16769 (2) POST THIS CARD NEAR FRONT OF BUILDING „rRMITNUMB ER
CITY OF CUPERTINO 16769
INSPECTION DIVISION
JOB INSPECTION RECORD
' - PERMIT EXPIRATION
JOB ADDRESS'. '/I+ 7.Z wE- .S�Fr UNIT# LOT#
- - .PERMIT E%PIKES IF WORK
OWNER - CONTRACTOR e c- IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- .
FOUNDATION - ANCE OR 180 DAYS FROM .
NOTE: LAST CAL LED I NSPECTI ON.
LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED I
PREGUNITE TO COMPLY WITH THE-APPROVED PLANS AND CITY OF PERnuT vALIMATTON-
CUPERTINO STANDARDS.
GARAGE SLABS PAW '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 7.
' UNDERGROUND /SLAB IML. �' l I 89 h j
PLUMBING _ /^��' ,L{ �I-+'
ELECTRICAL N� ISSUANCE DATE e . `V
MECHANICAL - BLDG I ELECT I PLG, VECH A
❑ 9 ❑ ❑ '
DO NOT POUR FLOOR UNTIL ABGVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOORINFORMATION
L
PLUMBING VALUATION SIFT.
-
MECHANICAL
ELECTRICAL PERMIT T
FRAMING
+"
INSULATION STORI.S TYPE CONSTR.
}
OCC GROUP RES UNITS
- Lyx
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FT FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALCBE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING HES IND CON PB OL"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED- FINALS DATE INSP. 0 El ❑ E:l [D I
ROUGH SAN.p ASSESSORS PARCEL NO.
PLUMBING - ELECT.ENERGY
" TUBSBSHOWER PAN- PLUMBING ENERGY IPACT No PARCEL NO.
MECHANICAL - MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING - - ELECT.FINAL TEST
ZONING ENG.SITE NO.
' INSULATION - PLUMBING
GAS TEST GAS
MECHANICAL PIRESPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y Y ❑ "�
PL000 ZONE A.L U C.
EXTERIOR SHEAR � ELECTRICAL RELEASE
"INTERIOR SHEAR FIRE DEPT. Y Y ❑ N[�
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC v 7-4)
-� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL �1
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 16769
ADDRESS
G7 tx� UILDING-ELECTRICAL-PLUMBING-MECHANICAL '�'
OWNER'S �+ PLAN CHECK VALIDATION
"AME CITY. ELECTRIC PERMIT FEE
PHONE
CON ACTOR UTLETS-SWITCHES-RECEP 10.00/1.00
Lic�/s(��"'. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
AADDS _
PANELS 10.00 DATE OF APPLICATION '
ORRCHIT T � - PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE C..NO.
ENGINEER
" uc.No. SIGNS TRANS. 3.00 '
AARCH,OR DDRESS EN��• SPECIALCIRCUIT 5.00 PERMIT VALIDATION
T ZIP EMP. METER OR POLE INS. 20.00 `7- Z(
ADDREs
APPLICANT MOTORS I SEE FEE SCH. S'
SERVICE CHANGE _ . 20.00ca 1 • ` �, ^
X ;!2 LICENSED CONTRACTORS DECLARATION ✓1' VI 141-'v` U ea
a i W I hereby affirm that I am licensed under provisions of Chapter 9 V _ _ ISSUANCE DATE
a a (Commencing with Section 7000)of Division 3 of Die Business and BLDG. .ELECT. PLG. ECH.
w i Ptnfessions Cod• and my license it in full Inrc�yyQ� ❑ � ❑ ❑
p
0 m W License I _far.Number_Y///
Date Conlran"or_A.LYJ2
st x E � ��-�4l BUILDING PERMIT
m a a OWNER-BUILDER DECLARATION - INFORMATION
w ; n I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
uoj Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Code:Any city or county which requires a permit to construct,alter,
KKQ � Improve.den1011SI1,111 rep81r8Dy$tfnCtllrC.prior to 1151ssnanel`,uI50 E ..0 TN. Lj'..NQ ELEC.
i O u requires the applicant for such permit to file a signed statement that LT TOTAL PERMIT T
K
m y he is licensed pursuant to the provisions of the Contractor's License
F z r
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
f i o Business and Professions Code)or that lie is exempt therefrom andOTV. PLUMBING PERMIT FEE
w E.�. the basis for the alleged exemption.Any violation of Sec(ion 7031.5 S RIS TYPE C STR.
age by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
r
of not more than five hundred dollars($500).1:
❑ 1,as owner of the property,or my CnsplOyces With wages as BACK FLOW PROTECT. DEVICE 4.00 DCC,GROUP RES.UNITS
their we compensation,will do the work,and the structure is not
intended or offered for sale(See. 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 FIXTURES-PER TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE
.
himself or throughnot
own emred for sale,
Ii.ed however,the
improve- GAS-EA.SYSTEM-1 6.00 _
meats are not intended or offered for sa ro f however,the building
or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
a
builder will have'd burden of proving that he did not build or im-
RES IND CON PB Omer
INDUSTRIAL prove For purpose of sale.). STRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
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 Lines not apply
to as owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a contractort sl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO, PARCEL NO.
❑ I um exempt under Sea..,BAP.C..for this
WATER HEATER W/VENT 6.00
reason
Owner - DateWATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORK Ii RS'COMPF"NSA'I'ION DECLARATION WATER TREATING EQUIP. . 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
r - copy thereof(Sce.3800,Lab.CJ. '
Policy No. Company '
❑ C ' cd copy is 1 reby f
Z Z erlifiedieyp�a city inspection division. FIRE SPRINK ENERGY T-29
0 Applicant //r///� MISC.- REFER TO ORD. Y ❑ N❑ v ❑ N❑
C N CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
C' 0( This section need not be completed if the permit is.for one TOTAL Y❑ N❑ " Y❑ N❑
hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mil is issued,I that not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws Of California. BUILDING
CL Date Applicant ALTER OR ADD TO MECH. 5.00 -
} or NOTIC17 TO APPLICANT: If,after making this Certificate of E.-
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must lorthwilh comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.C.).
Lender's Name HEATING UNIT(OVER100,000 B.T.U.)9.50 r 0
Lender's Address ELECTRIC
-
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is I entree(. agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMF(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city toe or upon Ile BOILER-COMP(Over l00,0008TU1SEE FEE SCH. MECHANICAL
\ above-mentioned property for inspection Purim
(We) agree to save, Ind nify and ke armless the-City of Misc.- REFER TO ORD.
Cupertino against lieb" ,judgme sts and expenses which CONST.TAX
may in any wa agai City in souse, •nce o the PERMIT ISSUANCE 10.00
ranting of / MECH.CONT. LIC.NO. MECH. ..
4 TOTAL TOTAL /
Sign eof Applicant/Contractor ate
OFFICE COPY