16971 POST THIS CARD NEAR FRONT OF BUILDING
' PERMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION 16971
JOB INSPECTION RECORD
'�1 u r L�' - PERMIT EXPIRATION
JOB ADDRESS jb tq( M JUL 'UNIT#' - LOT 4P
. - - .PERMIT EXPIRES IF WORK
owrvER• .� � coNTRAcroR P IS NOT STARTED WITHI1
N,
INSPECTION DATE I INSPECTOR fNSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE.SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE'APPROVED PLANS AND CITY OF —W- PERMIT,VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS. PAID _ �^^ /
.J
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB T,IN1~ 0 1989 ,�. _���1. ( •U A.c / /'
PLUMBING ^t �{//y�,�� V� i
ELECTRICAL gill v4$R11peyft ISSUANCE DATE
MECHANICALa UG 'ECT ECH.,
• • .❑ LG ❑ ,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION - $/FT.
PLUMBING - - �I�•�/]N
MECHANICAL -
ELECTRICAL N
-7P EMIT TO
FRAMING V rv—' —zkIV
INSULATION STORIES - TYPEC STR-
OCC GROUP Res UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID '
BUILDING USE
ROOF SHEATHING - RES IND❑ ❑ _❑N ❑ ❑
o '.
,•
PCAPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. qSS ESSOR$PARCNO
ROUGH SAN.N
PLUMBING ,$-2 ELECT.ENERGY
TRACT NO, PARCEL NO
TUBS 8SHOWER PAN PLUMBING ENERGY -
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC.DATE. ACC.FILE NO
FRAMING ELECT.FINAL TEST •ZONING ENG.SITE NO
INSULATION PLUMBING -
GAS TEST GAS .
MECHANICAL' - FIRE SERINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v ❑ N[- ` ❑ NE]
EXTERIOR-SHEAR- ELECTRICAL RELEASEFLOOD ZONE A.L-uc. -
INTERIOR SHEAR FIRE DEPT. i '❑ Np - v ❑ NQ
SHEETROCK ' GRADE FEE SUMMARY
EXTERIOR LATH BUILDING '" Z'- BUILDING
.INTERIOR LATH TEMPORARY APPROVAL
SCRATCH COAT ELECTRIC PLAN CHECK.
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIMI) OCCUPANCY SEISMIC FEE
OCCUPANCVOF BUILDING ISNOTPERMITTE DUNTILBUILDING FINALIS SIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC '
F ONE WORKING-DAY BEFORE REQUIRED INSPECTION. PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING. rv� L
Z MECHANICAL
- SEE PERMIT FOR-EXPIRATLON DATE
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL a\
CALLING FOR FINAL INSPECTION.
OFFICE COPY ."
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BV ILDVAId PROJECT IDENTIFICATION PERMIT NUMBER
aD,LE,NG APPLICATION & PERMIT "
ADDREss
_ I BUILDING—ELECTRICAL—PLUMBING—MECHANICAL L:� 16971 'i
oWNE PLAN CHECK VALIDATION
NAME ,� QTY. ELECTRIC PERMIT FEE �J2•�5
r 'HONE -
NpME RS .OUTLETS-SWITCHES-RECEP 10.00/1.00 •7, . 10
LIc.ND. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL - 4.00ADDRESS
'
PHONE R PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
On PANELS (OVER 200 AMP) 20.00 ' --
ENGINEER
' LIC.No. SIGNS TRANS., 3.00
ARCSPECIAL CIRCULI.
H OR ENG, PERMIT VALIDATION
ADDRESS 5'DO
ZIP TEMP.METER OR POLE INS. 20.00 y-
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS �{ T
SERVICE CHANGE 20.00 J t`i'VL ("-uvCL(
wo o LICENSED CONTRACTORS DECLARATION -
a u w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE -
H G aa_ (commencing with Section 7000)of Division 3 of the Business and I BLDG. ELECT. PLG. MECH.
H z Professions Code,and q�y license is in full force appd�_e�-Teggt WAYr'fjGf-
0 o Date Class�ej6_eLn Lic.Number �L}
¢ € / Of p���n0 BUILDING PERMIT
ce m w u OWNER-BUILDER DECLARATION �� �1!w •� INFORMATION
o A MISC.— REFER TO ORD
w 3 LL w 1 hereby affirm that 1 am exempt from the Contractor's License VALUATION S/FT.
ruoa
Law for Any
or countywhihng reason, e. uires a encinessand Professions PERMIT ISSUANCE 10.00
,A� Code.AnY cilY or county which rnmiresa Pannit to wnsiRlaL alter,
. IIJ 0� i
a ¢o mce,improve,demolish,or repair any structure,prior to its issuanalso ELEC.CONTE. LIC.NO. ELEC. Q (J
2
G u requires the applicant for such permit to file a signed stateept that - TOTAL I [ PERMIT TO
w he is licensed pursuantto the provisions of the Contractors License '
i INTO I ��
H z Law9(commencing with Section 7000)of Division 3 of the
¢ Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
at r m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE/CO ry/STH.
e � F_ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 ' V
Of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my 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,COND. 5.00Z't Qp
I, Code:The Contractor's License Law does not apply to an owner of n
property who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5,00 ,O V SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenetintendedoroffered for Sale.if,however,the building GAS-EA.SYSTEM-I INC.40UTLETS 6.00
or improvement is Sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 (EA) 200 - BUILDING USE
- builder will have the burden of proving that lie did not build or im- . . .
-RES IND CON PB Other
for purpose of sale.). INDUSTRIAL WASTE INTER. 30,00
❑ I,as owner of the property,am exclusively contracting with ❑' ❑ ❑ ❑ i❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor'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 a contraetods)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 am exempt under See.—,B.&II.C.for this WATER HEATER W/VENT 6.00 il9 -
reason
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 etalificnle o1'conN
sent to self-insure, - ZONING ENG.SITE O:
or a ivrtificate of Workers'Compensation Insurance,or a certified ..
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
ZZ ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ N❑
rnPERMIT ISSUANCE ' 10.00 ,2-6 FLOOD ZONE A.L.U.C.
� CF:RTI FICATEPF EXEMPTION TINS PROM WORKERS'
CL Q COMPENSATION INSURANCE the DLG.CONTE. CIL.NO. PLG. ,O ❑ ❑ ❑ ❑
(This section need not be completed if Om permit is (m one TOTAL V N V N
D Z hundred doll...IS 100)or less.)
U OI certify that in the pedornwnce of floe work,for which this per, OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued, I Shall not employ an,person'fany mangy as to ,
U hecmr�y�eyy�g the Workers'C at nLaws of C: i(tfrnio.
>_ y DntaSGti—AI
Applicant
ALTER OR ADD TO MECH. 5.00 BUILDING .
} N NOTICE O Ali'LICANT: If, ma ing t us f Ex
f" ? craption,you should become b' t to the Workers' Crop nm APPLIANCE 5.00 - PLAN CHECK
provisions of lire Labor de on must lorthwith comply with FEE
(� such provisions or this per loll be decnmd revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 C�---
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5A0 6.
the performance of the work for which this permit is issued(SeC.
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
,
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Yt + V•
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 '�D
information is correct. I agree to comply with all city and county PLUMBING
ordinances and slate laws rebating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00
10 hereby authorise representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. " MECHANICAL 7�
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, cc and expenses which PERMIT ISSUANCE 10.00 D.() CONST.TAX
may in any way accrue ainst u4-C a consequence of the
mntingof isperml MECH.CONT. LIC.NO. MECH. /
Z TOTAL TOTAL 3�j()LOd. /
gnat A .cant/ o ifs 0r Uat o7� r
OFFICE COPY C