ El ❑
Date— [�y�+• ��y--Contact _
a-y E �� `�✓ • - BUILDING PERMIT
5 IS i OWNER-BUILDER DECLARATION INFORMATION
wg LL H I hereby affirm that I am exempt from the Conta,mr's License MISC.— REFER TO ORD
004 Law for(lie following reason.(Sec.7031.5,Busiaessand Professions VALUATION S/FT.
Z.
— 0 � Code:Any eityor county which requires a permit to construct,alter,
PERMIT ISSUANCE 10.00
QQQ � improve,demolish,or repair any structure,priorto its issuance,also ELEC.CONTR. LIC.NO. ELEC.
m LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT O
u w he is licensed pursuant to the provisions of the Contractor's License
iii Law(Chapler9(commeocing with Section 7000)of Division 3 ofthe
i ao Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
C' H r� the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).).
❑ 1,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 Ilse work,and the structure is not
intended or offered for sale(Sec. 7044, Business and ProfessionsDRAINS-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
• meats are not ugh intends own roffend for s le If,ho ever,hat t h improve- GAS-EA.SYSTEM-1 1NC.4 OUTLETS 6.00
meats are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA) 200 BUILDING USE
builder will have the burden of proving Ism . . .
he did not build or im- RES IND CON PB Other
prove for purpose of the
INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,he exclusively contracting 744with ❑ ❑ ❑ ❑ ❑
licensed inions Cors to construct the project(Sec.does Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and n owner ns Code:The Contractor's o License Law does not apply
to an owner of h projects
bailor or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
the Cons for such projects with a cantrucloNs)licensed pursuant m
the Contractors License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ lam exempt under Sec,—.IL&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
1 hereby affirm that I have a certificate of Consent to self-insure, ZONING ENG.SITE NO.
G c rtific - s'Can, a dir r 'e r a t'ied
ah.C..
o, npany
Q ❑ Certified copy i iereby furnished FIRE SPRINK ENERGY T-24
Certifie Is filed th the city inspection division.
Z p O Applicant_ py MISC.- REFER TO ORD. .v❑ N❑ v ❑ N❑
~ va � PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU CC ; CIiR' HCATIi OF EXfiA ION FROM WORKERS'
COMPENSATI INSURANCE PLG.CONTR. ❑C.NO. p
CL O (This section need not be completed if the permit is for one Y❑ NO Y ❑ N❑
::) Z hundred dollars(1100)or less. s
U O I certify that in the performance of the work for which this per-t
MECHANICAL PERMIT FEE FEE SUMMARY-
LL I— mit is issued.I shall not employ any person in any manner so as to s 0 _
U become subject to the Workers'Compensation Lows of California. - \
Q lu Date A licant 'i �BUILDING
a pp ALTER OR ADD TO MECH.
} m NOTICE TO APPLICANT: IL after making this Certificate sa ion
F ? emvision you the L become Code, youCCt louse Wrthwit Ccomply with APPLIANCE 0 PLAN CHECK
provisions io the Labor Code, you must forthwith comply with FEE .
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10,00DGF. 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency forEXHAUST HOOD (WITH DUCT), 5.00
the performance of the work for which this permit is issued(Sec. HEATING UNIT LTO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ C.).
Lender's Name HEAT]NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address pT1
Icertify that lhateread this application and state that theahove VENTILATION FAN (SINGLE) 4.00
• information is correct.I agree to comply with all city and county - PLUMBING
ordinances -ad state laws relating to building construction, and BOILER-COMPQ H.P.or 100,000 B.T.U.) 6.00',
hereby au thorite representatives of this city to enter upon the B01 LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL Qct
above-mentioned property for inspection purposes. '
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which CONST.TAX
ay in any way accrue a• Inst City in consequence of the PERMIT ISSUANCE 10.00
I
a f this permit J'1�j� MECH.CONT. LIC.NO. MECH. o�
8• I� ySJS TOTAL ' TOTAL
gn ureof Applicant/ ontractor alae/ `- / �.• ii
OFFICE COPY