16039 (2) POST THIS CARD NEAR.FRONT OF BUILDING
' 'PERMIT NUMBF.H
CITY .0F. CUPERTINO
6O' 9
INSPECTION DIVISION
JOB INSPECTION RECORD {{
y• �,� I,� " PE RMIT-EXPIRAI'J�ON
JOB ADDRESS. rsUN1T4 - '_LOT# PERMITEXPIRES IF WORK
OWNER- �'Cyt '"' V CONTRACTOR` , ;IS NOT STARTED'WITHIN
f I SPEC ION DATE 'INSPECTOR ._ INSPECTION RECORD leo Dnvs OF PERMIT,issu '
_ ANCE'OR 180 DAYSIFROM.
FOUNDATION.'„ NOTE: -"
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION:
PREGUNI•TE - - TO COMPLYWITH THEAPPROVED PLANS AND CIN OF' PERMIT VALIDATION
CUPERTINO STANDARDS. "J ' - ,
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
' . UNDERGROUND /SLAB
PLUMBING ~ /q� �•�- '
ELECTRICAL. eLG. ISSUANCE UATc.
MECHANICAL' - -I ,•i - DELECT. P,LG, MIEECCH'. I
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED a ' BUILDING PERMIT
!"WOOD FLOOR INFORMATION
PLDMBING VALUATION $/FT.
MECHANICAL '
ELECTRICAL - - - I PERMIT TO/
FRAMING
INSULATION - - _ sroRiEs TTYPE CONSTR. -
• OCG GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
TTHE 0 FIN sn Fr.FLooH AREA TOTAL ncer acE
ROOF NOT
EN E:N AL INSP:SHALL BE MADE BEFORE _ {
DIAPHRAGM CONSTRUCTION TAX IS PAID
�'•... ROOF SHEATHING ,A HES IND ILD ON UST.
ROOF 'Ow"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑
' ROUGH, SAN.p Assessofls PARCEL NO
PLUMBING - ELECT.ENERGY
TRACT NO, PARCEL NO
TUBS 8 SHOWER PAN - 'PLUMBING ENERGY
• MECHANICAL MECH.,ENERGY '
ELECTRICAL — _ BUILDING ENERGY Acc.DATE ACC.FILE NO.
FRAMING'. ,o ( ELECT:-FINAL TEST
20NING HNG SITE NO;
INSULATION . . , PLUMBING
GAS TEST A, - GAS
MECHANICAL - FIRESPRINK ENERGY T.74
COVER NO WORK UNTIL ABOVE.HAS BEEN SIGNED -HEATING ,, - Y ❑ N[ Y ❑ N�
F LED ZONE
EXTERIOR'SHEAR, ELECTRICAL RELEASE 'A,L uc.
INTERIOR SHEAR - FIRE DEPT. '' Y❑ N Y ❑ N❑
' SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH. BUILDING `•
NTERIOR; LATH TEMPORARY APPROVALS BUILDING'
SCRATCH COAT ' i ELECTRIC PLAN CHECK
GAS . I. FEE
NO TAPE'OR"PLASTER UNTIL ABOVE HAS BEEN SIGNED-'OcOUPANCY SEISMIC FEE 1 j
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED-BV
BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC D!�
:k ~ 'ONE'WORKING DAY BEFORE REQUIRED INSPECTION.
i , PLUMBING
z° PLEASE GIVE JOB ADDRESS WHEN PHONING. .
�� ' I MECHANICAL
_ SEE PERMIT FOR EXPIRATION DATE - GD
IMPORTANT!
TANT! CONST'TAX'--,
PLEASE READ REVERSE SIDE BEFORE TOTAL \ t�
CALLING FOR FINAL INSPECTION.
, I
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATI ONI PERMIT NUMBER
_:p4 aooAEsi G T n w 'APPLICATION & PERMIT .116039
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL rz'- V
OWNER'S PLAN CHECK VALIDATION
SrO "AME OTY. ,ELECTRIC PERMIT •, . FEE
PHONE
CONTRACTORS / [� G, •�• .n�
e NAME $ UTLETS-SWITCHES-RECEP' 10.00/1.00 b0 `v' r
- _
'LIC.NO. LIGHTING,FIXTURES 10.00/1.00 ,D 1
crOR's
ADDRESS
, APPLIANCES-RESIDENTIAL 4.00
PHONE_ PANELS 18.00 DATE OF APPLICATION:
ARCHITECT -- - 'PLAN CHECK FEE P.C.NO.
OR • PANELS (OVER 200 AMP) 20.00 -
ENGINEER
Llc.NO. "T SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION -
ADDRESS SPECIAL CIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S " .ti' MOTORS
ADDRESS SEE FEE SCH`. .' �
SERVICECHANGE 20.00 - ,{ �•
w o o LICENSED CONTRACTORS DECLARATION ` ' rap ,,I,� I ��•IIGG�•
a u I hereby affirm that I am licensed under provisions of Chapter 9 - AFKJ �7 IS a NCE OATS
a, w (commencingwith Section 7000)of Division 3 of the Busines-:m
¢ $ r a BLDG. ELECT. PLG. MECH.
z w z'. Professions Code,and my license is in full force and effect -I -
O0 m o License Class Lie.Number .piht ,.L up I_ W ly 1 I yl
H m w Date - Contractor 'Pity VE I INY `W •I"`
BUILDING PERMIT-
¢ Ix re u OWNER-BUILDER DECLARATION• INFORMATION
X ;' N I hereby affirm that l am exempt from the Contractor's License MISC.- REFER TO ORD'.-
HUii.0 < Law for the following reason.(Sec.7031.5,Business and Professions - PERMIT ISSUANCE 10.00 2. 60 VALUATION SIFT.
iw > f Code:Anycity orcouity whichrequirceapermit LLs construct,alter,
I3 -0
rem ¢ C improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR: .,.LIC.NO. ELEC. q ) '
IS DLL requires the applicant for such permit m file a signed statement that TOTAL ems/6 b PERMIT TO
n w m he is licensed pursuant to the provisions of the Contractor's License ,{�
HiQ
Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe JT�L/%r'4
i 0 Business and Professions Code)or that he is exempt therefrom:and CITY. PLUMBING'PERMIT FEE
¢ r ora the basis for the alleged exemption.Any violation of Section 7031.$ STORIES ,TYPE CONSTR.
is. ; by any applicant for u permit subjects the applicant to a civil penally '
of not more than five hundred dollars IS500).): z ALTER-DRAIN& VENT,WATER (EA.) 5.00 r 0
0 1,as owner of the property,or my employees with wages as 0
their sole compensation,will do the work,and the structure is not ' BACK FLOW PROTECT.DEVICE 4.0 • !71) OCC.GROUP RES.UNITS
intended or offered for stile (Sec. 7044, Business and Professions Z DRAINS-FLOOR,ROOF,-AREA,COND. 5.00 00
Code:The Contractor,License Law does riot apply to no owner of -
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP, 5.00 SO.FT..FLOOR AREA TOTAL ACREAGE
w Prtshimself'or through his own employees,provided that such improve: 6�l
menon not intended or employeesale.Iided that building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 /
or improvement is sold within one year of completion,the owner-
t' . l uilder will have the burden of proving that he did not build or int. GAS-EA.SYSTEM-OVER 4 (EA.) ' 2.00 BUILDING USE
G - RES IND CON � PB Other
. " prove for purpose of Sale.). INDUSTRIAL WASTE INTER'. ' 30.00 ❑ -❑ •❑ ❑
I'd
as owner of the properly,t N exclusively. 0 4,Bu with
sed contractors ; 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 Joos not apply
to anowner nprosy who builds or improves thereon,and who LAWN SPRINKLERS•OVER 5 (EA.) .1.00
contracts for such
chh projects with a mntnlclnrfs)Ilcenv:A pursuant m'
' - the Contractor's License Law. SEWER-SANITARY,•STORM EA.200ft/10.00 TRACT NO. PARCEL No.
0 I am exempt or Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00
reason
�(Owner __ Dale WATER SYSTEM 15.00
ACC.GATE ACC.,FILE N0.
- WORKERS:C MI'IiNSAT10N DECLA RATIO WATER TREATING EQUIP. 5.00
I hereby uIfum that I have a ci rldi,an,ofconsent wself-insure.
or a'certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). -
Policy No. Company -
0 ❑ Certified copy is hereby lrrnished. FIRE SPRINK ENERGY T24
ZZ 0 Certified copy is filed with the city inspection division. -
p- Applicant MISC.- REFER TO ORD. Y N❑ 'Y❑ N❑ ,
� y CERTIFICATEOP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00 06 .FLOOD ZONE A.L.U.O.
W > COMPENSWION INSURANCE PLG.CONTH. - LIC.NOG'. PLG, '
1 0 _ (This section need not be completed if the permit is for are TOTAL 1_2 i 00 Y❑ N❑ Y❑ N❑
::> Z hundred dollar,IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT - FEE FEE SUMMARY
,•-
LL 1-„ mil is issued, I shall not employ any person in any banner so as to
V became subject to the Woiloco'Compensation Laws of Caliannia. -
Uatc Applicant ALTER OR ADD TO MECH. BUILDING �Y=
i -
>_ a ' NOTICE TO AI'PLICAN'1': If, ?taking aking this Ccrlificate of Ex- 5.00- ,
F. Z eruption,you should become subject to Ilse Workers'Compensation APPLIANCE 5.00 PLAN CHECK
prvisions of the LaborCode,you must forthwith comply with FEE
o -
U' such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10.000C.F:M.), 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00GRM.) 6.00 SEISMIC FEE - F
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
ss0
the performance of tire work for which this permit is issued(See. MICROFILM
3097;Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
., Lender's Name' -
Lender's Address HEATING UNIT(OVER 160,000 B.T.U:)9.50 ELECTRIC' ' QO
^• " Icertify that l bavetead ddsepplicalion and state thaYthe almvo VENTILATION FAN (SINGLE) 4.00
-`•" information Is correct I agree to comply with all city and county PLUMBING A U
nrdm,lnees and state laws relating to budding construction and BOILER-DOW(3 H.P.or 100,000 B.T.U.) 6.00
Imreby authorize representatives of this city to enter upon the + BOILER-COMP (Over 1o0,000 BTU hSEE'FEE SCH.
above-mentioned properly for inspection purposes. MECHANICAL t L O
0W0-ingice to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. -
upertino against liabilities,judgments, costs and expenses whichCONST.TAX
may in any way arcane-against Said City in consequence of the PERMIT ISSUANCE 10.00 UD
;HJU ti f th`permit, CONT. LIC.N0._ ` , MECH. - -
�\ u - .TOTAL 3 e D 6 TOTAL
t Sign Iplicant/ ontractor Data.
OFFICE COPY