16830 (2) POST THIS CARD NEAR FRONT OF BUILDING.'. 'PERMIT NUMBE 4
CITY OF CUPERTLNO 160,30
INSPECTION DIVISION
JOB INSPECTION RECORD -
• ., ��'7-�0' • L• PERMIT EXPIRATION
/_/ `.
JOB ADDRESS_ If S J /N G— GT, UNI LOITT*f .'
_ /� A� T PERMIT EXPIRES IF WORK?
owNER, l$�,Z-rr! L/ I• CONTRACTOR '4E:--� 'c 7 lz IS NOT STARTED WITHIN
INSPECTION DOE ' .'INSPECTOR - INSPECTION RECORD - - 180 DAYS OF PERMIT ISSO '
' FROM
.
FOUNDATION-� - NOTE: � ANCE OR 180'DAYS"
I
UFER �. , - ALL GRADING AND DRAINAGE_SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE' TO COMPLY WITH THE APPROVED PLANS AND CITY OF - PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS. - '• - - T' '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB' : r�
PLUMBING - - - - :.. ip` / •�
ELECTRICAL' - ISSUANCE DATE '
MECHANICAL' BLDG. '.ELECT. PLL, •MECII
o :❑ a a • ,❑
DO NOT POUR FLOOR UNTIL ABOVE HAS.BEEN SIGNED BUILDING PERMIT
� ` INFORMATION
WOOD,FLOOR ,' vnw(k,ION siEr...
PLUMBING -� - \,\%,. '\�\n� . Ct
MECHANICAL "` j
ELECTRICAL - - \ - PERMIT To - -•
FRAMING .- - '
INSULATION:; - - - �sroRie rvPE CONSTR. '
OCC.GROUP RES.UNITS
-..PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
,. SO,IT f LOOR'PgLA TOTAL ncH En CL
-
; ROOF '` - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX ISPAID", r
• •li HIS ILDING. CON Ovry
ROOF SHEATHING _ El ❑ ElIND ❑ C3APPLY NO ROOFING UNTIL ABOVE'HASBEEN SIGNED,- -FINALS DATE' ' INSP. nss[ssDRslARceLrvo .
' " ROUGH SAN.#
• .,'n PLUMBING -" ;,.• , .ELECT.ENERGY - -
TUBS B'SHOWER,PAN,. PLUMBING ENERGY , TRACT NO . , PARCEL No
MECHANICAL - MECH.ENERGY
ACC,DATE ACC.,FILE No, --
ELECTRICAL - BUILDING ENERGY
FRAMING '-' ELECT.FINAL TEST '
ZONING ENG,SITE NO,
INSULATION, PLUMBING
GAS TEST - . ' GAS r"
�� FIRE SPRINK ENERG� T.24
MECHANICAL
COVER NO'WORK UNTIL ABOVE HAS BEEN SIGNED- HEATING Y �� NO
_ EXTERIOR SHEAR ELECTRICAL RELEASE FL000 zoNE- El aL u.c. 1
INTERIOR SHEAR - FIRE DEPT. v NQ v --INEI
SHEETROCK GRADE FEE SUMMARY .
EXTERIOR;LATH BUILDING BUILDING
INTERIOR LATH , TEMPORAPPROVALS
ARY '
SCRATCH COAT- ELECTRIC PLAN CHECK
- GAS' FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY= r SEISMIC FEE
OCCUPANCY.,OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR.' KICROFILM '
ARRANGE FOR INSPECTION BY PHONING-252-4505," ELECTRIC'
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.'•-
Z " ':r - .. . MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION: of
OFFICE COPY c /
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.- USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFI CATION PERMIT NUMBER
BUILDING 1. APPLICATION & PERMIT - C /�J0
ADDRESS �.
BUILDING-ELECTRICAL-PLUMBING'-MECHANICAL � .• 6 8 3,
OWNER'S OO + PLAN CHECK VALIDATION
' NAME OTY. , ELECTRIC PERMIT FEE -
G !/r D/'1 PHONE
CONE c
NAMs UTLETS-SWITCHES-RECEP 10.00/1.00
NAME_ C -
` G"'� / G LIC.No.�1a p LIGHTING FIXTURES, - 10.00/1.00
ADDRESS croRs APPLIANCES'-RESIDENTIAL 4.00
ADDRESS O tY Ll�D/J 'PHONE PANELS 10.00 DATE OF APPLICATION L�
ncmrecT PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P:C NO.
oR
ENGINEER
LIC.No. SIGNS TRANS. -
ADDRESS.ENc. SPECIALCIRCUIT' 5.00 PERMIT VALIDATION
• ZIP EMP.METER Oq POLEINS 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADOREss / - 111 ❑`i❑++/tititi•+"-^-"�'�
d r. Ski 1N ✓ SERVICE CHANGE 20.00 �a /ry(
w o o LICENSED CONTRACTORS DECLARATION ,.�V� / (O p Y'
rt v I hereby alfirin that I am licensed under provisions of Chepler') ISSUANCE DATE
vHi a H (commencing with Section 7000)of Division 3 of the Business and r •glp ELECT. PL❑G. MECH,
E. w Z Professions Cod ",Id I&y ease is in full force a d effe1`�u,
z o,n- License CP s�q ./d Con ractor a.� l.'.)\
Q v, o Uate "-Y- Contractor
lt%PWILDING PERMIT
w - OWNIiR-BUILDER IN - - - ' Pe INFORMATION
'w ; LL m I hereby alfinn thm 1 am exempt I'rsao the Contractor's License - MISC.r, REFER TO ORD vgwgnoN S/FT.
r u_O J Law for the following reason.(Sec 7031.5:Business and Professions - pERM1T ISSUANCE ' 10.00 10
- Code:Any city or county which requio:s o permit to construct,alter,
ILIQ improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTR. _ LIC.NO. - ELEC. ¢0
O LL requires the applicant for such pe stmt to file a signed Statement him( TOTAL PERMIT TO
a w m he is licensed pursuant to the po viumo,of the Contractor's License -
i'
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe - r t
L a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE j
It I� the basis for the alleged exemption.Any violation of Section 703L5 . I ISTORIES TYPE CONSTR.
w. F, by any applicant for a permit subjects the applicant to a civil penalty .ALTER-DRAIN& VENT-WATER (EA.) 5.00 -
- of not more than livehundred dollars($500L)
❑ 1;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 lin sale(Sec. 7044„Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code The Contractors License Law does not apply to an owner of -
'H.mcoy who builds or improves thereon,and who does such work FIXTURES-PER TRAP, 5.00 s6,FT,FLOOR AREA TOTAL ACREAGE
• himself or through his own employees.provided Ilia,such improve-
stents aro not intended proffered fnrs:de.IL however,the building GAS-EA.SYSTEM-I1NC.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 no,build or in,- RES IND CON PB Omer
prose for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 El ❑ 11 ❑. 1:1❑ I,as owner of the properly,am exclusively contracting with
licensed contractors to Construct lire project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B: 6.00 - 'ASSESSORS PARCELNO.
and Professions Code:The Contractors 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 contractor0l licensed pursuant to
the Colnmclor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 'TRACT NO. PARCEL No.
❑ and exempt under Scc. ,B;&PC71or this WATER HEATER_W/VENT 6.00 '
1`e reason -
Owner Dare WATER SYSTEM 5.00 •ACC.OATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm That I have a certificate or consent to self-Insun'' ZONING ENG.SITE NO.
or a certificate of Workers Compensation Insurance,or a certified
ropy thereof(Sec.3800,Lub.0 1 _
Policy No. DO , ycY
O ❑ Certif ted copy is lure fora aheJ, FIRE SPHINK ENERGY T34
Z O ^6�-Certil'ie o dca t the It D' -r un ivown.
Imam_ t_ - MISC.- REFER TO ORD.
F A Y ❑ N❑ Y C]CC N❑
w " PERMIT ISSUANCE - 10.00 FLOODZONE A.L.uc.
CIiRTIP OWIPF I CF:MPT10N FRWORKIiRS'
' W � COh1PF.NSA1'ION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (Phis section need not be completed if The permit is lot oneTOTAL Y-❑' NE] Y❑ N❑
::) Z hundred dollar,(S 100)or Icss.) "
U O I cenry that in the performance Iof the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P mil is issued,I shall nor employ any person in any manner so as to
U beconm xobject to the Workers Comp ensatlon Laws of Calif ostia.
O w Dalc Applicant BUILDING
a ALTER OR ADD TO MECH'. 5.00
} rn N01 WE TO APPLICANT: If,.after making this Certificate of 17
F ? emption,you should become subject to the Workers'Compensation APPLIANCE '5.00 PLAN CHECK
provisions of the Labor Cade, you must forthwith comply with FEE
U such provisions or This permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.); 4.00
CONS'rRUC'I'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE
I hereby affum 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.(Sce. HEATING.UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097.Civ CJ. -
LendersNume HEATING UNIT(OVER 100,000 B.T.U.)9.50 - ELECTRIC
Lender's Address
I certify that I have read this application and stateIbar the above - VENTILATION FAN (SINGLE) - 4.00
information is correct. 1 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 authorise rclucamuraive, Of this city hl enter upon lire BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to Savo, indemnify and kcup hannlesS,the City of MISC.- REFER TO ORD,
uperlie.against liabilities,judgments, costs and expenses which CONST.TAX
may in any wa Centre against said City in consequence of rhe PERMIT ISSUANCE 10.00 -
grant fl epnd '7J MECH.CONT. LIC.NO. MECH.
rt�%/ 6yy� TOTAL TOTAL
Sig sure of Applicant/Contractor an _
OFFICE COPY