16100 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 16100
INSPECTION DIVISION
JOB INSPECTION RECORD
_! `
JOB ADDRESS DF �""`�V/ I (PERMIT EXPIRATION
UNIT# LOT#
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
'V"b �� - NOTE: LAST CALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMFI VALIDATION
CUPERTINO STANDARDS. '
GARAGE SLABS ;.1 '.•, II'�, ('�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING p�(�
ELECTRICAL PAW-
ISSUANCE DATE
MECHANICALBLD(. ELECT PLG MECH
pUv, E, _ d V v lz
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED d(',U . BUN INFORMATION
PERMIT
WOOD FLOOR
PLUMBING VALUAIIDN $TFT.
MECHANICAL i. �_(�('� .70
ELECTRICAL ,A( PERMIT TO
FRAMING
INSULATION - Si OHIES TYPE CONSTR
OCC GHOUP RE5.OMIS
PLACE NO SUBFLDOR UNTIL ABOVE HAS BEEN SIGNED sD.,T,11_0011 AHIIA TOTAL ACREAGE
ROOF NOTE'NO FINAL INSP.SHALL BE MADE BEFORE 1
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
auI LOIusLS[ROOF SHEATHING Res IrvD cON PB
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El E) El_ ASSESSORS PAHCE ENO .
ROUGH SAN.N
PLUMBING c - � ELECT.ENERGY '
TUBS&SHOWER PAN / - PLUMBING ENERGY T RACT NO PARCEL NO
MECHANICAL -gP- MECH.ENERGY
ACC DATE ACC FILE No
ELECTRICAL BUILDING ENERGY
FRAMING - lLL.' ELECT.FINAL TEST
INSULATION zoNlNc ENG.SITE NO.
(- F� PLUMBING :�
GAS TEST - GAS
MECHANICAL [ FIRE SPRINR ENERGY T.]J
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - G �� ✓ - ❑ °❑ `"❑ N�
ALU
EXTERIOR SHEAR ELECTRICAL RELEASE
"000 ZONE C.
Y❑ N❑ , ❑ N❑
INTERIOR SHEAR FIRE DEPT. "
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH BUILDING - y BUILDING II
INTERIOR LATH TEMPORARY APPROVALS
Ilk SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC U J
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING TIN
Z PLEASE GIVE JOB ADDRESS"WHEN PHONING: 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
BU I LDING PROJECT I DENTIFICATI ON .PERMIT NUMBER
BUILDING APPLICATION & PERMIT 16100.
ADORE D29#41 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
GWN 5 PLAN CHECK VALIDATION
QTY• ELECTRIC PERMIT FEE -r
PHONE 1 fir'tt T^
NoNTRAcroRs01 UTLETS-SWITCHES-RECEP 10.00/1.00
4 . vo
uc.No. �1 � LIGHTING FIXTURES 10.00/1.00
oNiHAcioR's PPLIANCES-RESIDENTIAL 4.00
-R
�j DC7( "41/4 �arosr?-93-2 PANELS 10.00
DATE OF APPLICATION
OR
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE .P.C:NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH.08
ENG' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
aDoR rq7- AI,1�-p-�11 x
APPLICANT MOTORS SEE FEE SCH. J• �I�t NI`1
DHESSEss
SERVICE CHANGE 20.00jl (oFa
0¢ i
,00 LICFNSI 1)CONTRACTORS UIiCLARKPION .
a u I hereby arfrm that I am licensed under provisions of Chapter 9 - 1
ISSUANCE OATS
z w (comrncacing with Suction 7000)of Division 3 of the Business and
t. < BLDG ELECT., PLG. MECH.
D z PrefLshous Code,and my license is in(all force and effect. I,LDG ILrCT
z 0 R E License ClassLie.Numher
O m -O Uale Conlruclor `Lf
Q y f J
OWNER-BUILDER DECLARATION BUILDING PERMIT
A. S MISC.- REF INFORMATION
w R I hereby affirm that I am exempt from the Contractor's License
va .. o law for the f011ovzog reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE VALUATION 4/FT.
Calc:Any city or county whkh requirev permit t0 constnet alteq -16� 1ACD
ec s- improve,demolish,or repair any structure,prior to its issuance.also ELEC. LIC.NO. ELEC. Q� 000 370
wD ¢ req WrM the applicant for such permit to file a signed Statement that TOTAL PERMIT TO
m he is licensed pursuant to the provisions of The Contractor's License -
Fzi Law(Chapter 9 fcommenciagwilh Section 7000fufDivision 3 ofthe
E x o BusinessunJ Professium that or Ihhe is exempt therefrom and QTV. PLUMBING PERMIT FEE {✓dJ ��{
Rr� the basis for file alleged exemption.Any violation of Section 7031.5
STORIES TYPE CONSTR.
by any applierm for a lwnnit subjects the upplicunt lr u civil penally LTER-DRAIN&VENT-WATER (EA.) 5.00
of lot marc than five hundred dollars(S500) SM
❑ 1,as owner of the pmNuy.or my cnpil0yccs with wages as
BACK FLOW PROTECT.DEVICE 4.00 Oce.GROUP RES.UNITS
their sole cumns
peafior,will du the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Calc: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 5.00a IT.FLOOR AREa ioraL aeREaeE
himself or through her own employee,provided that such improve-
mentsarenotintendedorofferedforsale.If,however.the,building GAS-EA.SYSTEM-1 1 NC.4 OUTLETS 6.00
Or imm
proveent 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 int- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ El ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO
and Professions Calc:The Contractor's License law docs not apply
to an owner of property who builds or improves Ihercom.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts fur such projects with a confactnrls)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
Cl I um exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILENO._. '
WORKERS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certi0cate of consent to self-insure,
or a certifiicattee5 of Workers'Compensation Insurance.or a certified ZONING END.SITE NO.
Palle AJ
Id e NA � . set //w=7
O 0 Corti 11 orp is hereby f hod.
z Z ❑ Cerli p' s dad It ei y' n cion division. FIRE SPRINK ENERGY T 24
H 0 Applicant MISC.- REFER TO ORD. YE] N Y ❑ N[3
y CBRI'IFICATE 01'EXEMPTION PROM WORKERS' PERMIT ISSUANCE I FLOOD ZONE A.L.U.C.
LU �> COMPENSATION INSURANCE PLG.COLOR. LIC.NO. PLG. /1 CQ Y N Y N
CL 0 ('this ectmn need not be completed if the permit is for he TOTAL Col
:3 Z hundred dollen IS 100)or lcnJ
U O 1 certify that in me ferformunce of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL M- mit ie issued,1 shall not employ any person in any manner V,as to
U become subject to the Worken CanpsnmIion Laws of California.
LU Datc Apph"m ALTER OR ADD TO MECH. 5.00 BUILDING 'a f7
} to NOTICE TO APPLICANT: If after making this Certificate of Ex-
I.- ? creation,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you mm1 forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10SMC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM16.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work fur which this permit is issue)(Sec. MICROFILM
3097,Civ.C:). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI N G U N IT(OVER ER 100,000 B.T.U.)9.50 Q
Lender's Address ELECTRIC
1 certify that I have orad this upplicwion and slate that the above VENTILATION FAN (SINGLE) 4.00 -
information is correct 1 agree to comply with all city and county PLUMBING
urdiemees and state laws retailing to building construction, and BOILER-CONP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorise representatives for
ins of the city to enter upon the BOILER-COMP (Osier 100,000 BTU)SEE FEE SCH. MECHANICAL D
show-meutioriz propertyforvesfkf this
purposes.to.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
urlertino against liabilities,judgments, costs and experri which CONST.TAX
my-,in,any way ac rl said City in Consequence of the PERMIT ISSUANCE 41
n i of ilio perm. MECH.CONT. UC.NO. MECH.
.-9'�- TOTAL �O
La 11
ignatureofA Ileum/Contractor Date - , TOTAL -677 1:'�
OFFICE COPY /