16639 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
" CITY OF CUPERTINO 16639
INSPECTION DIVISION
JOB INSPECTION RECORD
rl �-T PERMIT EXPIRATION ;
JOB ADDRESS - 10-,1-e3 3 / F�R'�� i ' UNIT# _lOT# PERMIT EXPIRES IF WORK
OWNER O Bc';°T 0 CONTRACTOR /V L IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM
FOUNDATION NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VA7DATION
CUPERTINO STANDARDS.
GARAGE SLABS _......
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _ ....J
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICALfCZ ?f1��I Dc ELECT PLc. - MecR
o ❑ ❑ o '
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ILDING PERMIT
INFORMATION
WOOD FLOOR A ION
SIFT.
PLUMBING ` ^ 1ty 0 Cpp 11.
MECHANICAL
ELECTRICAL
PERMIT TO
�^ _
J
FRAMING - e
INSULATION P/, . - ` STORIES TjlPE CONSTR
VV OCC GHOUv HES UNITS
I PLACE NO SU BFLOOR UNTIL ABOVE HAS BEEN SIGNEDl
50 ii FLOOR AREA TOTAL ACREAGE
n ROOF NOTE. O FINAL INSP.SHALL 8 ADE BEFORE
DIAPHRAGM THE CO TRUCTION TAX ISP ID
BUILDING USE
ROOF SHEATHING tics , IND CON PB Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.a
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE. ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY T24
MECHANICAL v ❑ NO v ❑ AD
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
PL000 zorvE nLuc
EXTERIOR SHEAR ELECTRICAL RELEASE �� N� L7 N❑
INTERIOR SHEAR FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
CRATCH COAT ELECTRIC PLAN.CHECK
GAS FEE
TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
UPANCY OF BUILDING ISNOTPE RMITTEDUNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
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 ,.f-�'
OFFICE COPY
F�PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
Y BUILDING PROJECT IDENTIFICATION
'PERMIT NUMBER
aDILOINc APPLICATION & PERMIT 16639
ADDRESS
41?-31 ��. `e BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
/�. OWNER'S PLAN CHECK VALIDATION
ti_ NAME / TV. ELECTRIC PERMIT FEE
F') oF/e� RDNE
rf CONTRACTORS
;� - NAME U UTLETS-SWITCHES-RECEP 10.00!1.00
`
LIC.rvo_Q� TO LIGHTING FIXTURES 10.00/1.00
r/G - q�
ADDS
ONTRAS R's
RESPPLIANCES-RESIDENTIAL 4.00
C /
e Cod HON /�� PANELS 10.00 DATE OF APPLICATION `
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C:NO.
DR
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDRESS Enc' SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE jVS. 20.00
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
0 0 o LICENSED CONTRACTORS DECLARATION
IF o u I hereby affirm that I am licensed under provisions of ChmIt,,9 ISSUANCE DATE
H a N (commencing with Section 70001 nl Division 3 of the Business untl ELECT. PLG. MECH.
Professions Code,and m license is RI full force and fl�ct. _ s „ ❑ ❑ ❑
z o m - License CI' Lia Number d 1T1-T' lie
-
Q m t�� Date Contractor A6. O
¢ m s 6.aXnSUILDING PERMIT
rt w a OWNIEk-BUILUER DECLARATION Q1`
E
i LL H I hereby affirm that i am exempt from the Contractor's License
MISC.- REFER TO OR INFORMATION
u. 0¢ Law for the followingreason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
L - Cade:Any city orcouNy which requiresu Pennitto cronstnmL olteq �.5�__�V
dQ 20 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG.NO. /
FE
ELEC.
O IF requires We applicant for such permit to file a signed statement Thal TOTAL PER
MITT
w w LL he is licensed pursuant to the provisions of the Contractor's License
F z is
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
- ¢ Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE A=if-[/T�
IF = $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TV E CONSTR.
T ; _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(55001.):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP BEs.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply to an owner of
Property who builds Or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.Fr.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
It
mmselfo norimmWcd own ttered lor employees,pool ed thathowevsuch
building GAS-EA.SVSTEM-I1NC.40UTLETS 6.00
or improvement is wld 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 no. BUILDING USE
p,ondforpurposc nfsalcJ. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with ❑ p ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code: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 forsuch projectswith Is contractorls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Cnntracto[a Liccnsc Law. TRACT NO. PARCEL NO.
O lural exempt under Sec. ,B,&P.C. nn this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC,FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of conscnl to self-insure, ZONING
or a certifiicate$gof Workers'Compensation In c,or as c Hified ENG.SITE NO.
Po thereof $q�ComLab
y�-74
Policyy N ti Sed pan
Q SYC'rlified copy is hereby fumished. FIRE$PRINK ENERGY T 2
Z ❑ Certified op I file th t��Ity inspection division.
O APE, can c rLGQAI MISC.- REFER TO ORD. v ❑ N❑ v ❑ N❑
to fTI EICA'I'Ii OF li%NNPT ON I*ROhf WORKERS PERMIT ISSUANCE 10.00 FLOOD ZONE A.L u.c.
> likCOMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG.
1 ('Phis action nccA not be completed if the permit is Im one TOTAL V❑ N❑ V ❑ N❑
2 hundred dollas(SIO(lorless.)
U Q 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL E- Hilt is issued, I shall not employ any person in any mm�nerSr as to
U beclance subject m the Workers'Compensation Laws of Calil'ornio.
ED
Date Applicant BUILDING
Q. ALTER OR ADD TO MECH. 5.00 /
} Ma NOTICE: TO APPLICANT: If,after....king this Certificate of Es--
F_ 2 mnption,you should become Subject m the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you nwst forthwith comply wish FEE
5 Inch provisions or this permshm
it all be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE J-D
1 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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Loader's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I cert ify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
\. information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby amhoriec representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
r above nwntioned 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 PERMIT ISSUANCE 10.00 CONST.TAX
ay i I any wa accn a against : City in .Plicnence of"One t Dern; MECH.CONT. LIC.NO. MECH,
"TA TOTAL �7
Sign veof Ap lican[ nlmctor DatI -
OFFICE COPY