16811 POST THIS CARD NEAR ,FRONT OF BUILDING
PQST
NUMBER
CITY ' OF CUPERTINO, 16811
INSPECTION DIVISION
JOB INSPECTION RECOR�B�l 7".j
'i q!n7 •�— . PERMIT'EXPIRATIONn
JOB ADDRESS —'-(—/` �^D•VN1.L ` UNIT# ` _LOT# ,v � ^ PERMIT�EXPIRESIF WORK
OWNER, ' �„ .l • `V CONTRACTOR �,1 1-"D y y` IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM -
FOUNDATION NOTE: LASTCALLED INSPECTION.
UFER :ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PEHnuT VALIOATION
CUPERTINO STANDARDS.
f GARAGE SLABS zj J'�S PC � r
NL� ,-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '
UNDERGROUND /SLABMAR 31 'H.,.
PLUMBING -
ELECTRICAL - ISSUANCE DATE
MEC HANICAL' - e ur,. ELEu. PLG. MECH.�
Fri CJJ w6�t t. 0(.7.iOwg
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT.
•9"�:J J.5 ' w: INFORMATION
WOOD FLOORm VALUATION $/FT,
PLUMBING , /n
MECHANICAL
ELECTRICAL PER+M_ITT TO
,V V.
FRAMING '
-. . BTONIEB TYPE CONBTR.
INSULATION - ,
Ofa GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.F T.FLOOFI ANLA IOiALACREAGE.
ROOF . - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE / Lpr
- 'TH N TRUCTION TAXI PAI - Ur
!`
DIAPHRAGM'- ECO S 5 D �� t
BUILDING USE
ROOF SHEATHING � •� - - Res IND CON PB ou...
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ 0 L L
ASSESSORS PARCEL NO.
` ROUGH SAN.# 8 3 -
PLUMBING- ' - ELECT.ENERGY 557-117— D2
TUBS&SHOWER PAN i�{- J 'PLUMBING ENERGY _ •TRAGI No. .PA11 NO
MECHANICAL. Ll MECH.ENERGY, Acc.On TE Acc.FILE NO.
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ' ENG:SITE No.
INSULATION �Z'j� PLUMBING '
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY c14
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y [j NL Y L N❑,
EXTERIOR SHEAR ELECTRICAL RELEASE FI-DOD ZONE 1,L'll.C.
INTERIOR SHEAR FIRE DEPT. Y L NL v L NL
SHEETROCK , GRADE FEE SUMMARY
EXTERIOR LATH IBUILDING - /
INTERIOR LATH TEMPORARY APPROVALS - BUILDING
SCRATCH COAT ELECTRIC ® PLAN CHECK
GAS FEE t
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I ,, SEISMIC FEE-,��y 7.r0,7
OCCUPANCY OF.BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM -�-
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC __ClLU 20'3
. ONE WORKING DAY BEFORE REQUIREDJNSPECTION• PLUMBING r*
;,,Z 007
O0 PLEASE GIVE JOB ADDRESS WHEN PHONING. , MECHANICAL
ZD:3
z
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAXI • , c pZ,o.
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
BU I LDING PROJECT I DENTIKICATI ON - !PERMIT NUMBER
SOLOING ^ �� APPLICATION & PERMIT 1CQ1
�t„`1-1•A BUILDING -ELECTRICAL-PLUMBING-MECHANICAL •'`" I U U I
/ OWNER'S PLAN CHECK VALIDATION
X NAME �^ � QTY, ELECTRIC PERMIT FEE i
Co
•. i,►g,� TIEfiJ
vHorvE
CONTRACTOR
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
NAME �/ j�j��jj��,�,�����pQ
UFO,T G,71�P/IJ LIC.No. LIGHTING FIXTURES 10.00/1.00 ,
croFs PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE " P.C.•NO.
OR A PANELS (OVER 200 AMP) 20.00
ENGINEER Gunk
• -"5` '•"LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. f}, PERMIT VALIDATION
ADDRESS '1561 SPECIAL CIRCUIT 5.00
807 �Oy���II-" AVnP3
EMP.METER OR POLE INS. 20.00
Ars
ADDR ASS MOTORS SEE FEE SCH.
DOR EE
SERVICE CHANGE 20.00 -J 0� Y(�L�•
wo O LICENSED CONTRACTORS DECLARATION - ..
<u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE T
u (commencing with Section 7000)of Division 3 of tie Business and .Pv a BLDG. ELECT. PLG. 'MECH.
H y i Professions Cod, 1 my license is in Tull II Ifo t. j
z rM
o m - Li,raw Clt Lic.Number_ 9 .. �..
w r o Date-y -f-f Qintraclor - p��I Op pis ^ ���°°°"'000"'
m ( !�'C city, l N 2 BUILDING PERMIT
rt le w ef OWNER-BUILDER DECLARA'T'ION INFORMATION
wis - MISC- REFER'TO ORD
3 ic e, 1 hereby elfin, that I um exempt (neat the Contractors License - VALUATION $/FT.
H LL o 4 Law for the following rcusan.(Sec.7031.5,Basins i d Professions PERMIT ISSUANCE 10.00
Code Any city airof my whi h r Imr a I pmo 'c
erit tstnnef alteq
m} p I Y r'or to ns isuencc,also ELEC.CONTE. LIC.NO.
4 0 ter rove,demolish r re lair un :InietUr,p i - ELEC. -
iL 0 ¢ requires the applicant forsuch p rni t to file a signed statement that TOTAL PERMIT TO
n w m' he is licensed pursuant fI theI r avis n: ,f theContractor's License _
Hzi Law(Chapter )t inm n '18 withSection 7000)of Division 3 ofthe �( ��
T o Business and Profession,fission,Code)or that he is acro,t 11 erefron,and OTY. PLUMBING PERMIT FEE V N-
I-o the basis for Ne alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
dam by any applicant for a permit subjects the applicant to a civil penalty - ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more titan live hundred dollars 155001.1:
❑ 1,as owner of the property,m 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 for sale(Sec. 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 docs such work FIXTURES-PER TRAP - 5.00 SO.FT.FLOOR AREA TOTALACREAGE `
himself or through his own employees,provided that such unions,
mems are not intended or offered for sale.IL however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 1
or improvement is sold within one year of completion.tie owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 - BUILDING USE
builder will have the burden of proving that he did not build or am- RES IND CON' PO Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,a 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 Pro fissions Code'I'he Contractor's License Law does not apply
to an owner at property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 �'7`'� D•]
4
contracts for such projects with a conlmetonsl licensed pursuant3
to 5
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 . TRACT NO. PARCEL NO.
❑ 1 um cscmpl under Scc. .B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 P` ACC.DATE ACC.FILENO.
WOR S' 11PENSlp�ylP t ApR�y/BION WATER TREATING EQUIP. 5.00
I hefRS� hal M v-c ktlTieoonsedt to self-insure. ZONING
or a cA,l4f1(a`ate of Workers'Co.,,pec 'tion Insurance,or a certified ENG.SITE NO.
copy the 11
3800.Lab.C.1
cy N
Polio Company_ Q
0 ❑ Certified copy is hereby furnished. FIRESPRINK ENERGY T-24
Z z b•Certificd///�+++W�y�p�yy I-1 1 . 'lli the city inspection division. MISC.- REFER TO ORD.
rA CERTIPIICCA1IIi�,O''I,''li%IiNPTION PROM WORK F,RS' PERMIT ISSUANCE 10.00 - FLOOD ZONE A.L.0 c.
W > COMI'IiNSAI']ON INSURANCE: PLG.CONTR. LIC.No. PLG. v❑ N❑ YE] N❑
.d 0 ('fhis motion need nut be cum Pleted if the permit is lar are TOTAL
Z hundred dollars IS 100)ars less.) -
0 O 1 certify teat in tint performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F not is issued, I shall not employ any person in any manner so us to
U become subject to the Workers'Conlpensalion Laws of California.
a Dam ApplicantALTER OR ADD TO MECH. 5.00 - ' BUILDING 3
} 0 NOTICE TO APPLICANI'1 It,after making this Certillcale of lit- _ -
r z enption,you should become subjce to Die Workers'Compensation APPLIANCE 5.00 PLAN CHECK
ov
prisions of lire Lubar Code, you mist forthwith c ..ply with FEE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
coNSTRuctdoN LENDING ncI:Ncv AIR HANDLING UNIT(OVER 10p00QF.M.) 6.00 SEISMIC FEE 70-7
I hereby of fir.., first there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 -
' - the perforal Of the work for which lits perm' is iss •d 1Sec. MICROFILM
30')],Cis..C.) HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Ndd,c,, -e- �1� HEATING UNIT(OVER 100,000B.T.U.18.50 ELECTRIC
Lender's Address_
I certify that l have read this applical ion and Stine that the above VENTILATION FAN (SINGLE) 4.00 -
information is correct.1 agree to comply with all city and county PLUMBING
ordinances and stale laws totaling to building construction, and BOILER-ODMPI3 H.P.o-100,000B.T.U.) 6.00 42.�3
hereby authorize representatives of this city to enter Inion the SOILER-COMP tOver 100,000 BTU)SEE FEE SCH: MECHANICA q q,03
- above-mentioned property for inspection Purposes.
(We) agree to Save, indemnify and keep harmless the City of MISC.- - .- REFER TO ORD.
Cupertino against liabilities,judgments. costs and expenses which CONST.TAX
""
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
of this permlL H.MECCONT. - LIC.NO. MECH.
� � y/_�� TOTAL TOTAL g18.
SiggramrcooffAAgpplicant Contractor Date 7
OFFICE COPY