16938 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO * . 16938
INSPECTION DIVISION
JOB INSPECTION RECORD
//[ 7 PERMIT EXPIRATION
JOB ADDRESS,--{ P149? UNIT# LOT#
- PERMIT EXPIRES IF WORK
_1
OWNER � 74u4N V CONTRACTOR W 4e_CO (IkL IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION NOTE: 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
CUPERTINO STANDARDS. p
GARAGE SLABS .2--1 3 '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /^ - 29 ^�
UNDERGROUND /SLAB
PLUMBING r -�Ca.-C�— R. C—y+�i SIL. me'-4 8
ELECTRICAL L (T C`I I i,,ECT E UAIE
MECHANICAL FlE+}moo(c ECT Lc cR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR -
PLUMBING VALUATION SIFT.
% w^
MECHANICAL - � � � O�X'
ELECTRICAL PE iO
FRAMING - r� nT �
SipRIF.S TYPECONSTR
INSULATION DEC 131968
DUE RES UNITS
PLACE NO SUBF,LOOR UNTIL ABOVE HAS BEEN SIGNED -
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE s°.Fr.aoolr AREA TOTAL ncR FAr,e
DIAPHRAGM. THE CONSTRUCTION TAX IS PAID
BLUIDI usE
ROOF SHEATHING RES IND CON PR a....
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.' 11 'El I] ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.N .
PLUMBING
or
ELECT.ENERGYTUBS&SHOWE PAN PLUMBING ENERGY E"Aci NO PARCEL ND
MECHANICAL MECH.ENERGYELECTRICAL BUILDING ENERGY
MLC DATE Acc.EILE No
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION — ✓ PLUMBING ,
GAS TEST GAS
FIRE srRINIc ENERGY T.Za
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y C] N❑ Y ❑ No
.
EXTERIORSHEAR ELECTRICAL RELEASE F LOOD ZONE ALUC i
INTERIOR SHEAR FIRE DEPT, YE
N� YL NEI
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH _ /- BUILDING
INTERIOR LATH /- TEMPORARY APPROVALS BUILDING , —T
SCRATCH COAT. MEL ELECTRIC PLAN'CHECK -
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 1T
OCCUPANCY OF BUILDING IS NOT PERMITTE DUNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
E
LU� ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC _
; ONE WORKING DAY BEFORE REQUIRED INSPECTION.. PLUMBING 00
' O PLEASE GIVE JQB ADDRESS WHEN PHONING.
z' AL -
— SEE PERMIT FOR EXPIRATION DATE — MECHANIC -m
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL a—r
CALLING FOR FINAL INSPECTION.
OFFICE COPY
Lewh
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING _ APPLICATION $i PERMIT
ADDRESSC n
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S
PLAN CHECK VALIDATION
NA
USTO a -•��r OTY. ELECTRIC PERMIT FEE
PHONE .�I)4�J
CONTRACTOR'$ O
NAME CoUTLETS-SWITCHES-RECEP 10.00/1.00
rw Rn E'1 C /„,)/`CLIC.NO (,iGGq LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
AD RPE�ss •xE J� ry� I-) �{ � J�q^J �j APPLIANCES-RESIDENTIAL 4.00
(J 0n,TIC.1�N /�(�� PHONEV •6333 PANELS 10.00 DATEOF APPLICATION
OARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ATDRCH
eons ENc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 /Z-�3•�
APPLICANTS MOTORS SEE FEE SCH. /
GADDRESS
SERVICE CHANGE r 20.00
2 F 0O 0 LICF:NSIiU CONTRACTORS DECLARATION
a U w I hereby affirm that I um licensed under provisions Of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)nI'Division 3 of the Business and
)n< y LOG. ELECT. PLG. MECH.
Us Z I'ruressiens CoAe, �y license Is In full force,'�d fJ'y q Is�VN,IIr I/yr�„II
Z 0 m- License Cl' s Lie.Number_pIAP/�7�'j, City Of CupertinC Ikewxi
O m r Date Conlrumor
a se BUILDING PERMIT
¢ ¢ ¢ OWNER-BUILDER DECLARATION -
¢ i u INFORMATION
X ;u_w I hereby affirm that I am exempt from the Contractors License MISC.- REFER TO ORD
LL 0 j Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION $/FT.
F- - PERMIT ISSUANCE 10.00 0
Code:Any city or coo my which structure p riot to consuance,also - (4 j coo W K a o improve,demolish,or torah any..mctofi prior C its issuance,also ELEC.CONTR. LIC.NO. ELEC. a� /(fir (/IJV
O ¢ ser is licensed
the•dp pursuant
t t the PC provisions
to of
a signed CState ontractor's
i that TOTAL PERMIT TO
a ea w m m he is licensed Pursuant td the provisions of the Contractor's License
HZ > Law(ChapterProfessions
ode)with Secthat
7s 00)exempt
andthe F��p
or 4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ r o Osc basis for the alleged exemption.Any violation of Sedinn 7031.5 STORIES PE CONSTR.
dam by any applicant fora permit subjectstlse applicant ton civil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00
carrot mora than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as ,ACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 1640D sD.FT FLOOR AREA TOTAL ACREAGE
himself or through his own employees,proviAeit that such imProve-
meetsarenotintendedor offered for sale.If,however,the building GAS,EA.SYSTEM-IINC;4OUTLETS 6.00 ,Z/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 fsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB 0me." .r
O 1,as owner of Ore property,um exclusively contracting with
licensed contractors to construct the project(Sec, 7044,BusinessLAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to in owner of property who builds or improves(hereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts for such projects with a contractorts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCELNO.
D l am exempt under Sec. ' ,B.&P.C.for this WATER HEATER W/VENT 6.00 VD
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
-I hereby affirm that I have a certificate ofconsent m self-insure, 7-
or a certificate of Workers'Compensation Insurance,or u certified - ZONING ENG.SITE NO.
copy thereof(sec.3800,LAC'l.2u,
_ Policy No. Company
O ❑ Certifie copy is hereby furnished. / FIRE SPRINK ENERGY T 24
Z Z X Certified o y isthe city inspection division. - -
� O Applimnt Y �A�--_. _ MISC.- REFER TO ORD. YE] NY � N,-,y CISRTIF CATS OP 1-)EM1'TION PROM WORKERS' PERMIT ISSUANCE 10.00 (2, UM FLOOD ZONE A.L.u.c.
LU COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG.
D" o (This section need not be completed if(lie permit is for one TOTAL �2e d Y El NEI Y NE)
Z hundred dollars(8100)or less)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mil is issued,I shall not employ any person in any manner so as to
become subject to 0m Workers' O
Compensation Laws of California. s ' Ui
0 0. Dare Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 1
} 0 NOTICE 1'O APPLICANT: If,after making this Certificate of Ex.
? emption,you should become supject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of.the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOMC.F.M.) 6.00 SEISMICFEE 6 ?�
1 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(Sea 1,� MICROFILM
3097,C,,C.), HEATING UNIT(TO 106,000 B.T.U.) 8.00 C1,00
Lender's Nude EATING UNIT(OVER 100,000 B.T.U.)9.50
Lenders Address HELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and Lomlly BOILER•CUMP13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. -MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilitiesjudgments, cysts unit expenses which PERMIT ISSUANCE _ 10.00 .L00 CONST.TAX
ma in an wa accrue again st Said Ci[ in consequence of the
d ing of this permit MECH.CONT. LIC.NO. TECH.
TDTA TOTAL S
Signe reof Applicant/Contractor Dat ,1 '
OFFICE COPY