16757 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY .OF CUPERTINO 16757
INSPECTION DIVISION
JOB INSPECTION RECORD
�'' _ .PERMIT EXPIRATION
SD cI �C�I(f ke UNIT#• LOT# f-..S/.
JOB ADDRESS_ 11 R
lPERM�T'EXP,I ES IF WORK :.
OWNER B e WTVL 'CONTRACTOR - IS NOT STARTED WITHIN
INSPECTION I DA E INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: '� LASTCALLED INSPECTION. •
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED '
PR EGUNITE
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMFT VAIJUATION
CUPERTIN0 STANDARDS. - 1
_ GARAGE SLABS - -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB ' /-3rC.IM. 2Lt1.C.{•C.,
PLUMBING
ELECTRICAL - ISSUANCE DATE
MECHANICAL - - FLOG, ELECT.I PLG. MECH.
❑ ❑ KI ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - -
'.VALUATION S/FT.
PLUMBING � -
MECHANICAL -
ELECTRICAL PAID PERMIT TO
FRAMING
,I
INSULATION h ST OHIES TYPE CONSTH.
I
DEC.GROUP RES UNITS
City, of Cupertino
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE $O FT FLOOR AREA 191.1 PaREACE MADE BEFORE ..
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHINGHes INBUILDINNG ILSEo CON PF otn., .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.a
A55E55OHS PARCEL NO
" '
PLUMBING —3/ ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO.
MECHANICAL - MECH.ENERGY I
ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO:
FRAMING ELECT.FINAL TEST
INSULATIONZONING ENG.SITE NO.
PLUMBING
GAS TEST GAS
MECHANICAL
FIRE SPHINK ENERGY T'2A
-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑ ` ❑ N❑
EXTERIOR SHEAR d ELECTRICAL RELEASE FLOOD ZONE A,L UC.
INTERIOR SHEAR FIRE DEPT. Y ❑ `v❑ ❑ N❑
SHEETROCK - - GRADE FEE SUMMARY
EXTERIOR LATH IBUILDING -
. INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BYPHONING 252-4505, ELECTRIC
. H ONE WORKING DAY.BEFORE REQUIRED INSPECTION. PLUMBING DD I
O PLEASE GIVE JOB ADDRESS WHEN PHONING. 6'
Z
• — SEE PERMIT FOR EXPIRATION.DATE —
MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE /
CALLING FOR FINAL INSPECTION. - TOTAL JDA 00
OFFICE COPY'
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 1 C� �]
r ADORESS I U 5 1�
.A�Q&I�' JII/E BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
NER'B PLAN CHECK VALIDATION
(JG{�l,/QTY. ELECTRIC PERMIT FEE
CONTRACTOR I� 16,�Pl V•r. !' GHDNE -NAA 's UTLETS-SWITCHES-RECEP 10.00/1.00
TORS LIC,C.No. LIGHTING FIXTURES 10.00/1.00 - ��
ADDRESS APPLIANCES-RESIDENTIAL 4.00 I
PHONE PANELS • 10.00 DATE OF APPLICATION y
ARCHITECT PANELS (OVER 200 AMP) ,20.00 PUN CHECK FEE a,c.:no.
on
ENGINEER
LIC.No. SIGNS,TRANS. 3.00
ADD iss ENC. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH.
ASy �SERVICE CHANGE 20.00
0 le
au O o LICENSED CONTRACTORS DECLARATION PAID
u v I hereby affirm that I am licensed under provisions of Chapter 9
ISSUANCE DATE
n G w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
Hoz I'ro(essians Code,and my license is in full force unit effect. Nov 7
❑ ❑ y ❑
z o `� - Licenw Class I.,,.Number 14OVsll
9 w r Date Contractor
< y BUILDING PERMIT
IF w a OWNER.BUILDER DECLARATION -
o a - INFORMATION
w ; LL y 1 hereby uffnm that I am exempt from the Conlractor;s License MISC.- REFER O OR
rs Oj L'JW for the remon.(Scc.7011.5.Business Professions VALUATION y/FT.
H - PERMIT ISSUANCE 10.00
Code:Any city or county which reyuiresa permit to construct.alter,
rtQ Q improve,demolish,or repair any structure,prior to its iawxncc-also ELEC.CONTE. - LIC.NO. ELEC.
D u requires the applicant for wch permit to File a signed statement that TOTAL
n w m he is licensed pursuant to the provisions of the Contmetur's License PERMIT TO
ri > Law(Chapter9(commencing with Section 7000)u(Division 3 of the -
a Rusiness and Professions Code)or that he is exempt Iherctrom and QTY. PLUMBING PERMIT FEE
¢ t$ the baso for the alleged exemption.An
8 0 the
otto a cion 703L5 STORIES TYPE CONSTR.
by any applicant fora permit dollars the applicant to a civil penalty
of not more than five hundred dollars(5500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ 1,as owner of the property or my employees with wagci m BACK FLOW PROTECT. DEVICE 4.00 DCC.GROUP RES.UNITS
their sole cumpensalion,will do the work.and the structure is not
intended or offered for sale (Sec. 7044, Business and Profvions 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 Ibemon,and who docs such work FIXTURES-PER TRAP '5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own erred fors Provided rhal such improve-
mmselfonotintendedorofferedfursaoovied Ohm
glhe building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement u sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 200
builder will have the burden of proving that he did riot build or ins- . BUILDING USE
pfor purpose of w . 30.00 le.L INDUSTRIAL WASTE INTEREES IND CON PR Dorn
Qp/lI,as owner out (lie properly,am exclusively contracting with 11 El .❑ El _
liXlcontractors In construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code'.'1'he Contractor's License does not apply
to an owner of property who builds or improves thereon.and who LAWN SPR INKLERS-OV ER,5(EA.) 1.00 �Q
contracts for such projects with a contractor(s)licensed punuam to
the Contmctnh Liccnsc law. SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Ium uxcnlpl under Scc.
RaSOn ,R.-- tlx anis WATER HEATER W/VENT 6.00
- WATER SYSTEM 5.00 - D ACC.DATE ACC.FILE NO.
/ WORK ERS'COMPENSA ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm thin l have a can illcale of con.ud t"wlf-insure.
or a cerlificule of Workeri Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Secf3800,Leb.C.). .
Policy No. Company
O ❑ Certilwd copy is hereby furnishedFIRE SPRINK ENERGY TRA
Z 2 ❑•C,rtificd copy is fled wilb Thecityinspection division.
� 0 Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
CrN CERTIFICATE OF EXEMPT ION FROM WORKERS' PERMIT ISSUANCE 10.00 '1 2.0 FLOODZONE A.L.U.C.
LU ?! COMPENSATION INSURANCE PLG.CONTE. LIC.NO. TPEG
OTAL 16106 ❑ ❑ ❑ N❑
CL O 'ffhis seei6o, need not he completed i(the - Y N Y
Z n Permit is Int one _
hundred dollars 1less.)
inthe pe
LL O - I certify that m the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
0 U mit is issued.I so t not Workers'
any perwn in any manner so ia to
O W becomc,wbject to the Workers'Compunsalion Laws of Calilomia.
C_ Dutc APNicam BUILDING
>_ W NOTICE'r0 APPLICANT: If,after makinN this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
F" 2 emption,you should become subject to the Wurkcrs'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
CJ such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONS']'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=11F.M.) 6.00 SEISMIC FEE
I hereby affirm that them is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work far which this pennit is issued(Sec. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.)' 8.D0
Lender's Name HEATING UNIT(OVER 100,ODO B.T.U.)9.50
Lender's Addmss ELECTRIC
1 certify that I have read this application and stare Ihaf.the above VENTILATION FAN (SINGLE) 4.00
information n estate. I agree ti comply with all city and county BOILER-COMPQ H.P.or 100,000 B.T.U.) 6.00 PLUMBING !6 , d 0
ordinances and state laws relating to building l city and co and
hereby oulhorim femme ,,rives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection pupmse,
(We) agree to save, indemnify and keep Imarmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments. Costs and expenses which CONST.TAX
ay' in any way accrue against said City in m�sequcnm of the PERMIT ISSUANCE 10.00
0(111 o�his eOr I. ., MECH.CONT, LIC.NO. MECH.
(LCITOTAL TOTAL �6, 06
ignature of Applicant/Contra r Dam
OFFICE COPY