16259 POST THIS CARD-NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO -'. 16259 `
INSPECTIOWDIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION•4
JOB ADDRESS, •I D3y�J .I031.D, I632D' 1033UNIT# SLOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION _ ANCE OR 180'DAYS FROM
NOTE:'
UFER ALL GRADING ANDDRAINAGEISHALL BE INSTALLED LASTCALLED INSPECTION.'
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF I PEHNm VALIDATION
GARAGE SLABS CUPERTINO STANDARDS. Owl
I % L-L1 !
�6macolt"a
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED `_�A.X7$ (�oueev „� %\("�•r;Li'�-1t,t,(i� _
UNDERGROUND /SLABPAID4'
PLUMBING Zv.
ELECTRICAL ' ^ (`� TSS iSSunncE DATL '
MECHANICAL - - - BOuc ELEcJ� PLG. ME,CH
❑ ® ❑' ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGN EO - BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING
VALUATION S/FT.
- � .x ',�
MECHANICAL - _
PERMIT TO
" ELECTRICAL- (_ .�
FRAMING. - - ( icG
INSULATION
STORIES YPc CONSTR.
' � -
+ - OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED _ -
ROOF. - NOT NO F AL INSP.SHALL BE MADE BEFORE so.FT.PLooa AHeA rornL ncnence
DIAPHRAGM 'THE CONS .RUCTION TAX IS PAID I
BUILDING use
ROOF SHEATHING - HIS IND CON A Ods.•
- -APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 'El 1:1 ❑ ❑ ❑
ASSESSORS PARCEL Nu
ROUGH SAN.H
PLUMBING - ELECT.ENERGY
_ IRACTNO PAHCEL NO.
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICALACC OATE ACC FILE NO
BUILDING ENERGY ,
FRAMING - - ELECT.FINAL.TEST
ZONING ENG.SITE NO.
INSULATION � '- PLUMBING
GAS TEST . GAS
FIRE SPRINK ENERGY T,2a -
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS'BEEN SIGNED HEATING "� "�
EXTERIOR SHEAR - ELECTRICAL RELEASE '0000 ZONE
INTERIOR SHEAR FIRE DEPT. Y ❑ NE ❑ NO
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 OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ' ELECTRIC
H I ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z. MECHANICAL .
—SEE PERMIT FOR EXPIRATION DATE --
IMPORTANT! coNsr.TAX
'PLEASE READ REVERSE SIDE BEFORE" TOTAL
CALLING FOR FINAL INSPECTION. �?
OFFICE COPY
APPLICANT,TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
'BUILDING PROJECT IDENTIFICATION - :PERMITNUMBER.
aooaess -vol� APPLICATION & PERMIT 1 3� /O 3 a1
/Q 300 f u.LA LIq k7 0 9 UILD ING-ELECTRICAL-PLUMBING-MECHANICAL ri
OWNER'$ b- PLAN CHECK VALIDATION
NAME _ QTY. ELECTRIC PERMIT FEE
RHONE S
NAHERAcroRs UTLETS-SWITCHES-RECEP 10.00/1.00
0 o 5 LIC No. LIGHTING FIXTURES 10.00/1.00
ADDTRAcron's U - APPLIANCES 4.00
ADDRESS _ -
20 4190 PACIFKA ZP.H E g/S S PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) ' 20.00 PLAN CHECK FEE •P.C.NO.
OR
O
ENGINEER
LIc,NO, SIGNS TRANS. 3.00
AARCHOR DDRESS ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP..•.:_• --'_=-=T POLE INS. -20.90 �1' �` 1 ��j/�
APPLI CANT MOTORS SEE FEE SCH. J, M 1_' I1 Z4
ADDRESS
SERVICE CHANGE 20.0 �y
8tinVV
woo. LICENSED CONTRACTORS D17CLARATION I
.. I hereby affirm that I or,,licensedunder provisions of Chapter 9ISSUANCE DATE
Zw (connnencing with Section 7000)of Division 3 of the Ihuiness and
rt w DG. ELEC PLG. MECH.
H N z License professions and my license is lull lune and effect. - ❑ ❑
Z O in - License Class Lin.Number U CuRi
O � H O DaleComlratlor
¢ m E BUILDING PERMIT
¢ ¢ OWNER-BUILDER DECLARATION
¢ w u - INFORMATION
K A I I hereby affirm Owt I um exempt fmm the Convuclori License MISC.- REFER TO ORDnil
LL o a Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 19.60 VALUATION SIFT.
Cale:Any city or wanly which requires a permit to construct,alter,
fea¢ improve,demolish,or repair any'structure.prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
as M-O u requires the applicant fur such pemril to file g signed statement that TOTAL PERMIT TO
' w 9 he is licensed pursuant to the provisions of the Contractor's License FIST HiQ
Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe
4 O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE lH
¢ H g the basis for the alleged exemption.Any vial.ti ,of Se,6,m 70315 STORIES YPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER IEA.) 5100
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
sole compensation,will do the work,and the structure is not
on
or offered for sale (See. 7044, Business and Professiaos - DRAINS-FLOOR,ROOF,AR EA,COND: 5.00
Code:The Contractor's License Law dors not apply In an qwner of
pmperly who bui Ws ur intproves IlVeVeon,mrd who does such work FIXTURES-PER TRAP 1,011 SO.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees.provided that so ch ire ments building
himself
throughot his or offered hes,or provided
that r.Suhebuilding GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 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 INTER. 8000 RES IND cory PB Omer
❑ 1,as',owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licenwd contractors to construct the project(See. 7044,Business LAWN SPRINKLERS-1 INC 6 V.B. 6.00 ASSESSORS PARCEL ND.
and Professions Cale:'Ihe Contractor's License Law dues not apply
to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a conlmemits)licensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ l am exempt under Sec.-,It&P.C.for this WATER HEATER W/VENT 6.00
R 1n
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE No.
WORKERS'COMPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure. ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE N0.
copy Ihemof(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished. - FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.O Applicant Y ❑ N❑ Y [J NC]
~ v_a PERMIT ISSUANCE 10.00
LU C.IiRTI FICATE E EXEMPT]ON FROM WORKERS' FLOOD ZONE A.L.u.C.
W COMPENSATION INSURANCEifthe PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y[:] N E]d O 1' section ction need Dol he cam if Plated thpermil is for one TOTAL
� Z hundmJ dollars($I00)Ur less.)
U.O 1 certify that in the performance of the work for which this Ni- One MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shall not employ any person in any manner so as to
O become subject to the Workers'Compensation Laws of California.
U a Datc Applicant' ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: If,after making this Certificme of Ex-
♦- Z emplion,you should become subjecl)o the Workers'Compensalion APPLIANCE 5.00 PLAN CHECK
provisions of the Lubar Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10.000C.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 cmil is issued(Sec. MICROFILM
3097,Civ.0.). - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that l have read thisapplicutima and stale that the above VENTILATION FAN (SINGLE) 4.00
information is comet. I agree to comply with all city and county PLUMBING
1` s„ ordiirances and stale laws relating to building construction, and
BOILFA-COMP I3 H.P.or 100,000 B.T.U) 6.00
" Z�l above-hereby authorize representatives of this city to,emcr upon the BOILER-COMP (Over 1N,NO BTU(SEE FEE SCH. MECHANICAL
� s,/ above-mmntioned property fonns�el inn purposes. '.
(We) agree to rose, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upsrtino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in comequence of the
antingofthu permit. MECH.CONT. LIG NO. MECH.
TOTAL TOTAL 00
Signature of Applicant/Contractor Date
OFFICE COPY