16404 (2) POST THIS CARD NEAR FRONT OF BUILDING,
PERM IT NUM1te ER
- CITY OF CUPEWINO ' 16404•
INSPECTION DIVISION
JOB INSPECTION RECORD
1 •T �PBHMITIEXP.IAATIOEN
JOB ADDRESS /0.0T '�eS� GGe lA-T UNIT# ' '_LOT# -, gg
11 PERIV116 4IF WORK
OWNER VPCL CONTRACTOR VCG• IS NOT 'STARTED WITHIN + .
INSPECTION DATE ANSPtCTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. )
FOUNDATION - ANCE-OR 180' DAYS FROM
^2- NOTE: LASTCALLED INSPECTION. ,
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
,PREGUNITE TO COMPLY WITH THE APPROVED PLAN&AND CITY OF, PERMIT VALIDATION
CUPERTINO STANDARDS. T :•�
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING ,
ELECTRICAL ISSUANCE DATE
MECHANICAL .eLOG ELECT PLO, . MPCR.
o ' o 0
OO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
. ' WOOD FLOOR VALUATION SIFT. .
' PLUMBING ', - � - � -
MECHANICAL
ELECTRICAL PERMIT To -
FRAMING `
INSULATION sroHlEs rYPE CONSTR
OCC-GROUP
UNITS
PLACE,NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 50 FT.FLOOR AREA '• TOTAL ACREAGE
,.� DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON. PH Om_
APPLY ROOFING UNTIL ABOVE HAS BEEN SIGNED , FINALS DATE INSP, . 0 0 1 11
ASSESSORS PARCEL NO
ROUGH SAN.a
PLUMBING ELECT.ENERGY -
TUBS&SHOWER
AN PLUMBING ENERGY - TRACT No, PARCEL NO
MECHANICAL - MECH.ENERGY
ACC DATE ACG FILE NO.
ELECTRICAL. - BUILDING ENERGY
FRAMING ELECT.FINAL TEST zoNlNc ENG.SITE NO ,
INSULATION PLUMBING ,
GAS TEST' GAS
MECHANICAL' E SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y NY
EXTERIOR SHEAR ' ELECTRICAL RELEASE FLOOD ZONE A.LUC.
INTERIOR SHEAR FIRE DEPTr 9 YF] 'No YL N❑I
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING - -
INTERIOR LATH TEMPO RAW APPROVALS BUILDING
SCRATCH COAT ELECTRIC . PLAN CHECK
GAS FEES .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE ,•T
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM `•'^`-•'
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC-
-ONE
w'
WORKING DAY BEFORE REQUIRED INSPECTION.
FPLUMBING -•�"'~
Z PLEASE GIVE JOB ADDRESS.WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
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 a PERMIT NUMBER ..
ADILDING l APPLICATION & PERMIT 1604[� A O %�
ADDRESS IO6w5I fJ f{ �}
�G/P�2T/No 1,4 JPO/if BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
OwNEWS PLAN CHECK VALIDATION
71 NAME
DTV. ELECTRIC PERMIT FEE IPJ
O 1I /all �'rT6ilN 6/ ':PHONEw6 d¢G. " I J PL., SIT
CONTRACTOR'S -
A NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
^1 /z C• LIC.No. LIGHTING FIXTURES 10.00/1.00 ..
CONTRACTOR'Sa332 TR/?�rLOi �Y y PPLIANCES-RESIDENTIAL 4,00 P
ADDRESS
PANELS - 10.00 , DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMPI 20.00 -
ENGINEER
LIC.No. SIGNS TRANS. 3.00 '
ARCH.Ess ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS., 20.00 /Q
APPLICANT'S
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE - 20.00
o o LICENSED CONTRACTORS DECLARATION
v I herebyaffirm that I am licensed under provisions of Cha ter 9 -
' p p ISSUANCE DATE
rt a, (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT, PLG, MECH,
H 7 i Professions Code,a my license is in full fore-and t
z o y- License Class Lic.Number ff -
o N r Date a1-�X-sy Contractor 4n -
a y s rt(R BUILDING PERMIT
w u
OWNER-BUILDER DECLARATION INFORMATION
wOo. MISC.— REFER TO ORD
S r_vHi 1 hereby affirm that 1 am exempt from the Contractor's License VALUATION $/FT.
H u O a. Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE
Code:Any city or county which requires a permit to construct,alter,
Q
Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
E: u requires the applicant for such permit to file a signed statement that' TOTAL PERMIT TO
E:
he is licensed pursuant to the provisions of the Contractor's License 11 a eGh t,•
Hii Low(Chapter 9(commencingwith Section 7000)ofDivision 3 ofthe J
4 o Business and ProfessionsCode)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE t`
H the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR.
a; by any applicant for a permit subjects the applicant to a civil penalty
of not more than rive hundred dollars($500).1: - ALTER-DRAIN&VENT-WATER (EA.) 5,00
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Dec.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 '
property who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
Humus arenot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.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 int- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 '� '�
❑ I,as owner of the property,am exclusively contracting with Q El 11
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 Contractors 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 contactors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ .I am exempt under Sec. ,R&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 '
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy theircof(See 3BQp,Lab.C.) -
Policy NdXt rl' Iiap ny LJC 9rdrZ 2f4!f4'!&
O ❑ Cerliliedcopyishereby furnished. FIRE SPRINK ENERGYT ZA
Z Z lCertifie� ynpy.Is fyI J wick- h� �Ily n ion division.
O AppliMISC.- REFER TO ORD. v[] N❑ v C3 N❑
jr y� CERTIFICATE OI'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LLLC.
LU COMPENSATION INSURANC17 PLG.CONTE. - LIC.NO. PLG.
Z (This section need not be completed i0 the permit is for one TOTAL V❑ v N❑ Y Fl. No
hundred dollars(S 100)or IessJ
C
..) O 1 certify that in the performance of the work for which this perOTV MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California. `�
y Dalc - Applicant ALTER OR ADD TO MECH. 5,00 BUILDING /
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex- - �^
F ? emplion,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK ► 1
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=11F.M.) 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 .
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9,50 ELECTRIC
,. Lender's Address _
I certify that l have read this application and state that We above VENTILATION FAN (SINGLE) 4.00 -
information n route. I agree to comply with all city and county PLUMBING
8ordinances and orrec laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the �-
above-mentioned property for inspection purposes. 'BOILER-COMP IGVa!100,000 BTU)SEE FEE BCH. MECHANICAL
(We) agree to save, indemnify and-keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments,'costs an. expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
grant go lhispe it, MECH.CONT. LIC.NO. - MECH. (�
- TOTAL TOTAL Tr .
ivatture of Ap scant/Contractor Date
OFFICE COPY
1