16231 (2) POST THIS CARD.NEAR FRONTOF BUILDING '
y PERMIT NUMBER
TITY OF `CUPERTINO 16231 .:;i
INSPECTION DIVISION r .
' JOB INSPECTION RECORD
/ //� � � RPERMIT EXPIRATION
Z6
JOB ADDRESS �61 (2N4 F-/,t>+�l! � UNITkk _.LOT# '
'- - PERMIT-EXPIRES'IF WORK
OWNER 0 [_,� corvTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: - LASTCALLEDI NSPECT,ION.
U F•ER y - _ . 'ALL GRADING AND DRAINAGE SHALL BE INSTALLED -
PREGUNITE TO COMPLY WITH-THE APPROVED PLANS AND CITY OF - PERMIT VALIDATION
GCUPERTINO STANDARDS.
ARAGE SLABS r
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,
., UNDERGROUND /SLAB `
PLUMBING
ELECTRICAL
ISSUANCE DATE
MECHANICAL - - BLDG: ELECT. , vLc. MECR
E] ❑' . ❑ ❑.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR PAID INFORMATION
PLUMBING
VALUATION SIFT.
- Ey _
.. " MECHANICAL {• " UG N li' •1: ��'ay
ELECTRICAL - /PERMIT TO/+ _
FRAMING . - - - Clr/ Gt COo • OL!s d.7u,&
INSULATION - STORIES TYPE CONSTR.
f OCC,CROUP Rot UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
"R 50 FT FLOOR AREA TOTAL ACREAGE
ROOF
NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM - - THE CONSTRUCTION TAX IS PAID
ROOF.SHEATHING RES IND ILDcourl usEP9
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Cl ED 13
ROUGH SAN.q
ASSESSORS FARCE L AD,,
' - .. � �.
PLUMBING ELECT.ENERGY t;
• TUBS 8 SHOWER PAN - PLUMBING ENERGY TRACT NO PARCEL NO.
-
MECHANICAL MECH.ENERGY .
ELECTRICALBUILDING ENERGY YACC,DATE .ACC.FILE NO .
FRAMING - ELECT.FINAL TEST
INSULATION - PLUMBING ZONING ENG SITE NO.
. GAS TEST' GAS
MECHANICAL- FIRE SPRINK ENERGY T]<
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 'Y 0' "0 Y ❑ '"❑
EXTERIOR SHEAR _ ECECTRI CAL RELEASE FLOOD ZONE A,L,u.c.
INTERIOR SHEAR - FIRE DEPT., v El Y ❑ rv❑I '
SHEETROCK , GRADEMIFEE SUMMARY
EXTERIOR LATH. - BUILDING
INTERIOR LATH •• TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE"
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED By BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505;' ELECTRIC
U,
� ONE`WORKING DAY BEFORE REQUIRED INSPECTION. r' PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN*PHONING..
SEE PERMIT FOR EXPIRATION DATE7r MECHANICAL
IMPORTANT! CONST.TAX
'PL'EASE READ REVERSE SIDE BEFORE "ml TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY,
PERMIT NUMBER.
., BUILDING PROJECT IDENTIFICATION - „APPLICATION SI PERMIT
• BUILDING � 16231
ADDREss BUILDING—ELECTRICAL—PLUMBING—MECHANICAL "
T JZfzf P.
PLAN CHECK VALIDATION
OWNER'S -
/
NAME
/- �/ QTY. ELECTRIC PERMIT FEE
7` t41 LI' PHONEQSL_i��
COrvTRACTOR$ UTLETS-SWITCHES-RECEP ,10.00/1.00
NAME
LIC.NO. LIGHTING FIXTURES 10.00/1.00 '. -
CONTRACTOR'5 PPLIANCES-.RESIDENTIAL —4-00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION +
PLAN CHECK FEE. .C.NO.
ARCHITECT - PANELS (OVER 200 AMP) 20.00
OR
ENGINEER SIGNS TRANS.' 3.00
LIQ NO. PERMIT VALIDATION
AR. ENG. SPECIAL CIRCUIT 5.00 -
ADDRESS
ss
ZIP EMP.METER OR POLE INS. 20.00 �I
APPLICANT'S MOTORS $EE FEE SCH.
' ADDRESS _ -
rj fD! SERVICE CHANGE, 20.00
91, ag( o ,
r o o LICENSED CONTRACTORS DECLARATION v
<u G, I hereby affirm that I am licensed under provisions of Chapter 9 IS ANCE DATE.
w (commencing with Section 7000)of Division 3 of the Business and 'BLDG. ELECT, PLG. MECH.
yi Professions Code;and my license is in full force and effect. a ❑
'0.— License Class Lie.Number
9 Date Contractor � - -
BUILDING PERMIT '
Q ¢ w OWNER-BUILDER DECLARATION INFORMATION
T
REFER O ORD
w0
°' N I hereby affirm that I am exempt from the Contractor's License MISC.— VALUATION S/FT,
H a 04 Law for the following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE 10.00 /
Code:Any city or county which requires permit to construct,alter, p4pL
Q Q Q Improve,demolish,Or repair any structure,prior to Its issuance,also ELEC.CONTR. - LIC.NO. -• ELEC.
p `9 '
0 0 requires the applicant for such permit to file a signed statement that TOTAL � PERMIT TMJ
.a w m¢ he is licensed pursuant to the provisions of the Contractor's License L[.('I lrx LA(T4 s.
H z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe 7Y v!
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE 0
f i O STORIES TYPE CONSTR.
¢ I—o the basis for the alleged exemption.Any violation of Section 7031.5
a ; m by any applicant for a permit subjects the applicant toacivilpenalty ALTER-DRAIN -WATER.(EA.) 5.00 -
of not more than five hundred dollars(5500)):
❑ 1,as owner of the property,or my employees with wages as BACKFLOW 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
•`»' r 1 property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5,001 so.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-11NC.40UTLETS, 6.00
molts are not intended or offered for Sale.If,however,lire building
or improvement is sold within one year of completion,the owner- —GAS-EA.SYSTEM-OVER 4 IEA.) -2.00 BUILDING USE
v builder will have the burden of proving that he did not build or am- RES IND DON PB . Omer
prvflr purpose of sale.). INDUSTRIAL WASTE INTER. ' 30.00
Is I,as 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 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 a contractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ Iamexemplunder Sec. ,B.&P.Gfnrthis WATER HEATER W/VENT 6.00 '
reason
Owner Of/' Dute W
ATER SYSTEM 6.00 Acc.DnTE ACC.FILE NO.
O KCRS�of�HP pS T UP�RATION TREATING EQUIP. 5,00 ,
I hereby affirm that 1 have a certificate ofcousent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. " Company
O ❑ Certified copy is hereby furnished. FIRESPRINK ENERGY T 24
Z'Z [I Certified copy is Filed with the city inspection division. REFER TO ORD. 'y[] NC] ' y [] N[]
I- yApplicant
ISSUANCE 10,00 . FLOOD ZONE A.L,U.C.CfiRTIFICATE OP F:XIiMPPION FROM WORKERS'LU COMPENSATION INSURANCE PL . . LIC.NO. PLG. Yo ' 'NC] Y[:] NQ
CL O (This section need not be completed if the permit is for one TOTAL
D Z hundred dollars 1$100)or less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
F mit is issued,I shall not employ any person in any manner so as to
O W becomesubject lofhe Workers''Compensation Laws of California. BUILDING
Date
Applicant OR ADD TO MECH. 5.00 dUL;
NOTICE TO APPLICANT: If,after making this Certificate of nix- -
r ? emplion,you should become Subject to tine Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with - FEE
(.1 such provisionsor this permit shall be deemed revoked. AIR HANDLING UNIT(7010,000QF.NL) 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 for EXHAUST HOOD (WITH DUCT) '5.00 MICROFILM -
the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.)' 8.00
3097,Cib.C.). _
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.501 ELECTRIC
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) _ 4'00 PLUMBING
information is correct. I agree to comply with ell city and county BOILER-COMP(3 H.P.Dr 100,000 B.T.U.) 6.00
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOF LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keen harmth
less e City of _ MISC. REFER TO;ORD.
Caper lion against Fatalities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
moll fthis permit MECN.CONT. LIC.NO. MECH.
v.'
TOTAL TOTAL o
Signature of Applican/Contractor
OFFICE COPY