16028 I _
POST THIS CARD NEAR FRONT OF BUILDING PERMTNUMBER
CITY OF CUPERTINO 16028
INSPECTION DIVISION
^y ' JOB INSPECTION RECORD• 1{
SS Vz o�7 •VOLLI�I�'.-.5,�1` J� .. PERMIT EXPI R-ATION
JOBADDRE
UNIT# - LOT
• ,. ,. ,' - _ PERMIT EXPIRES IF WORK
OWNER 144Ak L4 uf,L 0,,-/ CONTRACTOR IS NOT STARTED WITHIN•
INSPECTON DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
.- FOUNDATION NOTE: - ANCE OR 180 DAYS FROM
LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLEDINSPECTION.
• PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL 1 .
ISSUANCE unre I
MECHANICAL BLDG. ELECT —pLG. mECH .
QPM E] El ,.
.. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �"]�' - BUILDING PERMIT
WOOD FLOOR \,/ '('FORMATION
UATION SIFT.
PLUMBING - J w
MECHANICAL
ELECTRICAL .. PERmn To
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC GROUP .RES,uNTS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO-FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID.
BUILDING USE
• ROOF SHEATHING RES IND . .CON PB Om.+ .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ Cl ❑ ❑ ❑
ROUGH SAN.p
ASSESSORS PARCEL NO J-
- •
PLUMBING ELECT.ENERGY,
TUBS&SHOWER PAN -PLUMBING ENERGY TRACT NOPARCEL NO
MECHANICAL - MECH.ENERGY
ELECTRICAL - BUILDING ENERGY ACC.DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST -
INSULATION - PLUMBING ZONING ENG.SITE NO.
` GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T za
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ° ❑`' N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD zoNE A.L u.c.
INTERIOR SHEAR - FIRE DEPT. Y❑ •IN❑ Y ❑ •N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING - ,L
INTERIOR LATA TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS - 'FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE -0 .
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION-BY PHONING.252-4505, ELECTRIC
O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING..
- SEE PERMIT FOR EXPIRATION DATE'- MECHANICAL �0
• _ -IMPORTANT! CONST1..TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY " `
APPCANT. TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
13U LDING PROJECT I DENTI FICATI ON -PERMIT NUMBER
OURLOINc APPLICATION & PERMIT
ADDRESS o oLLI�6 _ . . 16 0 2 8
I � , BUILDING
VOWNER'S PLAN CHECK VALIDATION
NAME CITY. 'ELECTRIC PERMIT FEE I/11
W ' PNONE /
COME TG s UTLETS:SWITCHES-RECEP 10.00/1.00 3� T UyAµ\
• _ I.M.ND. LIGHTING FIXTURES 10.00/1.00
ADDRESS OR's
ADDRESS PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS - 10.00 DATE OF APPLICATION
AR CARE CT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
No. SIGNS TRANS. 3,00
ARCH,OR ENG. ' �S � SPECIALCIRCUIT 5,00 PERMIT VALIDATION
�[J ZIP EMP.METER OR POLE INS. 20.00
APPLIC
ADDRESS MOTORS SEE FEE,SCH.
SERVICE CHANGE 20.00
0C`
O O ' LICENSED CONTRACTORS DECLARATION
¢u u 1 hereby affirm that I am licensed under provisions of Chapter 9
w Z w s aISSUANCE DATE
¢ n (commencing with Section 7000)of Division 3 of the BusinesnJ ELECT. PLG. MELH.
H O i Professions Code,and my license is in full force and effect �' ❑
o z w W License Class Lic.Number
F a J Dalc Contractor
a r s a OWNER- BUILDING PERMIT
¢w� BUILDER DECLARATION
I'xu 0 LL N 1 hereby affirm that I am exempt from the Contractors License MISC.— REFER TO ORD IN ATION,
H u O¢ Law for the following reason.(Sec.703 L5,Business and Professions ION $/FT.
� w0 � Code:Any city or county which requires a permit to construct,alter,
PERMIT ISSUANCE 10.00
2 rt ¢ O improve,demolish,or repair any structure,prior[o its issuance,also ELEC.CONTE. LIC.NO. ELEC. /0 -
O u requires the applicant for such permit to file a signed statement that
TOTAL PE IT TO
n w m he is licensed pursuant to the provisions of the Contractor's License n .,
F z ¢
Law(Chapter 9(commencing with Section 7000)of Division 3 of l hu X ,�A •�,
4 O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE '♦d „/QU�'L
the basis for the alleged exemption.Any violation of Section 7031,5 STORIES TYPE CONSTR.
ni — by any applicant fora permit subjects the applicant nnttoacivil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than flue Perron subjects the ap.li
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is net oec.GROUP RES.UNITS
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 does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedol.ffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
•e. Prove for 1,aso nee of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB omv
❑ d as owner of the properly,he 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 s th does not apply
to tr owner of property who builds tr improves Thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contmcmrfs)licensed pursuant to
the lam exempt
License Law. SEWER-SANITARY-STORM EA.200ft/16.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for tllis
reason WATER HEATER W/VENT 6.00
Owner Dale WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO,
WORKI S'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
hereby affirm that I have a certilicateof consent to ell-insure'
or a certificate of Workers'Compensation Insurance,or u cerlit'icd ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company.
❑ Certified copy is hereby furnished..
Z Z ❑ icd copy is filed with the city inspection division. FIRE SPRINK ENERGY T-24
FO Applicant um MISC- -REFER TO ORD. Y ❑ IN Y N❑
Cr y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG
d O (This section need or be completed if[lie permit is for one - TOTAL Y❑ N❑ Y❑ N❑
:D Z hundred dollars(S 100)or less.)
U O 1 certify that in the performance of the work for which this per. FEE SUMMARY
1 QTY. MECHANICAL PERMIT FEE
LL U become
is issued,e I shall not employ any person in any manner so is to
becmne suhject to the Workers'Compensation Laws of California. /
i Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ Z NOTICli TO AI'PLICANT: If,'afner making,lhis Certificate of r...
1 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
V
provisions of the Labor Code, you must forthwith comply with - FEE such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 1Op00C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p000.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(See.3097, MICROFILM
Under's Nam _ HEATING UNIT(TO 100,000,B.T.U.)
Lender's Addle
Lender's AJdress HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify Out I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
ordinances n correct.I agree to comply with all city and county PLUMBING
ordinances is state laws relating comply
lima construction, andmy BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby aulhoriae representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SLH. MECHANICAL / �'C7.
above•menlioned property for inspection purposes.
• (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uPaulin- against liabilities,judgments, costs and expenses which- CONST.TAX
Tay in any way accrue against mid City in Consequence of the PERMIT ISSUANCE .}B-,BQ 1
nling Of this permit. MECH.CONT.
��I �� LIC.NO. MECH.
TOTAL TOTAL
Sign urea pplicanf/Contractor Date
Q
OFFICE COPY