16096 (2) T .
��_ • POST THIS CARD NEAR FRONT OF,BUILID ING n PERMIT NUMBER
CITY OF CUPERTINO 16096
INSPECTION DIVISION
JOB INSPECTION RECORD
�, • S Sv,L� `• PERMIT EXPIRATION
JOB ADDRESS l
/ D ` 3'� S�� X4.Z-d UNIT# - LOT# 'PERMIT EXPIRES IF.WORK
OWNER O Ce _ =CDC CONTRACTOR e 1'� a IS NOT STARTED WITHIN
IN PECTION DATE INSPECTOR - INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ,
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION. .
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS,AND CITY OF PERMIT VALIDATION
CUP RTINO STANDARDS.
GARAGE SLABS . - I V. QQ.. . ' r
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED IOCT51989 _
UNDERGROUND /SLAB 1989
PLUMBING
-
PLUMBING _ /^i
ity DiNTro.
ELECTRICAL. 4 ISSUANCE Orire
MECHANICAL BLDG ELECT I PLGj. MECH
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - - INFORMATION
VALUATION SIFT.
PLUMBING' ,
MECHANICAL -
ELECTRICAL /� PERM 10
FRAMING - V v'( )
INSULATION STORIES T CONSTR. .
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES ING CON PB 0"".
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS - DATE IN ❑ -El 10 ❑ ❑
ASSESSORS PARCEL NO,
ROUGH SAN.# 1
PLUMBING ELECT.ENERGY-
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
MECHANICAL - MECH.ENERGY
ELECTRICAL - BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING-.. ELECT.FINAL TEST
INSULATION PLUMBING
ZONING - .ENG SITE NO.
�GAS TEST GAS -
',.FwBsaRlNrc ENERGY T.Za
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y [] N❑ v ❑ . NE]
- EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A L U.c
INTERIOR SHEAR FIRE DEPT. YO- - NQ , Y ❑ N
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING -
INTERIOR LATHTEMPORARY APPROVALS BUILDING'
SCRATCH.COAT - ELECTRIC PLAN CHECK
GASFEE
Ty
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDI I NO IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING,INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. • PLUMBING, pQ
O PLEASE GIVE JOB ADDRESS WHEN PHONING. .
z MECHANICAL
• — SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST,TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL UD
L. OFFICE COPY .
AJWLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
— -� .PER
BUILDINOJyTIFICATON MIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS
la,,43,0 S, BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 10
7L- .
OWNER'S - PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
NAMERACTOR'S G OUTLETS-SWITCHES-RECEP 10.00/1.00
D .No. LIGHTING FIXTURES 10.00/1.00
ADDRESS TORS !f9 —OZ/� APPLIANCES-RESIDENTIAL 4.00
PANELS 10.00 DATE OF APPLICATION
AORRCHITECT PANELS (OVER 200 AMP) 20.00 ' PLAN CHECK FEE .C.NO.
ENGINEER
' LIC.No. SIGNS TRANS. 3.00
ADDRESS ENG. - SPECIALCIRCUIT - 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
APPLICANTS
ADDRMOTORS SEE FEE SCH.
ESS
AIAZO S2
SERVICE CHANGE ,00 ..
0 0 o LICENSED CONTR CTORS DECLARATION VI,V�C✓�
a U 1 hereby affirm Ihat 1 am licensed under provisions of Chapter 9 OCT J ♦ ISSUANCE DATE -
a,G w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H G i Professions Code,'nJ y�y licmtse is in full force and of �7i ❑ ❑ ❑
Z,o= — License Class—F SSL Lie.Number a u�p 1 n
q Z o Date ContractorCitY�
a Y f t:t _ __ - a BUILDING PERMIT
¢ as OWNER-BUILDER DL'CLA ATION
a5 A v INFORMATION
E
g;I N I hereby affirm that I um exempt from roc Cmssand P's License MISC.— REFER TO ORD
LLOa Law forthe following reason lSec.7031.5,business and Professions PERMIT ISSUANCE 1000 VALUATION $/FT.
EN> Code:Any city or county which requiresa permit to construct,alter,
¢ G Q O improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.,
i
w ,
u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License x
tit Law.(Chapter 9(commencing with Section 7000)u1'Division 3 of the 0/0"'t,
•
Q Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE 111
a r $ the basis for the alleged exemption.Any violation or Section 7031.5 TORIES T7E CONSTR.
a ; — by any applicant for apermilsuhjectsthe up licummaeivilpena0y ALTER-DRAIN -WATER (EA.) 5,00
of not more than five hundred dollars f 4500.):
❑ 1,as owner of the property,or my ployees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the wor ,and[he structure is not
intended or offered for sale ISec. 704 , Business and Professions DRAINS LOO OOF,AREA 5.00 A�
Code:The Contractor's License Law d as
not apply to an owner of -
property who builds or improves they on,and who does such work Q FIXTURES-PER TRAP 5.00 50.FT,FLOOR AREA TOTALACREAGE
himself or through his own employe .Provided that such improve-
mentsarenotilReadedorofferedf sele.lLbowever.0mbudding GAS-EA.SVSTEM-1 6.00
or improvemem is sold within one cur of completion,the owner GAS-EA.SYSTEM-OVER 4 (EA.) -2.00 BUILDING USE
builder will have the burden of pr ving that he did not build or im- RES IND CON PB OtM1er
prove for purpose of sale.)' INDUSTRIAL WASTE INTER. 30.00
' ❑ 1,as owner of the proper ,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to constr t the Project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Co tractor's License Law does not apply
to an owner of property wh builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects ithacontruci.q,)Iiccnwdpursuantto SEWER-SANITARY-STORM EA.200it/10.00
the Contractor's LicenseL TRACT NO. PARCEL NO.
❑ I am exempt under ec. ,B.&P.C,for this WATER HEATER W/VENT 6.00 a jq
reason
owner Date WATER SYSTEM 5.00 ,0V ACC.DATE ACC.FILE NO.
WORK IiRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent toself-insure, ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
ED py there I )3�800,Lab.C.).
Policy Nc FSN�[f.'ompanY�iAsL/�[C..
Q ❑ Certified copy isher,°byfurBlShed r FIRE SPRINK ENERGY T 24
Z Z �/Certified copy i jj�Iled with uto etjty inspection division.
O AppTcian ��iL�jif6C6'fo. MISC,- REFER TO ORD. Y❑ N❑ Y ❑ N❑
N CERTIFICATE OF I/J(EMPT'ION FROM WORKERS' PERMIT ISSUANCE 10.007 •'a FLOODZONE A.L.U.C.
LLI — COMPENSATION INSURANCE Pq�LyG��c�ONQT.R. LIC.NO. PLG.
1 0 ('Phis section need not be completed if the permit is for one ;Y49 a 'ID TOTAL !� Y❑ N❑ V ❑ N❑
=) Z hundreddollars(S100)orless,)
U O 1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I— mit is issued,1 shall not employ any person'n any manner so as to
O U become subject to the Worke/17NDING
ensaf n Laws of Calilarnia. BUILDING
IL Date ApplicanALTER OR ADD TO MECH. 5.00
} N NOTICE TO APPLICANT: Inu 'ing this Certificate of Ex-
?' emption,you should becomethe Workers'Compensution APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Comust forthwith comply with FEE
U such provisions or this permitdeemed revoked. AIR HANDLING UNIT(TO 10=CF.M,) 4.00
• CONSTRUCTIDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 -SEISMIC FEE
I hereby affirm that thernstruction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
rile performance of the cooich this Permit is issued(Sec. MICROFILM
3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
. Lender's Name HEATING UNIT DIV ER 100,000 B.T.U.)9.50
Lender's NAd Lame ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4,00
. information is correct.I agree to comply with all city and county PLUMBING C)
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby autharite representatives of this city to enter upon the BOILER-COMP (Over 100.000 BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against Said City in consequence of the
ranting of this IL MECH.CONT. LIC.NO. MECH.
/o:_ TOTAL TOTAL ��,OD
S oat of Applica Contractor - Uate '
OFFICE COPY