16253 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMB ER
CITY OF CUPERTINO 16253
INSPECTION DIVISION
JOB INSPECTION RECORD
40 PERMIT EXPIRATION
JOB ADDRESS �+� / X//�2 UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER, c— (TO FL pL-o U ✓/n/ CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PREGUNITE CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED " r
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL Q ISSUANCE UA r
MECHANICAL c ELECT PLG MEL++.
o 0 0,.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED C �\ ILDING PER IT
WOOD FLOOR F e INFORMATION
VALUATION a SIFT.
PLUMBING - (I`\ /o 00-y
MECHANICAL [D
PERMII TO
ELECTRICAL n
FRAMING c TOMES/HIES
TYPE CONSTR
INSULATION
OCC GROUP 'RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE saFr 11.00P APIA TOTAL ACREAGE.
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING I I r+Es IND CON PB ow.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 0 ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.a
PLUMBING ELECT,ENERGY
1RaC1 N0 PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY -
ELECTRICAL BUILDING ENERGY ,Acc DATE ACC PILE No
FRAMING ELECT.FINAL TEST ZONING ENG SITE NO.
INSULATION PLUMBING O, _g>p
GAS TEST GAS
FIRE SPRINK ENERGY T 2
MECHANICAL Y E] NNEI
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE ALU.L.
EXTERIOR SHEAR ELECTRICAL RELEASE
N
INTERIOR SHEAR FIRE DEPT. ❑ ❑ N[]
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
BUILDING
INTERIOR LATH - TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS I I
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I I SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC /3�D
� ONE WORKING DAY BEFORE REQUIRED INSPECTION. „_PLUMBING c?B
z0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL,
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL �S
CALLING FOR FINAL INSPECTION.
OFFICE COPY.
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION & PERMIT
BUILDING 16253
'74 ADDRESS BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
0 3D a ,b� e
5 ` , PLAN CHECK VALIDATION
" 1' jj J QTY. ELECTRIC PERMIT FEE
IGTa4 L�V/ PHDNE
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
NAME / ,f' 1�
IN/� MIC LYuc.NO l�'7�
b57a75 LIGHTING FIXTURES 10.00/1.00
LONTRACTo s APPLIANCES-RESIDENTIAL 4.00
ADDRESS I/
pva71PIWWIA_�C 1po PHDNE 4193-Orb PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHELK FEE P,C,NO.
OR
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
ZIP EMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 ' q-/ cr
w
02 LICENSED CONTRACTORS DECLARATION
a v 1 hereby affirnn that I am licensed under provisions of Chapter 9 1n ISSUANCE DATE
n G H (commencing with Section 7000)of Division 3 of The Business and LDG. ELECT. PLG. MECH.
F w z Professions Code,and my license o m full rem ruhit eff ❑
2 0 us- License Class 8 Lic.Number
Q w r Uate 2- Ccolmetur 1'_1-tC["—
Q y E j BUILDING PERMIT
¢ ¢w ¢ OWNER-BUILDER DECLARATION ORMATION
MISC.- REFER TO ORD
E
3 LL I- I hereby ullirm thus I um exempt from the Contractor's License LUATION $/FT.
H LL O j Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE -46:66 0 0
Code:Any city or county whichrequiresapennitla comirinu alter,
2 <o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. / 9
- D u requires the applicant for such permit to file u signed stalcmmnt that TOTAL l PERMIT TO
a w m he is licensed pursuant to the provisions of the Contractor's License
F z to
Lime.(Chapter 9(cumencing with Section 70001.1'Division 3 of the7ec/p/s/I
4 0 Busnm
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 70315 TORIES TYPE CONSTR.
n ; m by any applicant fur.pconit,ubject,the applicant to a evilpenilty IgLTER-DRAIN& VENT-WATER (EA.) 5.00
t more than five hundred dollars($500).):
I,o owner of the property,or my st I.yees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.caouP RES,UNITS
sole Compensation,will do the work,and the structure is not
intended nr offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law dues not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP ;1- SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
.cuts are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or ire' RES IND CON PB Ohber
prove for mGm.n1'sale.). INDUSTRIAL WASTE INTER. 30.00 El El C1 ❑ El
I,as owner of the property,am exclusively contracting with
Znsed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
Professions Code:The Contractor's License Law does 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 c0ntmcmgs)IiLemed pursuant to
the Contractor's License La w. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I' • h tundcr Sec. �� ,B&P.C ' rthls WATER HEATER W/VENT 6.00
Promo �O 'M. ,t E-„p
wncr Data WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO.
ORKIiRB'COMPfiNSA PION UIiCLARATIOM1 WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent toself-insure. �.QC ZONING ENG.SITE N0.
or a certificate of Workers'Cnmpcnsution Insurance,or a cert ificd
copy thereof(Sec.3800,Lab.C).
Policy No. Company
C) ❑ Certified copy is hereby furnished, FIRE SPRINK ENERGY TR4
Z Z ❑ Certified copy is filed with the city inspection division.
O Applicant MISC:- REFER TO ORD. -f v ❑ N YE) NE]
CIi R'I'IFICA'fR 01'liXliMl"PION PROM WORKIiRS. PERMIT ISSUANCE - �y FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG CONTR. LIC.NO. PLG.
EL ❑ (1 his section need not be d conhplet. if the pennit is for ane TOTAL Y❑ N❑ Y❑ N❑
=) Z hundred dollar,IS 100)or less.)
U O 1 certify that in the perfmoraoce of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL E- mil is issued.I shall not employ any person in any manner eo as to
U become subject to the Workers'Compensation Laws of Califurnia.
U u Date Applicant ALTER OR ADD TO MECH. 5.00 FELECTRIC
17
}.m NOTICE TO APPLICANT: If,after making this Certificate of IN-
F ? elnption,you should become subject to the Workers'Compensation APPLIANCE 5.00
provisions of the Labor Code, you must forthwith comply with
'U such provisions or this permit shall be Accord revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MCF.M.) 6.00
1 hereby affirrn that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the pertornhance ul'lire work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00
3097,Civ.C.1.
Lenders Name H. HEATING UNIT(OVER 100,000B.T.U.)9.50 /3 S-O
Lender's Address
I ccrlity that I have read this application and state that the above VENTILATION FAN (SINGLE) . 4.00
l . int onnation is correct. I agree to comply with all city and county PLUMBING
f ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authowe representatives of this city to enter upon lite BOILER-COMP(Over 100.000 BTU)SEE FEE SCH. MECHANICAL
xboveanentioned property for inspection purposes,
(We) agree to save, indemnify and keep harmless 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 consequence of the PERMIT ISSUANCE 10.00
G tugofthis pen MECH,CONT. LIC.NO. MECH.
TOTAL TOTALS�i
SI nater of Applicant/6eRMexler DaW
OFFICE COPY