16284 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO I
f 1
INSPECTION DIVISION 6223 '
JOB INSPECTION RECORD
• - ' ,� / fy�.J
441433 PERMIT EXPIRATION
JOB.ADDRESS Ni �dLY .. /� !� UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER, C-,/—A= CONTRACTOR ELT J IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: - LAST CALLED INSPECTI ON.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED `
UNDERGROUND /SLAB l
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLuc ELECT PLG. MECR
El El ,.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDI G PERMIT
WOOD FLOOR Al ATION
A A siFT
PLUMBING fl I I
MECHANICAL
ELECTRICAL \ PERMIT To
FRAMING J!"
INSULATION STORIES TYPE CONSTR.
DCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn.Er ELooR-arEA roTAL ACRE`cu
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PB Om"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING I ELECT.ENERGY
iNACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC.PILE No
'FRAMING ELECT.FINALTEST,
ZONING ENG.SITE N0,
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T•aa
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N i ❑ No
EXTERIOR SHEAR
ELECTRICAL RELEASE PEooD ZONE A.L u.c.�
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ NO
SHEETROCK GRADE - - FEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH TEMPORARY APPROVMA BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK p
GAS . FEE J
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING.DAY BEFORE REQUIRED INSPECTION. ;;?s, uM NG
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL a S
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• BUILDING PROJECT I DENTI FI TION .PERMIT NUMBER
no'oae"s° p APPLICATION & PERMIT 1 O 'A
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I of{
OWNER'S PLAN CHECK VALIDATION
NAME DTV. ELECTRIC PERMIT FEE
. DO,rAM 1-4., PRGNE
NAMERAc7ORs UTLETS-SWITCHES-RECEP 10.00/1.00
e t7ta S14,- LIc.No. LIGHTING FIXTURES 10.00/1.00 -
r-ory crag'sC �1�Oq APPLIANCES-RESIDENTIAL 4.00
ato AD
DRESS
'A ^ E PRONE PANELS 10.00 DATE OF APPLICATION i
On RITECT PANELS (OVER 200AMN 20.00 PLAN CHECK FEE C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ADDDRESSS Erva SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT S ( Q S ^ I.A. ^A-VI, q4{ MOTORS SEE FEE SCH.
L SERVICE CHANGE 20.00
F02
' - 1
oo LICENSED C NTRACTORS DECLARATION v3/
a v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w< m (commencing with Section 7000)of Division 3 of the Business and BLOC. ELECT. PLG. MECH.
F w 2 Professions Codc, d t y ' use is in full for al of ec.
o
2 w License lass Lie.Numbe ❑ ❑ ❑ ❑
9 y 4 w Uaro Contractor y
ns BUILDING PERMIT
¢ ¢
OWNER-BUILDER DECLARATION
a Q W u INFORMATION
F
;e N I hereby affirm that I am exempt from the Contractor's License M15D.- REFER TO ORD
AFEE
$/FT.
r:oj Law forthefollowingreason-(Sec.703 uires a, it to
Professions PERMIT ISSUANCE 10.00
i Code:Anymolish counlywhiny structurepermit prior
taconsuancalter,
= = <0 IIIIpfOVe,delnnhSy,Or repair any 6(rnClart.prl0f IO its IernanCL`.also ELEC.CONTR. LIC.N0. ELEC.
o w m u requires the applicant for Such permit to file a signed statement that TOTALIT 0
he is licensed pursuant to the provisions of the Contractor's License AWwZ¢ Law(Chapler IIcommencingwilhSeclion 1000)ofDivision3ofthe
Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT M J e the basis for the alleged exemption.Any violation ofSection 7031.5TVPE CONBTR.
;m by any applicant for a permit subjects the applicant to a civil penaltygLTER-DRAIN&VENT-WATER (EA.) 5.00
of not more lhon five hundred dollars(S500).):O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00RES.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,COND. 5.00
,. Code:The Contractor's License Law does not apply to an owner of
properly 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-meats are not intended or offered for sate.11,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that be did not build or im- RES IND CON PB Orae.
prove for purpose of sale.). , INOUSTRIALWASTE INTER. 30.00
CI 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
lice used contractors to construct the project(Sec. 7044,Businoss LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsueh projects with a contraclorts)licensed pursuant to SEWER-SANITARY-STORM EA.200h/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&PC.For this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO. '
WORKERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm (list I have a certificate of consent lO Sel Ginsure. ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
Copy thereof(Sec
Co.3 Lab C.I.
Polley No. Company J A
OCetliO dcopy i5 hereby furnished. FIRE SPRINK ENERGY T$4
Ce y ]ad�l1 �he city �nspectwo division.
Z ZO�XA plcanl_ -.I'Y ` �_ . MISC.- REFER TO ORD. Y❑ N❑ v❑ N❑
CC CERTIIICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
d
TOTAL Y N v 0 COMPEN$A'fiON INSURANCE PLG.CONTE. LIC.NO. PLG. ❑ ❑ C] ❑
(Phis Section need not be completed if the permit is fur one TN
D Z hundred dollars(SI 00)or less.)
U O 1 certify that in the performance of the work for which this per, OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mil is issued,I shall not employ any person in any manner sn us to
U become subject to the Workers'Compensation Laws of California.
y Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING .�
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions. of the Labor Code, you must forthwith comply with FEE Q r '
U sucprovsions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,OODGF.M.) 4.00
13
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.F.M.) 6.00 SEISMIC-FEE. s1�
I 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(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC
I certify that 1 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 county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon We BOILER-COMP(Over 100,000STU)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.
uperlo against liabilities,judgments, costs and expenses which CONST.TAX
ay iinn any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
of this per MECH.CONT, LIC,NO, MECH.
TOTAL
TOTAL 4
lure of A pplican t/Contractor Date
OFFICE COPY