16267 POST'THIS CARD NEAR-FRONT-OF BUILDING
NUMBER
• •CITY OHUPERTINO . ' ` 16267 f
INSPECTION;DIVISION
JOB INSPECTION RECORD `"
PERMIT EXPIRATION
JOB ADDRESS �1 V/`s�1�'•��C UNIT# _LOT#
PERMIT EXPIRES IF WORK i
OWNER -N S p - ' ' CONTFACTOR ,Ej-�, IS NOT STARTED WITHIN I
INSPECTION DATE INSPECTOR INSPECTION RECORD IOU DAYS OF rERMIT•ISSU-',;
n ' FOUNDATION . ANCE OR:180;DAYS,0ROM ,
"NOTE:. LAST CALLEDINSPECTION.
UFER ALL GRADING AND'DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF. PERMIT VALIDATION
PR EGUNITE ' OUPERTINO:STANDARDS..'
.GARAGE SLABS' ', . ' - - '- -��•
POUR NO CONBRETE UNTIL ABOVE HAS BEEN SIGNED T +• = ' r
'UNDERGROUND-
/SLAB
PLUMBING. ' , x•;1 /1 .. �' . ,/��r ,_r�
ELECTRICAL t= O'• ISSUANCE DATE
MECHANICAL mecR.•
El 1:1 ❑.'1`
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
CJ -' WOOD FLOOR INFORMATION
"` - a � /YALUATION $/FT., .1
PLUMBING '
y1
MECHANICAL '' .. >• . . /• - .� ;-
ELECTRICAL - :• -� PERMIT To
FRAMING
INSULATION - snlHles TYPE CONSTR.
(y /j occ.cnour -Res urvrts
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - NOTE: OFk AL INSP:SHALL BE MADE BEFOREsa rT�vLoal nacn �goTnL ncasnee -
DIAPHRAGM, THE CONSTRUCTION TAX'IS,PAID.-
, BUILDING USE
ROOF SHEATHING" .IND CON Pa 011,1.1
-APPLY NO ROOFING UNTIL ABOVE'HAS BEEN SIGNED` - FINALS.' K7EI�l INSP., 0` '❑ ❑ - ❑ �
ASSESSORS PARCEL NO
ROUGH SAN.#
+ PLUMBING ' - -
- ELECT.ENERGYTRAGI NO. PARCELNO.
TUBS.&SHOWER PAN � - PLUMBING ENERGYMECHANICALMECH:ENERGY.ELECTRICAL ' MECH.ENNG ERGY. Acc,DATE ACC.FILE NOFRAMING BUI ELECT.FINAL TESTZONWG ENG.SITE NO.
' INSULATION '' - � - PLUMBING
GAS TEST GAS
- +FIRE SKUNK' . ENERGY L]J.
MECHANICAL
COVER NO.WORK.UNTIL ABOVE HAS BEEN SIGNED HEATING Y��• "�� "�
.. 11_000ZONE- A,L.U.C..
EXTERIOR SHEAR -P EL'ECTRICAC'RELEASE " •+
INTERIOR SHEAR ` FIRE DEPT. Y.❑ ,N❑ v L7 "❑.'
SHEETROCK' - - GRADE ' - FEE SUMMARY
EXTERIOR LATH BUILDING -
,INTERIOR LATH - - TEMPORARY APPROVALS .y BUILDING � � �•,
SCRATCH COAT ELECTRIC PLAWCHECK ;
GAS; FEE '. .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE G "
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDI NGFINALIS SIGNED BY BUILDING INSPECTOR. MICROFILM a
' AR'RANGE.FOR INSPECTION-BY,PHON,ING 252-4505, ELECTRIC i
' Fi—�� . ONE WORKING DAY BEFORE'REOUIRED INSPECTION PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z — SEE PERMIT FOR EXPIRATION DATE MECHANICAL �! .
IMPORTANT!
CONST.TAX
' I r''•
PLEASE READ REVERSE SIDE BEFORE z TOTAL
CALL,ING'FOR FINAL INSPECTION:
OFFICE COPY.
APPLICANT TO FILL IN INFORMATION.WITHIN RED LINES — USE'BAL'L'POINT PEN ONLY —
,J3UILDINGPROJECT IDENTIFICATION - • 'PERMITNUMEIER,
BUILDING APPLICATION & PERMIT 62L+�
ao�E�� r- �f!/rY/ yp` • BUILDING —ELECTRICAL—PLUMBING—MECHANICAL _ C6
OWNER'S Ke !/1 V✓ F'' _ M PLAN CHECK,VALIDATION
NAM C'�- " '• ice.. z OTV. - ELECTRIC PERMIT , �F EE ,
PHONE J
CONTHAC RS
eNo. r
NAMERe x / UTLETS-'SWITCHES-RECEP 10.00/100
v m. lI 2— / LIGHTING FIXTURES '10.00/1 00 `
ADDRESS*
r - [///•JJ; /p rJ/'',y/� 'G - APPL01,1i ,fRESIDENTIAL 4.00 +
Z0 - k�N PHONE PANELS ` `10.00 GATE OF APPLICATION '
ARCHITECT •` PLAN CHECK FEE P C NO.
-
on
PANELS (OVER 200 AMP) 20X6
emcwEER'. ' ap'(iyp.�i uc.No.' SIGNSTRANS: _ 0 It
ARCH.OR ENG. PERMIT VALIDATION.
ADDRESS SPECIAL CIRCUIT 5.
•'tip EMP.METER OR POLE INS. ��
APPLICA NTS Ir MOTORS ' SEE FEE SC
,}•� ADDRESS Q n �1 -A(, E L4
2 L 1 �'(Jll (-, SERVICE CHANGE" 20.
woo - CICRNSEU CONTRACTORS DECLARATION
..
I h reby affirm that I am licensed under pnivfsfons of Ch after 9 - ISSUANCE DATE I•
a z w
(commencing
rot s ons C., is in full force( omencing with Section 7000) f Division i of fsil-
e BtSIRCIs and.
- BLDGELECT. PLO MECH.
0F License Class Lic Number (—]
0 m0Uatc Cotractor If,
fJ
"
m f ppe LDING PERMIT
¢ ' OWNER-B UILUER DECLAIjA'I'ION . - - Uy
6'a e- u - ? `- '- INFORMATION
w 0 a F 1 hereby affirm that 1 am exein t from'the Contractor's License MISC. <: v. REFER TO ORD
a. 0 Y I �`- VALUATION $/FT.
FUN J Law fortheity following
county
which Business tocodProfessions PERMIT ISSUANCE 10.00 `/M -
Ew g Code:Any city or county which reyuiresaperm tip cpnstnmt,alter, O V�
IC eaQ O improve,demolish,or repair any structure,.prig r to its Ixa'nice,also ELEC.CONTR.- I ILIC,NO. ELEC
A w0 C requires the applicant Cor such pent t0 file a sign ed statement that • TOTAL' , PERMIT TO
m he a licensed pursuant to lint provisions of the Contractor's License
F•z Q Law(Chapter9(commencing with Section 7000)of Division 3 of the
i o Business and Professions Code).or that he is exempt therefrom and DTV. PLUMBING PERMIT 'FEE
R F$ the taxis for the alleged exemption.Any vjokliol of Sectipm 7031.5 STORIES - TYPE CONSTR.
a ; by any applicant for a permit subjects the applicant toll civil penalty
of not more than five hundred dollars($S00).): ALTER-DRAIN'&'VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with.wases usBACK FLOW PROTECT.DEVICE' 4.00 OCC.GROUP RES.uNrts•
their sole compeneutlon,twill do the work,unit the etnwture'is not '
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 r
Code:The Contractor's License Law does not apply to an owner of -
prefoily who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 so,FT FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such.improve- -
memsarenotintendedmoffcool made.IE however,file building _' GAS-EA.SYSTEM-11NC.40UTLETS 6.00 -
�l or improvement is sold within one ycm of completion,the owner GAS-.EA.SYSTEM-'OVER 4 IEA.1 2.00 L BUILDING USE
;
builder will have the burden of proving that he did not build or int- - .RES IND CON � PB Omer
prove for purpnsc of soleal.' + ' INDUSTRIAL WASTE INTER. ' 30.00 +.
❑ 1,as owner of the property, L, xd,oivQly'cmItractmg with ❑ ❑ ❑ ' ❑ ❑
licensed contractors to construct life project(Sec:,1044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 .. A55EssoRS PARCEL NO.
and Professions Code:The Couromoor's License Law does not apply , -
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with it mntractons)licensed pursuunt to SEWER-SANITARY-STORM EA.200ft/10:00 -
file Conl racier),License L(w, TRACT N0, y .PARCEL NO.
❑ lam exempt under See �:B.&P.C.for Ilii, WATER HEATER W/VENT 6.00 -
reason
OwnerDate' WATER SYSTEM :5.00 ACC.DATEACC:FILE NO.
WORKERS'COMPFNSA1'ION DECLARATION WATER'TREATING EQUIP'. 5,00 I. .+ 11
-
I hereby affirm that I have a certificate of consent to selfersure;
or a e ofrcat,of Workers'Compensation Insure o,ora urtf Red ZONING ENG SITE NO.
LopY (Sea 3800 ab C)
1011CYl NNoo. C ,L �^
A).
Q (� ❑ Certified copy ishereby furnished - FIRE SPRINK ENERGYT24`.
Z 2 \ ❑ Certified co is fIsd with fire city inspection division. MIS - REFER TO.OR D.
AI PhLunt . Y ❑ N❑ Y ❑ .N❑
M ' PERMIT ISSUANCE; - ' •1000 -
P — C:RTIF ATF.O- :XEMI'TION FROh1 WORKERS' ,' FLOOD ZONE r 'A L.U.C.
LU - COMP17NSATION INSURANCE PLG.CONTR._ LIC.NO. PLG.
CL 0• Cfllis section need not'be completed it the permit is for one TOTAL Y C-] NC] Y❑ N❑
- hundred dollars($1000 or loss), �' • - -
U O (,certify that in the performance of the work for which this Per DTV. MECHANICAL PERMIT VFEEFEE SUMMARY
LL F mit is issued, I shall not employ any person in!ny manner so as to
O w become suhject to the Workers'Compensation Laws of California. -
y Dme APNicant ALTER OR ADD TO.MECH. ' 5.00 6 Ojrn NO'T'ICE TO APPLICANT': If,after making this Certifie:ile of lis.emptim,you should bettnme subject tp the Workers'Compensation APPLIANCE 5.00CK -prov¢Ions of the LaborCode, you must forthwith unnply'with,Usuch provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00E^.' 'I hereby affirm that there is a construction lending agency for EXHAUST,HOOD(WITH DUCT)• 5.00the performance bf the work for which thiipcimit is issued(Sec. M3097,Civ,C.). HEATING UNIT(TO100,000 B:T.U.). 8.00
Lender's NameHEATING UNIT(OVER 100,000 B.T.U.)9.50Lender's Address
I empty mat l have read this allb .ono,at slate that thcabove VENTILATION FAN,ISINGLE) • '400 '
�t mf Onation is correct I agree to Lonfply with all city and county 'BOILER-CON1P 13 H.P.or 100,000 B.T.U:1 600 PLUMBING ,
ordinances and slate laws relating to building construction, and
hereby-aufhorvc representatives of this city to enter,upon lilt
abovume ntioned property for Inspection purposes. BOILER-COMP (over 100,000 BTU(SEE FEE SCH. MECHANICAL
- (We) agree to save; indemnify and keep harmless the City at MISC.- " _ REFEWTO ORD. + -
Cupertino against liabilities,judgments, costs and expenses'which - CONST.TAX
ay in nay'way accrue against said City in consequence of.the PERMIT ISSUANCE 10.00 '
raOliIf IhiS permit MECH.CONT LIC.NO. - MECH.
TOTAL i ' TOTAL 9/
Signature of A pplican t/Contractor Date
OFFICE COPY.