16416 (2) I _
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY .OF CUPERTINO 16416
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS ,fib C11'0 tDtCrE ✓- UNIT# LOT# t
' .. I PERMIT EXPIRES IF WORK
OWNER /Q/t�i� V, s C, G E. CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION I ANCE OR 180 DAYS FROM
- NOTE: 'LASTCALLED INSPECTION.
LEER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PEFI VALioATION
CUPERTINO STANDARDS.
GARAGE SLABS n
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' p ,!
UNDERGROUND /SLAB w � ,
PLUMBING C` t. •�!�' F ,
ELECTRICAL C O -
\"O ISSUANCE uATE
MECHANICAL `-`� BLOG ELECT. PLG. •MBC.,
❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - INFORMATION
VALUATIONSIFT.
PLUMBING - -
MECHANICAL � '-
ELECTRICAL' - PERM" TO
FRAMING.
T
INSULATION
STORIES TYPE CONSTH.
� '
OCC-GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
'.
.• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE $O IT,FLOOR AHEA TOTAL ACREAGE '
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING HES IND aO`ON USEPH
DO-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
` ROUGH SAN.q
ASSE5SOHS PARCEL NO
� �
PLUMBING - ELECT.ENERGY
TUBS 8SHOWER PAN PLUMBING ENERGY TRACT NO, PARCEL NO.
MECHANICAL MECH.ENERGY
ACC,DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY &A I
FRAMING ELECT.FINAL TEST
INSULATION' PLUMBING ZONING ENG SITE No.
GAS TEST GAS
'I FIRE SHRINK ENERGY L7E
MECHANICAL till'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING -'Y ❑ "❑ ` ❑ "❑
_ FLooD zoNE A.L.u,c.
EXTERIOR SHEAR ELECTRICAL REE
INTERIOR SHEAR FIRE DEPT. Vu ❑ "❑ v ❑ "❑
SHEETROCK GRADE TFEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH ' TEMPORARY APPROVALS BUILDING �.'
SCRATCH COAT - ELECTRIC - - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED' occuPANcv SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE 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 .
CALLING FOR FINAL INSPECTION. TOTAL g d))
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LD1 NG PROJECT IDENTIFICATION PERMIT NUMBER
GUILDING APPLICATION & PERMIT L+ A 1
/DDRE U`F 1 6
/O Wires BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
PLAN CHECK VALIDATION
NAME
GrvE
QTY. ELECTRIC PERMIT FEE
CONNAMrRACTORs UTLETS-SWITCHES-RECEP 10.00/1.00
uC.NO. LIGHTING FIXTURES 10.00/1.00 -
ADDRESS
CONTRACTOR s
ADDRESS PPLIANCES-RESIDENTIAL 4.00
A
PHONE PANELS - 10.00 DATE OF APPLICATION r
OR
ARCHITECT PANELS (OVER 200 AMP) 20,00 ALAR CHECK FEE P.C.NO.
ENGINEER
C.No. SIGNS TRANS. 3.00
ADARE DRESS ENG. SPECIAL CIRCUIT 6,00 PERMIT VALIDATION
nv TEMP.METER OR POLE INS. 20.00 P11� �y
ASMOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
oC = - ` y�r� _
0 o LICENSED CONTRACTORS DECLARATION CUP
a u� I hereby efts..that 1 am licensed under provisions of Chapter 9 8 �
155UANCE DATE
m a w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H H z Professions Cods,.,,it my licsmc is in full force and effect.
iw License Class Lic.Number -
2 m H 0.J D.W Contractor
BUILDING PERMIT
i a. OWNER-BUILDER DECLARATION - INFORMATION
X
r " I hereby affirm the I um exempt from the Contrucmr's License MISC. REFER TO ORD -
.. o a Law for tiro following reason.(Sea 7031.5.Ilesinessand Professions VALUATION S/FT.
H - PERMIT ISSUANCE 10.00
Code Any city or county which requires une permit to construct,ua ,also
Q a¢ improve,demolish.Or repair any structure.prior In IIS ISS11anCC,a150 ELEC.CONTE. LIC.NO. �('• •�
EOTA
D w requires the applicant for such permit to fide a signed statement that TOTAL PERMIT TO
cy
E
he is licensed pursuant en 0m provisions of the )ofDivision License
Hui
Business
(Chapter Processions Codeng with Senium is
thereto and
Imo Business and Professions empt or that he is cion of ection 70 and QTY, PLUMBING PERMIT FEE W6L--L,
CE I- the basis for the alleged exemption.Any he applicant
of Section malty STORIES TYPE CONSTR.
a � by any applicant fore permit objects 55DO).licanl loaCivil penalty ALTER-DRAIN St VENT-WATER (EA.) 5.00
of not more than five hundred Dollars(my cui:
❑ I,as owner it the properly,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compenwtion,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, BIsinc,S and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SE,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that each improve-
mentsare not 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,0w owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that lie did not build or int- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PS Omer
❑ I,as owner of the property,am exclusively contracting with 0 0 . 0 0
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B: 6.00 ASSESSORS PARCEL NO.
and Professions Cods:The Contractor's License Law docs 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 contructorts)licensed pursuant to SEWEFf-SANITARY-STORM EA.200k/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ Iamcxc opt under Sec. ,B.&Y.C.for this WATER HEATER W/VENT. 6.00
on
Owner Dale WATER SYSTEM 5.00
/ ACC.DATE ACC.FILE NO.
WORKERS'COMPI:NSATION IvaLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm that 1 have a certificate of consent to sel Giewre.
or erlificate of Workers Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy Ilmorr f f5ec.3800,Lab.C.).
Policy No,-Company-
0
o, CompanyO ❑ Certified To,is hereby hunished. FIRE SPRINK ENERGY T 24
Z 2IJCertified copy is filed with the city inspection division. MISC'.- REFER TO ORD.
O Applicant v N� v N�
N CERTI PICATF:OF EXEMPTION FROM WORK FRS' PERMIT ISSUANCE 10A0 FLOOD ZONE A.L.UC.
W > COMPENSATION INSURANCE I PLG,CONTE. LIC.NO, PLG.
CL 0 ('Phis section need not he completed if the permit is for one TOTAL Y❑ N Y-E3 N1:1
::) Z hundred dollars IS 100)or less.)
U 01 certify that in the performance of the work for which this per- DTV. MECHANICAL
U PERMIT FEE FEE SUMMARY
IL F e mit is issued,I shall not employ any person in any manner so as to
O become subject to the Workers'Compensation Laws of California.
G.W Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING dr-0} to NOTICE TO AYYLICAN'I': II,after making this Certificate ificum of lix-
FZ emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
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 10MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=11EM.) 6.00 SEISMIC FEE
I hereby affirm that Oren is a'construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this Peron is isseed ISec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8A0
Lender's Name
Lenders Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Icrmrrythat Ihas,read W6 application and slate Iliad Ble above VENTILATION FAN (SINGLE) 4.00
int notation is correct. I agree to comply with all city and county PLUMBING
notation
and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
above-above-mentioned
roprrty for vee ec this city es corer upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL
breby aulioned property for inspection purpose.
(We) agree to save, indemnify and kec harrnles Due City of MISC.- REFER TO ORD.'
Caper.ti o uyaimit liabilities,judgments c t and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
uy in y way vicerue agai t mid i rorlseyuenec of[he
m g Ithu permit. -/� is,./ MECH.CONT. LIC.NO. MECH.
elf-MOR" TOTAL TOTAL p0J
gnalure of Applicant/Contractor Date - ca
OFFICE COPY