16973 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER'
CITY OF CUPERTINO
16973
• r
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADOR ESS (l IIV 6 UNIT# —LOT# PERMIT EXPIRES IF WORK i
OWNER 11 \ S CONTRACTOR '' IS.NOT STARTED WITHIN
INSPECTION IVATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - . - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION. '
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED.
PR EGUNITE ' TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS /'-•��`h'y
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING _ jAK
C-t,,1.I/L1'f'Z,yr•(�.,��
ELECTRICAL ISSUANCE DATE
MECHANICALFLOG ELECT PLC. MECK:
1�CN f UAV►2cor� 6 tzl6 IN
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED -(0-9q 1�4 BIN ORMATIONPERMIT
WOOD FLOOR
PLUMBING - vA UATIDy SIFT.
MECHANICAL �
�
ELECTRICAL Pi
PERMIT TO
T� _
FRAMING
INSULATION - STORIES TYPE CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.. ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SG IT FLOORAREA TOTALACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
B W LUI ON USE
ROOF SHEATHING _ � � RES IND CON Pa om�,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.#-
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS&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.SPR INK ENERGY T 2
- MECHANICAL �
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "Q ` ❑ "❑
' FLOOD ZONE AL.0 C,
EXTERIOR SHEAR. ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. - Y[3N❑ Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR(LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING I . 0 o
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE dw
OCCUPANCY OF BUILDINGJS NOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC a
t-� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING �D
y o PLEASE GIVE JOB ADDRESS WHEN PHONING. `
ZSMECHANICAL
" - EE PERMIT FOR EXPIRATION DATE - beo
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT 1 DENTI FICATI ON 1,PERMIT NUMBER
WnLDING, APPLICATION & PERMIT �, 16973
ADDRESS
( ,�11 C l�I� ,! BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
DINNER'S I LOT '116\\f/ZTS
NAME PLAN CHECK VALIDATION
Irl DTV. ELECTRIC PERMIT FEE
vRL PNONE7, 1Y .7Z
\ J CONME TRACTORS • ,3 OUTLETS-SWITCHES-RECEP 10.00/1.00 13,1 d,
LIC.NO. LIGHTING FIXTURES 10.00/1.00 Zr U
CONTRACTOR DR's APPLIANCES-RESIDENTIAL 4.00 .24 QO
CONTRAS
PHONE PANELS 10.00 (-24td DATE OF APPLICATION'. .t
RRcmTEGT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE- P.C.No.
O
ENGINEER
LIC,NO. SIGNS TRANS. 3.00
=' AENG. PERMIT VALIDATION
'' •
ADDRESS SPECIAL CIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 20.00
AESMOTORS SEE FEE SCH.
S
ADDRDDRESS
SERVICE CHANGE 20,00
W o o LICENSED CONTRACTORS DECLARATION
a u u I hereby affirm tlml I am licensed under provisions of Chapter 9 9 ISSUANCE DATE
"' (commencing with Section 7000)of Division 3 of the Business and
ti ¢'w LDG. ELECT- PLG. MECH.
0 w z Professions Corte,and my license is in full farce and effect.
o Z m a License Class Lic.Number Date Contractor City n1 Cuperhnu
r m H J
a Y s BUILDING PERMIT
Ix Ic w a OWNIi R-BUILDIiR DECLARATION
o A. u INFORMATION
A.
;u as I hereby uHSren that 1 am exempt from lire Contractor's License MISC.- REFER TO ORD ygLUAT101y S/FT.
LL 0¢ Luw for the following reason.(Sec.7031.5,Business and Professions U
PERMIT ISSUANCE 10.00 (Z�O0
Code:Any city or county which rcquiresa permit to construct,alter,
0
¢ ¢ <-o improve,demolish,or repair any structure,prior to its roomier,also ELEC.CONTR. LIC.NO. ELEC. 1/11
i w m•. requires the applicant for such permit to file a signed statement that TOTAL �t• T[[�P PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License f�
F z <
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �
f 4 0 Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
IS t- $ the basis for the alleged exemption.Any violation of Section malty STORIES TYPE CONSTR.
by any applicant fora permit subjects the applicant toa civil penalty 00) 5.
of n 1 more than five hundred dollars(5500)J: ALTER-DRAIN&VENT-WATER (EA. Z
too
1,as owner of the property,or my employees Willi wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
(heir 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
:P"' Code:The Cmitractor's License Law does not apply to an owner of
`M!QVG property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 Z,00 SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve.
mrc O
ents anot intended or offered for sale.If,however,the building GAS.EA.SYSTEM-I INC.4 OUTLETS 6.00 , Q
or Improvement is sold within one year of completion, the owner.
lir p'a� builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 )EA.) 2130 BUILDING USE
prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 _ RES IND CON PB Other
01,as owner of the property,am exclusively contracting with ❑ ❑ Cl ❑ ❑
„ licensed contractors to construct tire project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSE55ORS PARCEL NO.
and Professions Code: [*he 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 for such projects with a contractods)licensed pursuant to
lire Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under See.-,B.&P.C,to,this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 00 Aee.DATE ACC,FILE NO.
WORKF.RS'COMPF.NSA TION D17CLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a emiih ate of consent W self-insure. ZONING - ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O Cl Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Cer ified copy is filed with the city inspection division. ❑ ❑
F 0 Applicant MISC.- REFERTOORD. v❑ N❑N Y
� N CFRT'IFICAT17 OF EXFMI'I'ION FROM WORKERS' PERMIT ISSUANCE 10.00 Z-r OF FLOOD ZONE A.LU.C.
L (7041:NSATION INSURANCE PLG.CONTR. - LIC.NO. PLG. -q f�
d Cl (This section need 0' be completed it the permit is for one TOTAL �B E OV Y❑ N❑ Y ❑ N❑
Z hundred dollars($100)orless.)
U 0 1 certify that in the performance of lire work for which this pe" OTV. MECHANICAL PERMIT FEE FEE SUMMARY
L 1- mit is issued,I shall not employ troy person in So mannerso as fo
O w hecoer�1� the Warkers'C pe in,"I sol Culnlornia. -
y Dme/ nppliwnt- j.� ALTER OR ADD TO MECH. 5,00 BUILDING 1 Q b
} W NOTICE: '1 O , PPLICANT: If,after making this Ce ficute of lix-
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK CfL�
provisions of the Labor Code, you must forthwith comply with FEE
U - such provisions or this permit shall he 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 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
Lender's Name HEATINGUNIT(OVER 100,000 B.T.U.)9.50 4D
Lender's Address ELECTRIC I C
Icerfil'y that lhave read this application and stole that the aboveLER-COMP (over 100,000 BTUl SEE FEE SCH. MECHANICAL
VENTILATION FAN (SINGLE) 4.00 V'
information is correct. I agree to comply with all cif,and countyOILER-COMPQ H.P.or 100,000B.T.U.) 6.00 PLUMBING U•UD
i ordinances and state laws relating to buddin6 construction• and
hereby authorize representatives of this city to enter upon lire I�V
above-mentioned properly for inspection purposes.(We) agree to save, indemnify and keep harmless the City ofISC.- - REFER TO ORD.
uperlino against liabilities,judgments, costs andexpenses which PERMIT ISSUANCE 10.00 (•y Qf7 CONST.TAX
nay in any way accrue against said City in consequence of the
m g0 itis peri . MECH.CONT. LIC.NO. MECH.
1 / TOTALfbeC-�7 TOTAL 22.' 6
Slgnoture ol'Applicant ntractor f/ ate
OFFICE COPY