16277POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO
16277
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION `I
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JOB ADDRESS /�9`�S4 r (R91ST4- /Q UNIT# _LOT#
' -
PERMIT� EXPIRES IF WORK '
OWNER Q CONTRACTORS A{.C7,[>r `c—
CL—
IS NOT STARTED WITHIN
180 DAYS OFPERMIT ISSU.,
ANCE OR 180 DAYS FROM'
' INSPECTION DATE I INSPECTOR
INSPECTION RECORD
FOUNDATION -
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
LASTCALLED INSPECTION:
LIFER
PREGUNITE
PIMMn VAI.IDAI ION
CUPERTINO STANDARDS.
-
/ .-
!I
G'. r• i' '-
ISSUANCE DATE
—FIFE1—LE
GARAGE SLABS •-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
.;UNDERGROUND/SLAB
PLUMBING
- -
ELECTRICAL
MECHANICAL
C r:
PLO ME Il,
❑
I 0 I
❑ ® 1
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
. . .
BUILDING PERMIT
INFORMATION
' WOOD FLOOR
VALUATION
Q � M' '.
D
$ITT.
PLUMBING � � -
� .• �
MECHANICAL
ELECTRICAL
``\\
PERM"r/o�i��
FRAMING
T
INSULATION
\ri
sroRles
TYv CONSTR
I ''
OCC GROUP
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF.
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
so IT. FLOOD Anka
roraL acneacE
DIAPHRAGM
ROOF SHEATHING
BUILDING USE
,RES IND CON PB 00—
❑ . ❑ ❑ ❑ 1:1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE •INSP.
ROUGH
SAN.N
ASSESSORS PARCEL NO
PLUMBING
ELECT. ENERGY - -
TUBS 8 SHOWER PAN � -
PLUMBING ENERGY � '
TRACT NO.,
PARCEL NO
MECHANICAL
MECH.ENERGY
ELECTRICAL
BUILDING ENERGY
ACC GATE
Acc, PiLg No
FRAMING -
ELECT. FINAL TEST
INSULATION
PLUMBING
ZONING
ENG. SR'E NO.
GAS TEST
GAS
MECHANICAL
PIRESPRINK
F�
ENERGY T.24
N ;
"O
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR - -
ELECTRICAL RELEASE
NE
P�poo ZONE
`
Y ❑ NO
_ A. L,U.c.
` ❑•N❑�
INTERIOR SHEAR
FIRE DEPT. - -
SHEETROCK
GRADE -
FLEE SUMMARY
EXTERIOR LATH I
BUILDING (—' Z
BUILDING
INTERIOR LATH'
TEMPORARY-APPR0 ALS
SCRATCH COAT
ELECTRIC
PLAN CHECK
FEE
"
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY
-
SEISMIC FEE;
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL- BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC'
Iw—� ONE WORKING DAY BEFORE,REOUIRED INSPECTION.
PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
a �'
z
—SEE PERMIT FOR EXPIRATION DATE —.'
CONST. rnx,
IMPORTANT!
TOTAL
\�Z)
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
...;
OFFICE COPY
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API'LICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.9UILDING PROJECT IDENTIFICATION
-
APPLICATION &PERMIT
BUILDING — ELECTRICAL— PLUMBING — MECHANICAL?'
PERMIT NUMBER ;
r 1
BUILDING
ADDRESS
.0
OWNERS
NAME
a+►has, pay 1AC410d..NE 6-`Zlo
OTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
"
DATE OF APPLICATION
CONTRACTOR 5 !� A �� `
NAME.(, fL7 /_0-/qd'(�S�
i1C. N0. 44115 S'
cu%ACESAre---_--___. _.r
aooREas
% 5 N. i9✓ 1(Jpo" PHONE' ?4'00
OUTLETS -SWITCHES -RECEP"10,00/1.00
LIGHTING FIXTURES 10.00/1.00
APPLIANCES -RESIDENTIAL - 4.00
.I PANELS .14= ��,
onCHITECT
ENGINEER uc. No.
PANELS (OVER 200 AMP) 20.00`
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ARCH. OR ADDRESS ENG.
-
ZIP
1 SPECIALCIRCUIT '(&"F
PERMIT VALIDATION
ISSUANCE GATE
SLOGELECT. PLG. MECH.
. ❑
-
BUILDING PERMIT
INFORMATION
At -DATION $/FT.
EMP. METER OR POLE INS. 20.00
AS
ADDREDDRESSS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20,00
LICENSED CONTRACTORS DECLARATION
1 hereby affirm that I am licensed Under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full forcq yqd of •c .
License Class_a Lic. Number—
Date
(�
- ,, 19
OWNER-BUILDERsri DECLARATION
I hereby afCinSE,exn that 1 sm empt from the Contractor's License
Law for the following reason. (Sue. 7031.5, Businessund Professions
Code: A Gy city or con n ty which requires a perm it to consuct, al ler,'
tr
improve, demolish, or repair any stmdure, prior to its issuance, also
requires (be applicant for such permit to file a signed statement But
he is licensed pursuant to The provisions of the Contractor's License
Law (Chapter 9(commencing with Section 7000)o f Division 3 .1 (1,C
Business and Professions Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.$
by any applicant for a permit subjects the applicant (oa civil penally
of not more than five hundred dollars ($500).):
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will do The work, and the structure is not
intended or offered for sale (Sec. 7044, Business and professions
Code. The Contractor's License Luw,dues not apply to an owner of
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve
mems are not intended or offered for sale. If, however, the building
or Improvement is sold within one year (if completion, the owne
builder will have the burden of proving that he did not build or int.r-
prove for purpose of sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, BusinessLAWN
and Professions Code: The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon, and who
contracts for such projects with a corllruelm(s) licensed Pursuant In
theConlractor'sLicenseLaw.
❑ IUm exempt under Sec. ,B.&P.C. for dais
re ton
MISC.— REFER TOOPF
PERMIT ISSUANCE
ELEC. CONTR, LIC. NO.
ELEC. '}
TOTAL .Z
3
PERMIT TO
QTY. PLUMBING PERMIT - FEE
STORIES
TYPE CONSTR.
ALTER -DRAIN& VENT -WATER (EA.) 5.00
BACK FLOW PROTECT. DEVICE. 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AR EA, COND. 5.00
FIXTURES - PER TRAP 5.00
GAS - EA. SYSTEM -11 NC.4 OUTLETS 6.00
so. FT. FLOOR AREA
TOTALACREAGE
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDING USE
RES WD CON PB Our.,
INDUSTRIAL WASTE INTER. 30.00
SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
SEWER -SANITARY -STORM EA. 200ft/10.00 -
TRACT NO,
'
PARCEL NO.
WATER HEATER W/VENT 6.00
owner Date
WORK ERS'COMPENSATION DECLARATION
I hereby affirm that 1 have u certificate of consent to self -insure,
or it certificate of Workers Compensation Insa inCe, or a certified
copy thereof (See. 3800, Lab.C.).
Policy No. Company
❑ Corlified< IS m fumishod'
❑ Ceftifte y with she city inspection division.
Applicant
CRTIF KG
E,ATE OI' EX PROM WO RK Ii RS'
COMPENSATION INSURANCE
(This section need Intl be completed it the permit is for one
hundred dollars (S 100) or less.)
I certify that in the performance of the work for which this per-
alit is issued, I shall not employ any person in any Unarm so us to
become subject To the Workers' Compensation laws of California.
Dare Applicant
NOTICE '1'O APPLICANT: If, uRer milking this Certiticate of Ex-
entption, you should become subject to the Workers'Compensalion
provisions of the Labor Code, you must forthwith comply withFEE
such proons or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is it construction lending agency for
the performance of The work for which this permit is issued (Sec.
3097, Civ.C.).
WATER SYSTEM 5,00
ACC.DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
ZONING
ENG. SITE NO.
FIRE $PRINK
y[] N�
F�NERGV T-24
Y[] N �
MISC.- REFER TO ORD.
PERMIT ISSUANCE 10.00
FLOOD ZONE
V C] N
A.L.U.C.
Y [:] N�
PLG.CONTR. LIC. NO. -
PLG.
TOTAL
,..
OTY. MECHANICALPERMIT +0'" FE
J 1+
FEE SUMMARY
BUILDING
ALTER OR ADD TO MECH.
APPLIANCE , 0\
AIR HANDLING UNIT (TO 10MG.F. .)
PLAN CHECK
AIR HANDLING UNIT (OVER 10=C.F.M.TJ, 0
SEISMIC FEE
EXHAUST HOOD (WITH DUCT) 5.00 '
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.)
Lender's Name
Lender's nddriss
1 certify that I have read this application and state that the above
information is correct. 1 agree to comply with all city and county
onlinonocs slid elute laws relating to building construction,' and
hereby
hereby authorize representatives of this city es enter upon the
above-mentioned properly far representativesf this
purposes.
(We) agree to aave; indemnify and keep harmless the City of
upertino against liabilities, judgments, costs trod expenses which
ay in wa ac<r against said City in consequence of the
ranlin hi er
H EATI N G UN IT (OVER 100,000 B.T.U.) 9.50
ELECTRIC
VENTILATION FAN (SINGLE) 4.00
PLUMBING
BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEESCH.
MECHANICAL
p2-7 �
MISC. - REFER TO ORD. -
pERMiT ISSUANCE ,ag;g0
CONST. TAX
MECH. CONT. LIC. NO. MECH.
OTAL 7 S�
TOTAL
SJ S
$nature of Ap 'ca I/Contractor Date
OFFICE COPY