16863 POST THIS CARD'NEAR FRONT OF BUILDING
Ilk
PERMIT NUMBER. •CITY OF CUPERTINO ` 16863
L, INSPECTION DIVISION
JOB INSPECTION RECORD
/ } O P RMITc@XPIRATION
� IX
JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK
-> so�i�I�S 1�r R C.� z Cr✓u� '
_
OWNER CONTRACTOR .� IS NOT STARTED WITHIN -
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION 'NOTE: _ ANCE OR 180 DAYS FROM LAST .
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED -I CALLED INSPECTION.
PREGUNITE ' TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT vnuon rloN
CUPERTINO STANDARDS,
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE UAIL
MECHANICALa ELECT PLG. NECH
I ❑- ❑ ❑ ❑ I
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL - " •��'V
ELECTRICAL - ��!!''`` PERM1 r•r
FRAMING'
IOHI[$
INSULATION CON$TR
F
1
OCC.GROUP HES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
SO ET FLOOR AREA TOTAL ACREAGE
' ROOF TE: pr
INS AL BE MAYE BEFORE '
DIAPHRAGM T ECO AXIS ID
/ RUILOING.usE
ROOF SHEATHING Hes IND CON Pu' 011111
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED INALS DATE INSP.
- ASSESSORS PARCEL NO
ROUGH SA .p ,
PLUMBING .ENERGY -
' TRACT NO PARCEL NO.
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC FILE No
ELECTRICAL
BUILDING ENERGY
FRAMING. ` ELECT.FINAL TEST 'ZONING ENC.SITE No.
INSULATION _ PLUMBING
GASTEST GAS
FIRE SPRI IN N ENERGY_L
MECHANICAL Y Q NQ. v � �
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALU C.
INTERIOR SHEAR - FIRE DEPT. Y❑ .N� Y ❑ riQ
R'
SHEETROCK GRADE' _ FEE SUMMARY
EXTERIOR LATH BUILDING
"r INTERIOR LATH - TEMPORARY APPROVALS rBDING �� 00
-•,J SCRATCH COAT . ELECTRIC CHECK
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - IC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTEDUNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. OFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, rRIc
�� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
— SEE PERMIT FOR EXPIRATION DATE —
MECHANICAL
y - IMPORTANT! CONST.TAX
�PLEASE READ READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE ODPYE
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDING PROJECT I DENTI FICATI ON VERMIT NUMBER
APPLICATION PERMIT 16863
np �P ING -ELECTRICAL-PLUMBING-MECHANICAL � �`
A, OANER'5 PLAN CHECK VALIDATION
"AME DTV. ELECTRIC PERMIT FEE
_
PHONE
CONTRACTOR'S q
NAME UTLETS"-SWITCHES-RECEP 10.00/1.00
uc.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR
AC CRESS
PPLIANCES-RESIDENTIAL 4.00
PHONE/A PANELS 10.00 DATE OF APPLICATION 1
ARCHITECT PLAN CHECK FEE
oR - uPANELS (OVER 200 AMP) 20.00
ENGINEER
c.No. SIGNS TRANS. 3.00
ARCH.OR E.G. - PERMIT VALIDATION
ADDREss / !�r3 SPECIAL CIRCUIT 5.00
4 O P 9xs� EMP. METER OR POLE INS. 20.00 AD Adi f L/
APPucnrvT's MOTORS : SEE FEE SCH.
ADDRESS o
` '✓� zh'✓ .112RSERVICE CHANGE 20.00 �O
o o LICENSED CONI'RACfOkS UGCLARA'I'ION FWD
I hereby affirm (hut I am Iiconsed under provisions of Chapter 9 SSUANCE DATE ,
may Icrmmancing with Section 7000)of Division 3 of the 9usinessmd BLD ELECT. PLG. MECH:
H 4.4 1989
m z Professioro Code,an y license is in full for f ❑ ❑ ❑
oi u, o License Class Lia Numlur_ -
H m H w Date Con(mcmf_
- BUILDING PERMIT
V.� ¢ ¢w¢ O Ii R-BUILDER DEC ATION
A O a ° MISC.- O ORD INFORMATION
w 1 hereby affirm that 1 am exempt from the Contractor's License
a- o j Law for the following reason(Sec.7031.5,Business and Professions '"PERMIT ISSUANCE 10.00 VALUATION 'S/FT.
9 r - Code:Any city or county which requires permit to construct,alter,
1 x a improve,demolirilt,or repair any structure,prior to its issuance,also ELEC.CONTR., LIC.NO. ELEC.
D ¢ requires the applicant for such penuit to Glc a signed statement that TOTAL -
u w$ lie is licensed pursuant to the provisions of the Contractor's License PERMt ..
Ir, r ¢ �w Law(Chapter 9(cmumencingwiWSectimt 7000)ofDi ,um3of the
Business and Professions Code)or that be is exempt therefrom and QTY. PLUMBING PERMIT FEE rJ�/
.10 0 the basis for the alleged exemption.Any violation of Section 7031.5 CONSTR.
r. d by any applicant for a permit subjects the applicant tea civil penally ALTER-DRAIN& VENT-WATER (EA.) 5.00
o(not more than five handed dollum($500).): -
•I ❑ ,I,as owner of the property,or nsy employees with wages as 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 (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONE). 5.00
Code,The Contractors License Low dos not apply to an owner of
property who builds or insptnve.thereon,and who docs such work FIXTURES-PER TRAP .5.00 SO.FT FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve
ments notintendedor within
tf y...sale.If,however,the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or Improrcmenl is sold within one yea 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 1,as owner
of sthe p INDUSTRIAL WASTE INTER. 30.00 RES IND El Dross
❑ L as owner of the construct
he exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to co Contrs the project(Sec. 7094,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions of Calc The Contractor's I-kenos Law does not apply
t man owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) . 1.00
contracts for such projects with u mntrlraclurl sl licensed Phnuanl rn
�
the Contractor's License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT no. - PARCEL No.
❑ Iumvsemptuxder Sbc. ,BAP.C.for this WATER HEATER W/VENT 6.DO
reason
Owner Dat, WATER SYSTEM 5.00 ACC.DATE ACC FILE NO:
_ WORKF-RS'CO.NPENSATION DECIARAIION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofconsent m self-insure
or a certil icute of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy tNu. IScc.3800, an
Lah.C.).;///zys
Policy Na Compy !/ ��iL
❑ Certified copy is hereby furnished.
Z 2 Cerlilkd copy is file with the oily inspection division. � FIRE BPRINK ENERGY T 2
It /ri, MISC.- V REFERTOORD. ElN❑ V E) ❑
M1'tfllCunl N
y C 1 R'I'I FIC E E7,SIPTION FROM WORKERS' PERMIT ISSUANCE .10.00 FLOOD ZONE A.L.U.C.
UJ > MPEN'SATION'INSURANCE PLG.CONTR. LIC.NO. PLG.
d O Irhis section need not,be.conspleted if the permit is for one
TOTAL V❑ NNC] V ❑ N
Z Z hundmd dollars IS 100)or less)
I certify that in the performance of the work for which this per- QTV. MECHANICAL PERMIT FEE FEE SUMMARY
V LL F- mit is issued,I shall not employ any perom in any manner m as to
O was become subject to the Workers'Compensation Laws of California. -
Dam-Applicant BUILDING
} n NOTICE'TO APPLICANT': If,utter making this Certilicate of lix- ALTER OR ADD TO MECH. 5.00 �s OD
F= emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
' provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10 47-F. L) 6.00 SEISMIC FEE O�
I hereby of Ce that (here is r construction this It lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance o tl a work for whi this permit is issued IScc. MICROFILM
31)97, Nan. Giii�ssc/ � HEATING UNIT(TO 100,000 B.T.U.) 8.00
IAF Lender's,',Name
Lender's Address F � HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I cenily that 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
-, information is correct. I agree to comply with all city and v.only PLUMBING -
ordinances and state laws relating to building construction, and BOILER-CObP(3 H.P.or 100,000 B.T.U.) 6.00
hereby enthosed rogeny fori s ec this city es enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
hereby autiotsed property for inspersion purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. -
'upertino against liabilities,judgnsonts, u,1., and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
say in any way accme against said City in consequence of the
noting of this r1 g. MECH.CONT. LIC NO. MECH.
TOTAL TOTAL
Signature pplicant/Contractus Da
OFFICE COPY