16263 (2) POST THIS CARD NEAR FRONT.OF BUILDING
PERMIT NUMBER
.:_. CITY OF CUPERTINO 16263
INSPECTION DIVISION
1 JOB INSPECTION RECORD
L _
PERMIT EXPIRATION'
" JOB ADDRESS .40 3 QU jjL, UNIT# LOT#
PERMIT EXPIRES IF WORK
' OWNER L cE�� d-.�� CONTRACTOR x, /(„�'`�/.q� IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
'NOTE:
UFERALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF - PEinnT Vn I.IDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED "
UNDERGROUND /SLAB
PLUMBING
i J 4
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG ELECTPLc. MECH
❑ El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED . . . BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION SIFT.
� �
MECHANICAL vQ'�
ELECTRICAL - PERM I TSO,/--
. FRAMING
INSULATION'
STo Es IYEE CORSET,
� � '
.. OCC.GHOUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO IT.FL(1(IIi AREA TOTAL ACRLAGE
- - ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID'
BUILDING USE
ROOF SHEATHING RES IND -CON PB.'. Omn i
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
Assessa lis PnnceL Na.
ROUGH SAN.p -
PLUMBING ELECT.ENERGY ( .
I I
TUBS&SHOWER PAN PLUMBING EN TRACT NO, PARCEL NO
-
MECHANICAL MECH.ENERGY I'
. ,
ELECTRICAL � BUILDING—ENERGY ACC DATEACC.PILE NO.
FRAMING ELECT.FINAL TEST
INSULATION -
ZONING ENG.SITE NO.'' � PLUMBING � '
GAS TEST GAS _
FIRE SPRINK ENERGY T-2a
MECHANICALYL]T
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� ` "E]
EXTERIOR SHEAR - ELECTRICAL RELEASE • . . FLOOD ZONE- A,L.U.C.
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ ° ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH' BUILDING
gUILDING /Oa
.INTERIOR LATH TEMPORARY APPROVALS —Y
SCRATCH COAT ELECTRIC PLAN CHECK'
GAS FEE T_
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE
OCCUPANCY'OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY-PHONING 252-4505, ELECTRIC /
LEI WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 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
- I ;
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATI ON 'PERMIT NUMBER
. AE APPLICATION & PERMIT . • 1 L+�'[��
/1_( O3 O FI� ONIo pQ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL I U �7
O'NNER'S PLAN CHECK VALIDATION
/ NAME OTV- ELECTRIC PERMIT FEE
E20-/Z92
-/Z
CONTRACTORS
N B^� OUTLETS-SWITCHES-RECEP 10.0011.
h1G /- tiXl c.uo.S�6ry� LIGHTING FIXTURES 10.00/1.00 iv
ADDRESS'oR's �Qp - PPLIANCES-RESIDENTIAL - 4.00
PRONE yJ PANELS 10.00 DATE OF APPLICATION'
OgcloTwr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .C.NO.
ENGINEER
LIC.NO, SIGNS TRANS. 3.00
ADDRESS ERG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. ,20.00
APPLICANT'S Y -
ADDRESS - MOTORS SEE FEE SCH.
o � =
Foo LICENSED COY]'RACI'ORS DECLARATION SERVICE CHANGE 20.00
Fz w I hereby affirm that I am licensed under provisions of Chapter 9 "v•s'1 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and L G. . ECT. PLG. MECH.
H i Professions COde,aid my liecnsr rs in full force a d c f ro ,
a. o'2 - License jR_./,5__t_Lic.Number_ _ MalEl
o z F D Date_ Contractor ON
-
a y F BUILDING PERMIT
OWNER-BUILDER DECLARATION
a o d INFORMATION
w g; LL I- 1 for the
acillo That or exempt from the Contractor's License MISC.- REFER TO ORD
LL0� Law or Onlywhi Sec.7ineira Businessand Professions VALUATION S/FT.
F _ PERMIT ISSUANCE - to nn
Calc:Any city or wunty whiny 01reftneC permit to cansuance.lter.also
ic x Q itttprovc,dcmoliah,or repair any struclurt,prior to its issuance,also ELEC.CONTR. LIC.NO, ELEC:
DLL requires the applicant for such pernlll to till'a signed statement that
w$ he is licensed pursuant to the provisions of the Contractor's License TOTAL PERMIT TO
FZt Law(Chapter 9(commencing with Section 7000)of-Division 3 ofthe S� ����
a Business and Pndlviuna Code)or That hr is exempt thcmfrom and DTV. PLUMBING PERMIT FEE
¢ F0 the basis for the alleged exemplloll.Any violation ofSection 7031.5 STORIES TYPE CONSTR.
n 3 by any applicant for a permit subjects the applicant to a civil penalty
of not mom than five hundred dollms(S500).): . ALTER-DRAIN&VENT-WATER IEA.) 5.00
❑ 1,as owner of The property,or my employrcs with wages as BACK FLOW PROTECT. DEVICE 4.00 ec. Roue RES.UNITStheir sole compensation,will do the work,and the srrocture,is tint
'mended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND- 5.00
Codr: The Contractor's License Law does not apply to an owner of
• property who builds or improve,Ihemon,and who docs such well FIXTURES-PER TRAP 5,00 so.
himFT.FLOOR AREA TOTAL ACREAGE
self or through his own employees,provided that such improve-
mentsamnotintendedorofferedlbr sak.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,The owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or int- BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER3000 RES IND 'CON Pe Omar
. .
❑ 1,as owner of The property,am exclusively contracting with ❑ ❑ ❑ - ❑ ❑
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 Contractor's License Law does not apply
to an owner of properly who builds or improves therenn,and who LAWN SPR INKLERS-OVER 5(EA:) 1.00
contracts for such projects with a cuntractoda)licensed pursuant In
the Contractori License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,BAKC,tie,this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILENO.
WORK ERS'COMPENSA1'ION DECLARATION .WATER TREATING EQUIP. 5.00
I hcmyy affirm That I have a lentilkale of con.nl tn41f-instuc' ZONING
or a certificate of Workers'Compensation Insurance,ser' eeJTl I icit - ENG.SITE NO.
ONYY thereof J800,1.ab.Y.). 1/�
Polic Nq(Q�/ (JClGI'an LG.6.._ L/_\CiLQrLs9
O ❑ Certifc byf rnislt FIRE SPRINK ENERGY T-24
Z Z ❑ CerY d ie ill I cit vection division. MISC.- REFER TO ORD.
Applican Y E] N❑ Y E] NE],O
LU CERTPICA'PE A1IFROM WORKERS* PERMIT ISSUANCE 10.00
FLOOD ZOrvE A.L.0 c.
W COMPENSATION INSURANCE
PLG.CONTR. LIC.N0. PLG
CL O (This section need not be compkted it The permit n for one TOTAL Y❑ N[] V ❑ N❑
0 Z hundred dolhok(S100)or 1.) _
U O I mrlily that in tlm pur(unnancu of um work for wl' his per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mit is issued,I shall not amp loyp ny I nne s to -
O W beco subject to The Workers .1"I'
of w.
Date ZL=3=AvNicanT so - ALTER OR ADD TO MECH. 5.00 BUILDING a/
} w NOTICE '1 O APPLICAN I''. IL aver makin this Ccrlif cute of Ex-
Z emplion,you ilmuld beconm subjen to tl Worker,'Compensation APPLIANCE 5.00 PLAN CHECK Q
Provisions of the labor Code, you must forthwith comply with FEE
U soch provisions or This permit shall he deemed revokes]. AIR HANDLING UNIT(TO 10)(00OF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOGEM.) 6.00 SEISMIC FEE: J-0
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.C.). �oN B HEATING UNIT(TO 100,000 B.T.U.) 8.00
Leader's Na
Addme
Lender's ress HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 cemily Ihal I have read I his applicut ion and state 01m the abmn VENTILATION FAN (SINGLE) 4.00
informulion is correct. I agree to comply with all -it) and county PLUMBING
ordinances and stale laws relating to building Construction, unit BOILER-COfeP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize roprmontmives of The lily to enter upon the BOILER-COMP (Own 100,000 BTU) FEE SCH.
above,-mentioned property for inspection purpso s, MECHANICAL
(we) agree to save, inde...nify and keep harmless the Cil,of MISC.- REFER TO ORD.
Cupertino a t liabilitunfIgiapols, costs and expenses which CONST.TAX
may ie, wa a agai d 'yin conscqucnre of the PERMIT ISSUANCE 10.00
rami fth MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL f-�4S'
ignatum o ppli t/Contractor Dale
OFFICE COPY