16210 (2) POST THIS CARD NEAR FRONT OFBUILDING , ;EiiM„NUMBER.
,.CITY: OF CUPERTINO
1621-0
INSPECTION DIVISION
JOB INSPECTION RECORD
T / OO� v'^- � _ LOT0, ., PERMIT EXPIRATION I
JOB ADDRESS IT# _
z� PERMIT EXPIRES IF WORK
I
OWNERCONTRACTOR z� 7 -e(/v V/L_' - �fjy /-� -IS NOT STARTED WITHIN'
' . 1
INSPECTION, DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180DAYSFROM
NOTE: - LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED 'XI
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
' CUPERTINO STANDARDS.
GARAGE SLABS. - - • ' W
POUR NO-CONCRETE UNTIL ABOVE HAS BEEN SIGNED
' UNDERGROUND,
/SLAB
PLUMBING -
ELECTRICAL. ' •�. ISSUANCE BATE
SoBLF ELECT PLG. ML
J MECHANICAL" fii�of- ,•.�
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED . -ftwam @uao RM TION s
_MAERMIT
INF,O
WOOD FLOOR - VALUATION - . tsIFT,
PLUMBING ,�,•� OQ
MECHANICAL. '" PERMIT TD
ELECTRICAL '• - - ., , in
FRAMING ' '��-�• ,
STORIES TVPE,CONSTR.
INSULATION .
OCG GROUP RES.UNITS
f
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
'. • • • ` , S. I'T.f1.00R ARTA MAL ACHI_AGE
•�`"�";`• ROOF '" NOTE:NO FINAL INSP,SHALL BE MADE BEFORE _
THE CONSTRUCTION TAX IS PAID 4
DIAPHRAGM. _ - BUILDING USE. .
ROOF SHEATHING -.HCS IND
CON PIT on�.•.�
APPLY'NO,ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.- El El 0 � �
ASSESSORS PARCEL NO•
ROUGH SAN.0
PLUMBING - ELECT.ENERGY
IRACT NO. .PARCEL NO; ,
TUBS 8 SHOWER PAN' PLUMBING ENERGY
MECHANICAL MECH.ENERGY �T 7
^CT3opyrt•..•. • ACC.FILE NO.y
ELECTRICAL " BUILDING ENERGY
FRAMING'; ELECT.FINAL TEST'.
ZONING ._ ENG,SITE NO.
INSULATION"' PLUMBING .
.
GAS TEST GAS FIRETSPRINI( ENEHGvT.14
_ e MECHANICAL
HEATING
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
BLOOD/ON6 A,L.D,C.
EXTERIOR.SHEAR ELECTRICAL RELEASE '
INTERIOR SHEAR
FIRE DEPT. - v� ',N� vL1., N❑�
SHEETROCK GRADE''' � � -' FEE SUMMARY
EXTERIOR LATH BUILDING • BUICDING'
INTERIOR' LATH'' - .� , .TEMPORARY APPROVALS ''.
SCRATCH COAT' •' ELECTRIC •.PLAN CHECK`4-
FEE
GAS
NO TAPE OR PLASTER UNTILABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE '
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
w r ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
F ,` PLEASE GIVE'JOB ADDRESS WHEN PHONING.
t Z I MECHANICAL
f�'• - SEE.PERMIT FOR:EXPIRATION DATE -
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
'' .CALLING FOR FINAL INSPECTION. - TOTdL 1 l7 U
OFFICE COPY,
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Eirs
-
BUILDINGPROJECT IDENTIFICATION ' PERMIT NUMBER
BUILDING APPLICATION &.PERMIT 1 �� 0
ADDRESS B� 9,Ini
` Lr.• f
p. �\J BUILDING=ELECTRICAL—PLUMBING—MECHANICAL
` wNER'S ^ l PLANCHECKVALIDATION
-
E DTV. - ELECTRIC PERMIT FEE '
PRONE
( CONTRACTOR s OUTLETS-SWITCHES-RECEP 10.00/1.00 `
N ME
- . IC.No + LIGHTING FIXTURES 10:00/1.00
r, NTRACToas L/ APPLIANCES-RESIDENTIAL - 4.00
DD -'
t7^ ' PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT —t^/N PANELS (OVER 200 AMP) _ 20.00 PLAN CHECK FEE P,C.NO.
OR VLJ
[ ENGINEER
' im.NO. �SIGNS TRANS. 3.00 _
ARCH,OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION '
ADDRESS
ZIP EMP.METER OR POLE INS. 20.00QLt
APPLICANT'S r + Jl�.�// +✓�`
ADDRESS •- MOTORS SEE FEE SCH. ��ll
SERVICE CHANGE' 20.00
0 ' LICI:NSIdU CONI RACTORS DECLARATION '
a v u I hL'reby affirm that I am licensed under provisions of Chapter 9 ` ISSUANCE DATE
Nam (commencing with Section 7000)0l'Division 3 of the Business andjApi BLDG. ELECT. PLG. ME
r m zOlate.cions Codi, 1 sin full
z o w — re" Numbe ❑ ❑ ❑
Q Z � � Dam—W=1 Conlrector •
< m ¢a OWNER-BUILDER DECLARATION BUILDING PERMIT
AEFERYOORD INFORMATION
¢ cw
w3 LL m I hereby ul(inn him l am exempt briny Int Contractor's Lreease MISC,— _
cost Law for tiro following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 ELATION 5/FT.
E — Code:Any city Or County which requiresa permit to construct,alter, �'�
ES ¢< improve,denuilish,or repair any structure,prior to its issuanet.also ELEC.CONTR LIC.NO. ELEC,
— O IS requires the applicant for such permit to file a signed Aaltment that - TOTAL -PERMIT TO
E
ho is licensed pursuant to the provisions of tire Contractor's License '
i
Law(Chapter 9(commencing with Section 7000)of Division 3 print
a Business and Professions Code)or that he is exempt Therefrom and CITY. PLUMBING PERMIT - FEE T
H 0 the basis fpr the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant per,civil Penalty .ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ h as owner of the property,or my employees with wages as •BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their we compensation,will do the work,and the structure is not
unaided or offered for sale (Sec. 7044, Business and Plolessians DRAINS-FLOOR,ROOF,AREA,COND. 5.00 '
Code:The Contractors License Law does not apply to un owner of
Property who builds or Improves thereon,and who does such work FIXTURES-PER TRAP .5.00 50.FT.FLOOR AREA TOTAL ACREAGE
j himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-11NC.40UTLETS;6.00
mems arc not intended or uwtvtr,ftbred for all.11;huthe holding
or impropement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.1 . 2.00 BUILDING USE '
builder,will,have the burden o'proving that did notbuild or im- - RES IND CON PB Omer
prove for pulposc'ofsale:). " INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ - ❑ ❑ ❑ ❑
' licensed contractors to construct lire 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 r
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 commeions)licensed pursuant to -
theContractor'sLicenseLaw. SEWER-SANITARY-STORM4RDO
TRACT NO. PARCEL NO.
, ❑ lam tiered under Sed ,B.&P.C.for this r WATER HEATER W/VENT
teaser
Dare WATER SYSTEM ACC.OATE ACC.FILENO.
WURKBRS'COMPIiNSA('ION DECLARATION "I WATER TREATING EQUIP1 hereby atfino that 1 have a certificate or consent to self-insure, ZONING ENG.SITE N0.
o ,tifieauc of Workers'Corm;k.tion Insurance r a teniced(huFT��W, ab.C.),A AGI -
Pahe F n,pany--1�❑ Allied 'opy is hereby f iShed. - FIRESPRINK ENERGY T-24
z 2 Wt'CrYft 7jfflu(rLw,5 c `y^ns`Tim, divisionMISC.- R : - Y❑ NY ❑ N❑p Applicant 1�fFPERMIT ISSUANCE0 FLooD zoNE AL.0c.
CERTI FIC\'IF.OFI:XF,MPIIONPROMWORKIiRS'.LU COMPIiNSA'I'ION INSURANCE " PLG.CONTE. - LIC.NO. - s 'Y❑ N❑ Y ❑ N❑CL O 1l his section teed not be completed i1' Ilit penor is for ant
2 hundmd dollars(S100)or essf
U O 1 certify that in the performance of the work for which this per. QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any hihanner so as to
O L) beconm subject to lire Workers'Compensation Laws of California.
a
Date—Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} rn NOTICE"f0 APPLICANT: If,after making this Certificate or Ex.
F_ ? emotion,you should become subject m the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must furthwi ll comply with FEE
U such provisions or[his permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)"C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C:F.M.) 6.00 SEISMIC FEE
I hereby from 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(See. MICROFILM `
3097 Ci,C) HEATING UNIT(TO 100,000'B.T.U,)
Lender's Nun.c H EATING UN IT(OVER100,000_BT.U. ELECTRIC
Lender's Address
I eerthy that I have read this application and Sate that the above VENTILATION FAN (SINGLE)+• e_ 4.00
Information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws fluting to building construction, and BOILER-COMP(3 H.P.or.100,000 B.T.U.1 6.00 '
hereby autlmnee representatives of this city to enter upon (lie BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. - MECHANICAL'
above mentioned property for inspection purpuses. -
(We),aI to save, indemnify and keep brimless the City of MISC.- REFER TO ORD_. -
Cupertino against liabilities,judgments, costs,und expenses which - CONST.TAX
" may in an way accrue against said City in Consequence of the , PERMIT ISSUANCE -
ra hh f his per it. MECH.CONT. LIG NO:-' - MECH. 1
pr�`1c�1 Tl(1r 35— 5� TOr�n/�(l I� TOTAL p��r
i at a.I'Applicant/Contractor Dale J v_
,OFFICE COPY