16808 (2) POST THIS CARD NEAR FRONT OF BUILDING. '
PERMIT
68
CITY OF CUPERTINO -
INSPECTION DIVISION ��oU
JOB INSPECTION RECORD
'PERMIT EXPIRATION
(� s
JOB ADDRESS—� Z6 � �V1� UNIT# - _LOT# _
PERMIT EXPIRES IF WORK
OWNER O C (�j CONTFiACTOR i - IS NOT STARTED WITHIN'
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - - - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
'UFER ALL GRADING AND�DRAINAGE'SHALL BE INSTALLED f -
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF ,{v PERMIT VALIDATION ..
GARAGE SLABS
CUPERTINO STANDARDS. I`y
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING -
ELECTRICAL - ISSUANCE DATE -
MECHANICAL - RLOGELECT. -.PLG. MECH:
D?. ' ❑ ❑ 1. 0 '
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR
PLUMBING VALUATION SIFT.
- Sq -
MECHANICAL I ' -a ,
ELECTRICAL - PERMIT TO
FRAMING - .PAID
STORIES TYPE CONSTR.
INSULATION -
V15 1988 occ GROUP FEB MN TS
I PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED Cjty Of CU BItIOD
W,fi FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM _ THE CONSTRUCTION TAXIS PAID .
BUILDING USE )
C ROOF SHEATHING I❑ IND❑ ❑N ❑ F-1APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Assessoas PARCEL No
ROUGH SANA
PLUMBING ELECT:ENERGY
I TUBS 8 SHOWER PAN - PLUMBING ENERGY TRACT NO. PARCEEND� -
, MECHANICAL - MECH. ENERGY ACC.DATE .ACC.FILE NO.: .
.ELECTRICAL BUILDING ENERGY
FRAMING - ELECT.FINAL TEST -
INSULATION, PLUMBING zoNlNc ENG.SITE No.
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T-24
'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING YE] N D NO
EXTERIOR SHEAR � ELECTRICAL RELEASE FLOOD ZONE AL,U C.
INTERIOR SHEAR FIRE DEPT. Y❑ NY ❑ N❑
SHEETROCK GRADE FEE SUMMARY
' 'EXTERIOR LATH • . ,' BUILDING (-
.INTERIOR LATH TEMPORARY PPROVALS BUILDING : { L
SCRATCH COAT ELECTRIC PLAN CHECK
FEE , ^
GAS 5
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE'
r
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL SSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY,PHONING 252'4505, ELECTRIC
�i 1rr
LEI
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING �-
q� °z PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR-EXPIRATION DATE = MECHANICAL -�=1
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION.WITHIN REDLINES - USE BALL POINT PEN ONLY
.,BUILDING PROJECT IDENTIFICATION - -PERMIT NUMBER
/• BUILDING - - APPLICATION & PERMIT . 16808
ADOq �I • �JELECTRICAL-PLUMBING-MECHANIRz BUILDINGCAL 1U J 0Q
OWNER'S
PLAN CHECK VALIDATION
NAME 1�[� ,) QTY. ELECTRIC PERMIT FEE
(' HONE-t 7
HOMERACTORS - " OUTLETS-SWITCHES-RECEP 10.0011.00
,LIC.No. - LIGHTING FIXTURES ', 10.00/1,00
ADDRESS TORS. t s, PPLIANCES-RESIDENTIAL - 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
on - PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO SIGNS TRANS. 3.00
ARCH,OR ENG. I PERMIT VALIDATION.
ADDRESS SPECIAL CIRCUIT' - 5.00
ZIP TEMP.METER OR POLE INS.. 20,00
APPLICANTS
ADDRESS' MOTORS SEE FEE SCH,
'
SERVICECHANGE
A• 20.00
woo LICENSED CONTRACTORS DECLARATION " -PAID
Q.0 I hereby affirm that I am licensed under provisions of Chapter 9 ?-ISSUANCE DATE
H I" (commencing with Section 7000)of Division 3 of the Business and -
m¢ c - BLDG. ELECT. PLG. MECH.
r D i Professions Code,and my license is in full force and effect - No V1
J I•�,..[P/I, Q O O
o i In W License Class ' Lie.Number
2 m r Date Contractor F
id
d CI at Cupertino. BUILDING PERMIT
E a ¢ OWNER-BUILDFRDECLARATION
o,d D _INFORMATION
K 3: u I hereby alltrm tha( I sin axempf from the Contractor's License 'MISC.-- REFER TO ORD
'o a- O¢ Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
r _ m PERMIT ISSUANCE 10.00
f . > f Code prior
alter, 6.0
ar ¢ ¢O improve,demolish,or repair any structure,prior(o its issuance,also ELEC.CONTR. LIC.NO. ELEC.
ca O LL requires the applicant for such permit to file a signed statement that TOTAL - IT ro
F
$ he is licensed pursuant to the provisions of the Contractor's License - \
H z i Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe /Oq Il
4 ¢o Business and Professions Code)or that he is exempt therefronimsd OTY. ,'PLUMBING PERMIT FEE N.1-19
¢ r S the basis for the alleged exemption.Any violation of Section 7031.5 _ , ' . STORIES TYPE CONSTR.
a ; _ by any applicant for a permit subjects the applicant to a civil penalty ALTER -WATER (EA.) 5.00 -
of not more than five hundred dollars(8500).1: -
�- ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.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 does not apply to an owner of
_ property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 s0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- -
mentsarenotintended'or of for sale.If,however,the building GAS-EA.SYSTEM-1,1 NC.4 OUTLETS 6.00 '
•� or improvement is sold 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 ins- - BUILDING USE
prove for purpose of sale.). - INDUSTRIAL WASTE INTER. •30.00 RES IND CON PB. Other
V 1,as owner of(he property,am exclusively contracting with 0 0 Ell ED E
licensed contractors to 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 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 contractors)licensed pursuant to
the Contractor's License Luw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑-I am exempt under Sec.-,BAP.C.for this - WATER HEATER W/VENT 6.00
reason
Owner n,Ia///f WATER SYSTEM 5.00 ACC.DATE Acc,PILE NO.
WORKS RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 - -
1 hereby of thmPl have a certificate of consent to self-msuic. - ZONING ENG.SITE NO.
or a certificate of Workcrs%Cnmpenultion Insurance,or a certified
copy thereof(Sec.3600,Lab.C.). -- - -
Policy No.' '• 'Company `
O ❑. Certified copy is hereby furnished.
Z Z ❑ Certified copy is filed with the city inspection.division. - Y O N� Y FIRE$PRINK ENERGY L24
24
F O Applicant MISC.- REFER TO ORD.
fr w. CER'I'IFICATEOF EXEMPTION FROM WO RK ERS'. PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.u.c.
1 0 COMPENSATION INSURANCE PLG.CONTR. LIC.NO.- - PLG. ', Y[:] N� v�� N[]
Z (This.section need not be completed if the permit is for one _
hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which(his per: OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
d Date "ApplicantALTER OR ADD TO MECH. 5.00 BUILDING QQ
>_ N NOTICE '1'O APPLICANT: If,utter making this Certificate of E.. --
2 11
emption;you should become subject to the Workers'Compensa(iols APPLIANCE 5.00 PLAN CHECK /+
provisions of the Labor Code,�you must forthwith comply with FEE I, 1
U such provisions or this permit shall 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 - rQ
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.C.). ' ' HEATING UNIT(TO 100,000 B.T.U.)' 8.00
ener's Nunn
e s HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that l have read this application and shne that the shove VENTILATION FAN (SINGLE) 4.00 - -_
information is correct. I agree to comply with all city and county PLUMBING
q ordinances and stare laws relating to building construction, and BOILER-�(7MPI3 H.P. 100,000B.T.U.) 6.00
\ hereby aulhorme representatives of this city to enter upon the BOILER-COMP'IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, Indemnifyand keep hunnless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, casts and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any-way accrue against said City in consequence of the
ra ling of this pe.r�mist. MECH.CONT. LIC.NO, MECH.
�pplica/t�r� // /5•E�8 TOTAL TOTAL y S y
stun of App Meant/Contractor Uute
OFFICE COPY