16657 (3) POST THIS CARD NEAR FRONT OF BUILDING
. PERMIT NUMBER
CIYY- OF CUPERTINO6657
INSPECTION DIVISION '
JOB INSPECTION RECORD
• , �. _ 'PERMIT EXPIRATION
,r
'JOB ADDRESS 2- _ UNIT# I _LOT# ((.. PERMIT EXPIRES IF WORK
OWNER , C Q , c - C6NTRAC``rOR y � ^, 1 I. J ISNOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE:
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.a i t 4 7 l
GARAGE SLABS
,. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 1 9 1988 _
. UNDERGROUND /SLAB
DECL
' PLUMBING � - �
L'IIy OT CUpe13100
ELECTRICAL
ISSUANCE DATE
MECHANICAL PF1F LAN Loc ELECT. PLG.. MECH
co a�R,v�-moi -
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
WOOD FLOOR bit Q�' O,p -5y-y ' INFORMATION
PLUMBING ���3-. - VALUATION SIFT.
Q U AlDcYLFgoo P I N A oe
MECHANICAL - $�L'L-'A A2C'F# ChA/ =rol
ELECTRICAL - 12 mTr � 1{0 clay PERMIT i
FRAMING SOv?IL y. T 1 f G'
INSULATION W lS Ci-}1 r PE corvsTn
9-z4- N caFl.002Focri
3 OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP,SHALL BE MADE B FLDDR AREn TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING HES IND ILOCONusEPB 00—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP u, . u u ❑ 0
ASSESSORS PARCEL NO
ROUGH SAN.q
PLUMBING ELECT.ENERGY
.
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
MECHANICAL MECH.ENERGY
. ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING. : - ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG SITENO.,
-
GAS TEST' GAS
FIRE SPRINK ENERGY L14
MECHANICAL v � 'N� v ❑ N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
.
EXTERIOR SHEAR ELECTRICAL RELEASE F L000 ZONE AL UC.
INTERIOR SHEAR ' FIRE DEPT. Y ❑ N[] Y 0 N�
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDINGV1a'v
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE t
Q 0-
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
. , w ELECTRIC ARRANGE FOR INSPECTION BY PHONING 252-4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING �Q
. z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION.DATE – MECHANICAL �—
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE Q/
CALLING FOR FINAL INSPECTION. TOTAL M,C0It
OFFICE COPY
APOLICANT TO-FILL IN. INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
SUI LDI NG PROJECT I DENT)FyCATIQN
PERMITNUMBER
BUILDING APPLICATION & PERMIT11
16657ADDREss
'+ � s' BUILDING-ELECTRICAL-PLUMBING-MECHANICAL �=
OWNERS - N/VELc. PLAN CHECK VALIDATION
TV. ELECTRIC PERMIT FEE rr.ff
3L? ��
N°naeRAO R OUTLETS-SWITCHES-RECEP 10.00/1.00 (2,10 U
cJT^ LIC.No, LFGTFE NG FIXTURES 10.00/1.00 71UV
ADDREss TDRs PPLIANCES-RESIDENTIAL 4.00
ss�9v�3
PHONE PANELS IO.00 GATE OF APPLICATION .,
ARCHITECT V PLAN CHECK FEE P.C.NO.
OR �k�J ��� PANELS (OVER 200 AMP) 20.00
NGINES
P SIGNS TRANS. 3.00
ARCH. PERMIT VALIDATION
ADORE SPECIAL CIRCUIT 5.00
Ioa nP EMP.METER OR POLE INS. 20.00 '
ADDRESS rs MOTORS SEE FEE SCH,
ADDRESS
QD ' SERVICE CHANGE 20.00 .
Da
FOO i
LICEN-ED CONTRA TORS DECLARATI N ± s}
<u w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y (commencing with Section 7000)of Division 3 of the Business and
¢ N BLDG. ELECT. PLG. MECH.
H w Z Professions Cnde,/�d ny license is in full lone and effect ❑
Qi,nO License CJgse-,�p�Lic.Numbery ��At _r
Date /Vf�"-. ConhaclorK yr.�
a m s BUILDING PERMIT
¢ BE a D OWNER-BUILDER DECLARATION INFORMATION
wg LL y I hereby al firm that I am exempt from she Contractor's License MISC.- REFS D
F a.0 to Law for the following reason.(Sec.7031.5,Business and Professions pERM1T ISSUANCE. 10.00 VALUATION $/FT.
� wto Code:Anycityorcounty which requires a permit to construct,alter,
/�
ELEC.CONTR. LIC NO. 9� QeQ
Le ¢ ¢O improve,demolish,or repair any structure,prior¢s its issuance,also ELEC. �'a I/ 0'
Le
e ¢ requires the applicant for such permit to file a signed statement that TOTALOf
K
m a` he is licensed pursuant to the provisions of the Contractor's License PERMIT yo
zF
Law(Chapter 9(cammencing with Section 7000)of Division 3 ofthe
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
W I-a� file basis for the alleged exemption.Any violation of Section 7031.5 - !iTORRE9 TYPEICONSTFL
T ; by any applicant for it permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 r
of not more than five hundred dollars($500).1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.uNrtS
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,AR EA,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 4 FIXTURES-PER TRAP 5.60 rO SO FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended oroffered for sale,If.however,the building GAS-EA,SYSTEM-11NC.40UTLETS 6.00 / �`U
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM OVER 4 (EA) 200 77
builder will have the burden of proving that he did not build or int- . - . .
BUILDING USE
prove for purpose of the
RES IND CON PB Other
sale.), Ur o [3 0
❑ 1,as owner of the propeft Y.am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
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 suds cenjeaL with a contrmtor(s)licensed pursua"t m SEWER-SANITARY-STORM EA.200ft/10.00
lila Ca1mcexe License Law. TRACT NO. PARCEL N0.
❑ lam exempt under Sec. ,B.&P.C.for this
nrvason WATER HEATER W/VENT 6.00
Owner Dare WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSAIION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofconsem In ser&insuro,
or a certificate of Workers'Compensation hssunusee,or it Certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,I.A.C.).
Policy No. Company
O Cl Certified copy is hereby furnished. FIRE SPRINK ENERGY T-Z4
z Z O Certified copy is filed with rhe city inspection division. MISC. REFER TO ORD.
L) Applicant - V N Y E] .NC]
2 T CER'FIFICAT 1,OF EXF.MPIION FROM WORKERS. PERMIT ISSUANCE 10.00 3y d FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. On
IL O (This section need not be completed if the permit is for one TOTAL a6 rV V❑' N� Y NE3
0 Z hundred dollars(S I OD or less.)
U O, I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shall not employ any person in any manner so as to
O w become subject to the Workv,s Compensufion Laws of California.
Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 6a 30l
} N NOTIC17 10 APPLICANT: If,after making this Corrif,ulc of Fx-
I-.. ?. emption,you should beconsc subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provtsmas of the Labor Code, you must forthwith comply with FEE
U such-provisions or this permit Shall he deemed rovoked. AIR HANDLING UNIT(TO 10MCF.M.) 4.00
CONS'I'RUCFION LENDING AGENCY AIR HANDLING UNIT(OVER l00MC.F.M.) 6.00 SEISMIC FEE r
I 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,Cie.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50 l l
Lender's Redress ELECTRIC
I certify Iha,1 have read this application and ,are that the above VENTILATION FAN (SINGLE) 4.00 0
information is correct.I agree to comply with all city and county g01LER-COMP 13 H.P.or 100,000 B.T.U.1 6,00 PLUMBING t
ordinances and state laws relating to building construction, and
P hereby above-mentioned
representatives of this city m enter upon the BOILER-COMP (Ova,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection or
purposes.
(We) agree 16 Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way acerae against said City in consequence of the PERMIT ISSUANCE 10.00
r 'ng of t perm' MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL K56rY
Si co App cant/Contractor arc
OFFICE COPY
CITY OF CUPERTINO
INSPECTION DIVISION
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