16187 POST THIS CARD NEAR FRONT OF, BUILDING
PERMIT NUMBER-
CITY OF . CUPERTINO 161 $7
t INSPECTION DIVISION
JOB INSPECTION,RECORD
1�l/ ' PERMIT EXPIRATION
at ADDRESS) ✓ � n1 Clu, UNIT.# LOT#
i
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR 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
PREGUTO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALmATION
GARAGE SLABSITE CUPERTINO STANDARDS.
GARAGE '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL _ ISSUANCE DATE
MECHANICAL - RLnr, ELEc r. PLc. MEC-
p ❑ ,I ❑ I ❑ C^7
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED % 9o"INFORMATILDING IONIT
WOOD FLOOR VALUATION SIFT.
PLUMBING s EW
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING
I
STORIES. TYPE CONSTR.
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,IT.FLOOII AREA TOTAL ACREAGE
ROOF I NOTE:NO FINAL INSP,SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTIONJAX iS PAID
.. BUILDING USE
ROOF SHEATHING RES IND CON PIT QIP ,11 ,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El 11 E)
ASSESSORS PARCEL NO
ROUGH - SAN.p
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL-NO,
TUBS&SHOWER PAN PLUMBING ENERGY - ..
MECHANICAL MECH.ENERGY
1
' ELECTRICAL BUILDING ENERGY ACC.DATE ACC FILE No,
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO,
INSULATION PLUMBING
GAS TEST GAS -
MECHANICALFIRE SERI INS ENERGY T 74
o, Y ❑ N Y .N❑
COVER NO WORK UNTIL ABOVE HAS BEEN'SIGNED HEATING
EXTERIOR SHEAR' ELECTRICACRELEASE FLOOD zorvE aL.1
❑ N❑ No
�
INTERIOR SHEAR FIRE�DEPT.
SHEETROCK � GRADE - FEE SUMMARY
EXTERIOR LATH IBUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING,
SCRATCH COAT _ ELECTRIC PLAN CHECK
GAS FEE
,NO TAPE'ORPLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY
SEISMIC FEE
OCCUPANCY OF BUILDI NG IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY.BUILDING INSPECTOR. MICROFILM,
ARRANGE FOR INSPECTLON BY PHONING 252-4505, _ ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z_ - `MECHANICAL
SEE PERMIT FOR EXPIRATION DATE
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
f- r .BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT . 16187
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
p OWNERa PLAN CHECK VALIDATION
qAAAE QTY. ELECTRIC PERMIT FEE
�� - CONTRACTORS IUTLETS-SWITCHES-RECEP 10.00/1.00
NAM
uc.uo LIGHTING FIXTURES 10.00/1.00
CONTRACTORS sari
,.Tu APPLIANCES-RESIDENTIAL 4.00
PHOrvE PANELS. 10.00 . DATE OF APPLICATION_l
ARCHITECT PANELS (OVER 200 AMP) 28,60 PLAN CHECK FEE P.GNO.
OR "
ENGINEER
LIC.NO, SIGNS TRANS. '3.00
ADD ESS Ervc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR PO LE INS. 20.00
e APPLICANTS
Accosts MOTORS SEE FEE SCH.
SERVICE CHANGE '20.00
w o o LICENSED CONTRACTORS DECLARATION
u. I hereby affirm that 1 am liccn.w.,d under provisions of Chapter 9 ISSUANCE DATE
r 2 w (conunencing willWILDING
00)Of Uivisiun J OI the Business a BLDG. ELECT. PLG. MECH.
D i Professions Cose is in full for
z O'� —ys Licca dossLi
c.Numb r
Q Y aye Dalf � COnttacl _ _ _ _ _ te�t El
¢ 2 w¢ OWNER-BUILDER 118CLARA'f10N PERMIT
aoa " MISQ- REFER TOO INFORMATION
X ; u a- 1 hereby al llrm that I am exempt from the Contractor's License VALUATION f/FT.
H LL 004 law for the following reason.(Sec.7031.5,Businrssand Professions PERMIT ISSUANCE
Code:Any city or county which requires a permit to construct,alter,
¢ Q improve,demolish,or repair structure,prior to its issuance,also ELEC.CONTR. , LIC.NO ELEC.
or - 0 to requires the applicant for such permit to rile a signed statement that - TOTAL PERMITTO
w ud he is liccnpursuant to the provisions of the Contractors License
F z a 1XX)
Law(Chapter 9(commencing with Section 7 )of isi
Divun 3 oflhe ',/-l4f✓yrl
E 4 0 Business and Professions Cole)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r S the basis for the alleged exemption-Any violation of`Sv,tron 7031.5 _ STORIES TYPE CONSrR.
a ; by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages to BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure rs not
intended or offered for IS (Sec 7044, Business and Poite sons DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code'fhc Contractor's License Law does not apply to an owner of -
properlywh0builds orimprovesthereon.and who docs such work FIXTURES-PER TRAP + - 5,00 Sp,FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees:provided that such improve-
• meats are cel intended or offered for Sale.IL however,the building GAS-EA.SYSTEM-11NCAOUTLETS 6.00
or improvement Is sold within one year ofcompletion,the owner. GAS-EA.SYSTEM-OVER 4 IEA.[ 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). , INDUSTRIAL WASTE INTER30.00 RES IND CON Be Omer
❑ 1,as owner of the properly,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.
unit Professions Codc The Conlmdor's License Law docs not apply - -
1.an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
conthe sfuru¢hprojects Lwilhamntracwrts)licensed pursuantm SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
the Contractor's or License Law.
❑ I an,exempt under Sec.' ,B.&P.C.for this ' WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
W'ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to sitGinsurt. ZONING ENG.SITE NO.
or a ce.t -'ate of ky oI Linn Irsurm ec,of a certifed
Q copy thy.xf+pU L�
Policy'. o I y
0 ❑ died copy is In chy fur d. FIRE SPRINK ENERGY T-]<
Z 2 Ce E Py
's -I wit c c' I , Aivisioo' MISC.- 'REFER TO ORD.
O Applicant ' _ - - V ❑ N❑ V ❑ N❑'
irN CERTIF ATEOF EXENIPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C.
W > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
CL 0( This rection need not be nn ipl,trd if the pennif is for one TOTAL Y❑ N C] Y ❑ N❑
hundred dollars IS 100)or less.)
U O 1 certify that in the peRormantt Of the work for which this per-mit n MECHANICAL PERMIT FEE FEE SUMMARY
LL I- issued,I shall not employ any person in any manner so as to
O ° become subject to the Workers'Compencation Laws of Celifomia. BUILDING
to Date Applicant _ ALTER OR ADD TO MECH. 5.00
} w NOTICE TO APPLICANT: If,after making this Ccnificxw of Fx- ,
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such Boomers or this permit shat[be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M) 4.00
CONSI'RU(.TION LENDING AGENCY 'AIR HANDLING UNIT(OVER 10)(300C.F.M.) 6.00 - SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the
periv Cance of the work for which this permit is Issued(Sec. NG UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender'sNan
Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify Ihal 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
• information n correct, 1 ogre to comply with all city and county BOILER-CONP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
information
and stale laws refining c tr, building coney andun, and
hereby authmrRe'rcpresentmivcs of this city to enter No the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep hmmlcss the City of MISC.- - REFER TO ORD. .
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE — CONST.TAX
nay in any wu5s mere against mid City in c nscquc v o he
'ng of fits pcmtiL MECH.CONT. LIC.NQ .MECH. /
roTAL p't 1 TOTAL
\ Si tureof Applicant Convector Date
'( OFFICE COPY