16536 POST THIS CARD NEAR FRONTO'F BUILDING PERMIT NUM GET
�-4 CITY. OF CUPERINO
INSPECTION DIVISION .1 SSW..
JOB INSPECTION RECORD
•T PERMIT gflFV 1TION
.JOB ADDRESS_( ( � y LCW -A-V�UNIT# LOT# /PERMIT EXPIRES/S'IF WORK
OWNER \- a CDNTRACTOR ,•b Q f IS,'NOT STARTED WITHIN-
- INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
-
FOUNDATIONNOTE
r : - ANCE OR 180 DAYS FROM
- -
UFER ALL GRADING AND-DRAINAGE SHALL BE INSTALLED 'LAST CALLED INSPECTION'
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND,CITY OF PERMIT VALIDATION,
GARAGE SLABS
CUPERTINO� STANDARDS..
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL 'Issu ANCE UArE
MECHANICAL - BLDG ELECT. ,PLG. MECH.
. E] ❑ ❑ IKJ
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT-
INFORMATION
WOOD FLOOR ' 't vnwnnoN.• SIFT.,
.PLUMBING
MECHANICAL' ,
ELECTRICAL - PERMn TO
FRAMING P�� Al ec_�
INSULATION + OCT TORIES• TYPE CONSTTi,
OCC GNOUP Res UNITS
City of Cupertino
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - -
Y ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn.Er FEoua AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAXIS PAID '
ROOF SHEATHING RES- ING : CON BUILDING USE PB 00
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE: INSP. ❑ • 0 ❑ El
.Ab5LSSOHS PARCEL NO,
ROUGH • SAN.# .- - -
PLUMBING - ELECT.ENERGY
TRACT NO, PARCEL NO
TUBS&SHOWER PAN - - PLUMBING'ENERGY -
MECHANICAL MECH.ENERGY'-
• ELECTRICAL BUILDING ENERGY ACC.DATE ACC.FILE Na.
FRAMING : ` - 'ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING11--21-
GAS TEST GAS ,
FIRE SPRINK ENERGY T,7A
MECHANICAL ' vNy Nf
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
, .
EXTERIOR'SH EAR - � � ELECTRICAL RELEASE FLOOD ZONE ALU.C.
INTERIOR SHEAREIgE DEPT. ' t' °❑ N❑ Y "❑:
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH- BUILDING
NTERIOR LATH - 'TEMPORARY APPROVALS BUILDING
,RATCH COAT ELECTRIC PLAN CHECK
_ GAS FEE '
TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE .
•PANCY OF BUILDING ISNOTPERMITTED UNTILBUILDMG FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT! covsr.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL 00
CALLING FOR FINAL INSPECTION.
OFFICE COPY .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER
DLOINGRESS APPLICATION & PERMIT
ADDRESS DDRE I - I 3
I BUILDING -ELECTRICAL-PLUMBING -MECHANICAL q
OWNER'S PLAN CHECK VALIDATION
NAME E' 253-719 TY, ELECTRIC PERMIT FEE )
+ Q 1
PHON
C NTRACTOR'9 r �\/
NAME -OUTLETS-SWITCHES-RECEP 10.00/1.00 ! D
1 C\,,& Zt.,C-GE le),.;s sec.No. Z 33 SS B LIGHTING FIXTURES 10.00/1.00 ` l
Doqs
ADDRESS
�/
APPLIANCES-RESIDENTIAL 4.00
A
.y PNONE - PANELS 10.00 DATEOFARPLICATION '
AgcRnecr, PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE v.aoNo.,
ENGINEER "
LIC.No. SIGNS TRANS. 3.00
AARCH OR
DDRESS ENG. SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION
ZIP EMP:METER OR POLE INS. 20.00
APPLICANT rs MOTORS SEE FEE'SCH.
ADDRESS
SERVICE CHANGE 20.00
o o LICENSED CONERACfORS DECLARATION - -
¢ u u I hereby affirm that I um licensed under provisions of Chapter ISSUANCE DATE
yA (commencing with Section 7000)of Division 3 of the Business and
¢ BLDG. ELECT. PLG. M CH.
F N z Professions Code,an y license is in full farce and of et ❑ ❑ ❑
i u, o Licemso Clea C Lic.Numhur
- R m w Du¢ _ Contractor ""``
¢ r E ; rI City of Cupertino BUILDING PERMIT
¢ ¢ ¢ OWNIi -B ILDIiR DECLARA'T'ION
¢ w u - INFORMATION
w `; n m 1 hereby affirm that 1 am exempt from the Contractor's License _ MISC.-' r REFER TO ORD
LL o ¢ Law for the following reason.(Sec.7031.5.Busincssand Professions PERMIT ISSUANCE 10.00
runtyVALUATION S/FT.
� - Code Any city or which rv,,mreSa,S,m,it tocanstmeEidwa -
rt ¢ a improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO, ELEC.
n wO ¢ requires the applicant for such p unit to file a signed statement that TOTAL PERMIT TO
$w he is licensed pursuant to the provisions of the Cmttuator's License -
Fi >
Law(Chapter 9(commencing with Section 7000)o(Dlvision 3 ofthe
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING,PERMIT .FEE
E i O
¢ I the basisfor the allegedermnpubje Anyviolation o RSa cion enally - STORIES TYPE CONSTR.
by any applicant for u Penner dollars the applicant loo civil penalty -
ofnot more than five hundred dollars(S500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ 1,as owner of the p...Nny,or my employees with wages us 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 (Sea 7044, Business and Professions - DRAINS-FLOOR,ROOF,AREA,COND. 5.00 - -
Code:'fhe Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who don such work FIXTURES-PER TRAP 5.00 g0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- ,
merits are not intended or offered for sale.If,however.the building GAS-EA.SYSTEM-I'INC.40UTLETS 6.00 '
or improvement is cold within one year of coinpletion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
provefor pprpescofsale.). INDUSTRIAL WASTEINTER. 30.00 RES IND CON PB. OIImm-�elr
❑ I,as owner of the property,um exclmively contracting with ❑ El El LJ
licensed contractors to corrstmet the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCELNO.
and Professions Codc:'I he Coelmctor's License Law does not apply
to an owner of property who'builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
ramncts for such projects with a rontnetons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Tum exemptunder Sec. ,B.&P.C.to,Ods WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM '5.00 ACC.OATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP., 5.00 - -
1 hereby affirm that I have a certificate of conumt to self-insun;. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thercof(Sce.3800,Lab.C. PP /�
Policy NaQ.K_&99'yC qq .n Dr. C."GI[ C
U ❑ Certified copy I Ne 'by for {tied. " I�
2 FIRE gPgINK ENERGY T-24
Z Z v" Qrtified co is filed w the inspection'division.
O pllcum MISC. REFER TO ORD. y[:] N y 0 N❑'
0. yPERMIT ISSUANCE - 10.00 FLOODZONE ALU.C.
�(Cl'TTIFATE P IiXIiAI PI' PROM WORKIiRS' -
W 7 ENSATION INSURANCIiPLG.CONTRLIC.NO. PLGy� N� Y � N�0- C Ilhot be completed if the permit is for one TOTALhtmdror1v.)
U O 1 certify that in theperformance of the work ITr which this per- GTY -MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is issued,I shall not employ any person in any manner so m to
Ow become subject to the Workers'Compensalion Laws ofCalifornia.
OF Dmc Apph,mI ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT'. It,after making this Certificate of Ex-
2 emption,you should become wbjecl to the Workem:Compenwtion APPLIANCE 5.00 PLAN CHECK
provisions of the Latour Code, you must forthwith comply with FEE
U such provisions or this permit shall he decnmd revoked AIR HANDLING.UNIT(TO 10MOC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNff(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 perturmance of the work for which this permit is issued(Sec. MICROFILM
3097,Cis C.). HEATING UNIT(TO 100,000 B.T.U.) B.00 s 00
Lender's Name HEATING UNIT(OV ER 1 DO,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify thal I have read I his application and stmt that the above VENTILATION FAN (SINGLE) 4.00
+� information is correct. 1 agree to comply with all city and county PLUMBING
ordinance and state laws relating to building construction, and BOILER-CCNJP(3 H.P.or 100,0008.T.U.1.6.00
hereby enthoriea roperty tutivn of this city v, enter upon Ih° BOILER-0OMP (Over 100,DDO BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep brD.Iv.s the City of MISC.- - REFER TO ORD.
upertino d Inst liabilities,judgments, costs and expenses whichCONST.TAX '
Tay in an way accrue against 10 City consequence of the PERMIT ISSUANCE 10.00 1
ranting this permit MECH.CONT. LIC.NO. MECH. -
/ TOTAL TOTAL
sign of Applican Co Or )ate
OFFICE COPY