16882 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF. CUPERTINO QQ
INSPECTION DIVISION' �uV�
JOB INSPECTION RECORD
C,'p/ y n PERMIT EXPIRATION "
JOB ADDRESS_(_ ((1�.y�,�"� �a LIN
IT# LOT#
PERMIT EXPIRES IF.WORK
}— ;
OWNER lr VA,L CONTRACTOR �e.S ` V d-/lF :G IS NOT, STARTED WITHIN.
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATIONANCE 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 VALBTATION
CUPERTINO STANDARDS.
GARAGE SLABS
4
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB,
PLUMBING '
ELECTRICAL ISSUANCE DATE
BLDG ELECT PLG. MECH
MECHANICAL' '
❑ ❑ 2S} ❑
OO,NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED suIL
INFOORMRM PERMITATION
WOOD FLOOR v,ALUATION .s/FT
PLUMBING ..
MECHANICAL
ELECTRICAL L PEH(I TTD
FRAMING ` LQ(I) ^,,
STORIES Tv CONSTR
• INSULATION - � _ _ � ..
OCC.GROUP RES UN,TS
' I
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - - sD IT FLooR AeeA TOTAL ACBFmE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
,.• DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILOMG USE
ROOF SHEATHING HES IND CON PB Om., .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED.,... FINALS DATE INSP. 0 ID - ❑. El ❑
ASSESSOHS PARCEL NO,
ROUGH SAN.N
PLUMBING ELECT.ENERGY
` TRACT NO. PARCEL NO
TUBS 6 SHOWER PAN � � PLUMBING ENERGY
MECHANICAL" MECH.ENERGY '
ACC.DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION - - - PLUMBING
GAS TEST GAS -
MECHANICAL FIRE SPRINK ENERGY T 24
Y [] No Y E] N[]COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE 4.LUC.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR-SHEAR - FIRE DEPT. Y❑ N❑ ° ❑, NO
SHEETROCK GRADE- FEE SUMMARY.
EXTERIOR LATH BUILDING '
r INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT T r ELECTRIC FEE CHECK i
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,, ELEcralc
JJ ONE WORKING DAY BEFORE'REQUIRED INSPECTION. PLUMBING ag
O� PLEASE GIVE JOB ADDRESS WHEN PHONING. 100
ZMECHANICAL
— SEE PERMITTOR EXPIRATION DATE —
IMPORTANT! coNsr.rnx
PLEASE READ REVERSE SIDE BEFORE TOTAL ; aOlo0
CALLINGTOR FINAL INSPECTION.
OFFICE COPY.
4iPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY '
BUILDING PROJECT 1 DENT[FICATION
-PERMIT NUMBER
6OILOING e) APPLICATION & PERMIT "
POORE55 �a49 ... 16882
w wQ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
CNAN 5
NosSIN MA `' 'I1WGIM455 QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
1 „sT I✓ ; 1
PHONE i ,
.�jj) OUTLETS-SWITCHES=RECEP. 10.00/1.00 .
u LIC.No(r LIGHTING FIXTURES 10,00/1.00
CDDNTRACTOR�S APPLIANCES-RESIDENTIAL 4.00 -
IAV@PRONE PANELS 10.00 DATE OF APPLICATION
ORCRITECTPANELS (OVER 200 AMP) 20.00 PLAN_CHECK FEE .C.yNO.
OR
ENGINEER
• uc.No. SIGNS TRANS. 3:00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zlv EMP.METER OR POLE INS. . 20.00
ADDRESS
ADRRCANESS - MOTORS SEE FEE SCH.
ss
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION
u I hereby uffirm that 1 am licensed under Provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business,nd
¢^ BLDG. ELECT. PLG. MECH.
Professions Co a license is in full Dole
H y i
z o a- License C,,JP��///...s Loc.Number Lsl-I ❑ ❑ �, ❑
o lL r OContraclor
--
¢ y s Jkwa BUILDING PERMIT
¢ 2 w OWNER-BUILDER DECLARATION - INFORMATION
wo a H I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
3 0 VALUATION $/FT.
HLLOa Law for the fallowing reason.(See,7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit m construct alter,
2 c 0 improve,Demolish,or repair any structure,prior to its issuance,else ETEC.CONTR. LIC.NO, ELEC.
ai
A wO s requires the applicant for such permit to file a signed statement that TOTAL - PERMIT TO
m a. he is licensed pursuant to the provisions of the Contrnmor's License1
Fz'A Law(Chapter 9(commencing with Section 7000)of Division 3 of lite
¢ Business and Professions Code)or that he is exempt Darefrom and QTY. PLUMBING PERMIT FEE (/ N `
¢ r$ the basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES TYPP CONSTR.
a3 _ by any applicant for a permit subjects the applicant toe civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑,I,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 the work,and the structure is not
intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,GOND. 5.00 ]• t U Q -
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such workFIXTURES-PER TRAP '5.00 V V $0.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
mems are not intended or offered for sale.l f,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that h - .e did not build or im-
Prove for purpose ofRES IND CON PB Other
sale.). INDUSTRIAL W ASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an..net of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 -
contracts for such projects with a eomraetor(sl licensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under See, ,B.&P.C.for this WATER HEATERW/VENT 6.00 ,'Z. f
reason
Owner Doe WATER SYSTEM 5.00 ACC.DATE ACG FILE NO.
WORK HRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 '
I hereby affirm that 1 have a certificate ofermsent to self-insure,` ZONING ENG.SITE NO.*Nx,• or a certificate of Workers'Compensation Insurance,ora certified _
copy thereof(Sec.3800,Lab C.).
Policy No. Company '
Q poContifiad copy is hereby furnished. FIRE SPRINK ENERGY T-24
Cer" co i til wi t ins ection division. MISC.- REFER TO ORD.
O PP ICanL Y ❑ N❑. Y ❑ N❑
~
CC CERTIPICATI:OI'EXEMPTION FROM ERS'm PERMIT ISSUANCE 10.00 IP-s' FLOOD zorvE A.L.u.c.
1 : t
LU > COMPENSATION INSURANCE PLG,CONTR. LIC.NO. - PLG. )
O_ D
(I his section need not be completed it' it,, permit is for one IT
OTAL�CA COD Y❑ N❑ Y❑ NC]
Z hundred dollan(S 10(1 or less.)
U O- I certify that in the perfornance of the work I'or which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,1 shall not employ any person in any manner m as to
OL) become subject to the Workers'Compensation Laws of Califomia.
y Date AppluanlALTER OR ADD TO MECH. 5.00 BUILDING
} tD NOTICE TO APPLICANT': If,after making this Certificate of Ex-
)... Z emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply witlh FEE
U such provisions or this permit Shull he deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONSTRUC'T'ION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency lot EXHAUST HOOD(WITH DUCT) 5.00
Hunt performance of Lite work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's.Name - HEATINGUNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address -
Icertify lha(I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and countyPLUMBING UL.IJO
ordinances and state laws relating to building construction, and BOILER-COW(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize 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 CONST.TAX
may in any way accrue against said City in cons-quence of the PERMIT ISSUANCE 10.00
on gof ti er MECH.CONT. LIC.NO. MECH. 1-
I ' I TOTAL TOTAL Qv
Si Lure o'Apphcan[Con ractor Rate fl
OFFICE COPY