16421 POST THIS CARD NEAR FRONT,OF BUILDING +"'•q '
PERMIT NUMBER"
CITY OF CUPERTINO 1:6421 ',
INSPECTION DIVISION '
JOB INSPECTION RECORD
' a �.Y¢•j Ir, ,�•,,,GG PERMIT EXPIRATION
T JOB'ADDRESS T7 /. � Ok0 if1-fl/a C. _ . UNIT#' _LOT#
' PERMIT EXPIRES IF WORK
OWNER' L/J N/ " CONTRACTOR "dd e AS, NOT STARTED WITHIN
INSPECTION DATE " INSPECTOR 14SPECTION RECORD 180 DAYS OF PERMIT,,ISSU-
FOUNDATION'- - - ANCE OR.190 DAYS FROM
NOTE:
LAST CALLED INSPECTION.
,. UFER _ � ALL GRADING AN• E-SHALL BE INSTALLED
PR EGUNITE ' •TO COMPLY HTHE D PLANS AND CITY OF PERMIT VAr.R�ATiorv,
CUPERT STANDAR
GARAGE'SCABS •� R•
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .
UNDERGROUND /SLABQq u
i
PLUMBING /
ELECTRICAL T`t ISSUANCEUAIE
MECHANICAL BL LECT. PLG. MECH,
p "� o ❑ E]
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGN D r ING PERMIT
WOOD FLOOR ',�`y CVp IN IORMA710Ntir
VALUATION FT.
PLUMBING
MECHANICAL "' "
ELECTRICAL - •.• yn PERMIT io
FRAMING - /\� NI .• WR-/FJ1L..
. . INSULATION :ULS
ses
OCC.ORDUv RES.UNITS
eP.LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' - " so.IT,,FLOOR AIIEA TOTALACRLAGL
'" •( - ROOF N NO FIN .SHALL DE B FOR -
DIAPHRAGM TH CONST N TAX I P - -
BULL TNG USE
ROOF.SHEATHING - RES IND CON PB om., I
—APPLY NO ROOFING UNTIL ABOVE HAS-BEEN SIGNED` LS DA INSP. '
ASSESSORS PARCEL NU.
• ROUGH S I j
PLUMBING, ECT.E '
TRACI NO. PARCF.L NO.
TUBS&SHOWER PAN PLUMBIN . N GY -
MECHANICAL.; - MECH:EN
'
ACC.DAre ACC.FILE No.
ELECTRICAL
- BUILDING ENERGY• •,r, ,
' FRAMING ' - :ELECT'FINAL TEST . ZONING ENC.slrE No.
INSULATION PLUMBING i;'..'
.r
GAS TEST - GAS -
FwESPIaNIo LNkiHGV Tla," '
q.- MECHANICAL
'COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED . HEATING y N:� v ❑ .. PIE]
EXTERIOR SHEAR ELECTRICAL RELEASE - FLOOD mrvE -A.L.u.c.
INTERIOR SHEAR FIRE DEPT. - _ .! `O No ❑ N❑
, SHEETROCK GRADE FEE SUMMARY
d EXTERIOR LATH. BUILDING , '
INTERIOR LATH - TEMPORARY'APPROVALS ' - BUILDINGS
k
SCRATCH COAT ELECTRIC •"" PLAN CHECK
GAS FEE '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY a SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRICBfl
F, ONE WORKING DAY BEFORE REQUIRED INSPECTION. ' PLUMBING
87 r
- PLEASE GIVE JOB ADDRESS WHEN-PHONING.
z I I Ir MECHANICAL
I - SEE PERMIT FOR EXPIRATION DATE
. . . IMPORTANT! coNst.TAX
PLEASE READ REVERSE SIDE BEFORE - TOTAL.,:
CALLING FOR FINAL INSPECTION.'
OFFICE COPY
C4 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES =USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATIONPERMITNUMBER
BUILDING APPLICATION & PERMIT 14 Z1
ADDRESS.
' - _ ,r--71 /� O Nap UILDING-ELECTRICAL-PLUMBING-.MECHANICAL
y OWNS 5 -/ 'PLAN CHECK VALIDATION
NAME
."r ^ OTY. - ELECTRIC PERMIT FEE -
/.
I /� vrvoNE
CDNNTRacTDRs C /, .�ib.J ni. OUTLETS-SWITCHES-RECEP 10.00!1.00
� /FG��Y✓ ��
LIGHTING FIXTURES 16-08{4:80 p2
' -
CONTFACT45.es PPLIANCES-RESIDENTIAL 4.00 •
ADDRE 5 / / &4L_
] h^
Q �o L.G p� PHONE' -J / PANELS ,, 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER ZOO AMP) 20.00 "PLAN CHECK FEE P.C:NO.
OR
` ENGINEER "
LIC.No. SIGNS TRANS. '3.00
ARCH.on END. SPECIAL CIRCUIT I S.00 ' PERMIT VALIDATION
ADDRESS - '•
ZIP TEMPI METER OR"POLE INS. 20.00 -,
APPLICANT'S
ADDRESS MOTORS SEE FEE.SCH.
SERVICE CHANGE a 20.00
C o LICIiNS1iD CON'T'RACTORS DECLARATION
or U 1 hercby affirm that 1 con licensed under provisions of Cltuptcr 9 e DANCE DATE" •-
wQ w (commencing with Section 7000)of Division Of the Business and V ELT. PLG. MECH.
H z License ons Class"'")?l ny.liansc is in full foryy-L.-��'qp � ❑ ❑
z o m - License ClasLic.Nivnber
O H'w Date
ve Contractor
H /V •r
a Y¢ ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
¢ oaU MISC.- REFER TO ORD INFORMATION
X
3 u Ii I hereby afl'inn that I am exempl from the Contractor's License -
F LL o ve Law for life following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE vALUATIOry S/FT.
iA Code:Any city or county which retluiresa Patnlit toconetrucl.xlter.
as ¢0 improve,demolish,of repair any structure,prior to its issuance,also ELEC.CONTR.
O e, requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO.
a w m he is licensed pursuant to the provisions of the Contractor's License 1
HiQLaw(Charter a(conlmencing with Section 7000)of Division 3 of the -9B'/•�, L(,.V}-TeT2�
i o Business and Pro@ssion,s Code)or that he O exempt therefrom and QTY. PLUMBING PERMIT FEE
Q the basis for the alleged exemption.Any violation of Section 7031.5 STORIES PE COC R:
n ;m._ by any applicant for a permit subjects the applicant toe civil penalty . ALTER-DRAIN&VENT-WATER (EA.)•5.00 fill
of not more than five hundred dollars(S500)J:
❑ I,as owner of the property,or illy employees with wages as BACK F LOW PROTECT. DEV ICE 4.00 OCC.GROUP RES.UNITS.
their sole compensation, ,111 do the work,and the stnmture is not
intended or offered for sale (Scc. 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 50.FT,FLOOR AREA TOTAL ACREAGE
>
himself or through his own employees,provided that such improve -
mvlfsare But
intendedorofferedlot sale.If,however.life building GAS-EA.SYSTEM-I INC.4 OUTLETS .6.00
r•� APim Provement is sold within one year of completion,the owner- +
GAS-EA.SYSTEM-O
buildwill have the burden of proving that he did not buildof im- OVER 4(EA.). 2.00 BUILDING USE
er
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. - 30.00 RES IND CON ; PB Oil.,
O -I,its owner of the property,am exclusively contu ling with ❑ El El 1:1 ❑
licenwd comractors,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 properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such proj"Is with it contractors)liccllwd punuanl to -
theCommclorLicenseLaw, SEWER-SANITARY-STORM EAt 200ft/10.00 TRACT NO. PARCEL NO.
❑ umexemptunder Scc. BAI'.C.for this WATER HEATERW/VENT . s 6.00
reason
Owner Date WATER SYSTEM - 5.00 ACC.OATE •ACC.FILE NO.
-.WORKERS'COMPENSATION DECLARATION. WATER TREATING EQUIP.' 5.00
1 hereby affirm that I have a certificate of consent to set&insure. - ZOrvIrvG
or a certificate of Workers'Compensation In.suelfce,Or u c,rtil,cd ENG.SITE NO.
COPY Iheryygq1��Secc.�.3ggOO.La b.C.l.' O `<'G - .
I'olicY Ny*IA Z'Q'rf etch y� .
Q ❑ Cm11 IN copy is hercby lurnnbc � FIRE SPRINK ENERGY T24
❑ Ce25
50( c�fIIed with 0yy}�y inspection division.. MISC. - REFER TO ORD. Y ❑' N❑ V ❑ N❑
z O APpfc:lnt ✓f p 1��l ,
I-- rn Y " :PERMIT ISSUANCE' '10.00 FLOODZONE -'A.L.U.C.
Lu Lu '
CE RTI FICA 11; FN.XWI PTINS FROM WORKERS' - .
Q - COMPIiNSATION INSURANCI'. + PLG.CONTR. LIC.NO. PLG. ❑ ❑. ❑ ❑
CL 11'If x section need not be completed if the Permit is for one _ TOTAL V N V N
D Z hundred dollars(SIOO)or less,!
U O . 1 certify that in the Performance of the work flit which this per- QTY. MECHANICAL'PERMIT FEE FEE SUMMARY
LL I- mil is issued,I shall not employ any Person in any mannerso as to ."
O become subject to the Workers'Compensation Laws of California.
O w Dnte - APplicunt BUILDING
a ALTER OR ADD TO MECH. , 5.00
} w NOl'ICE TO AIIPLICAN'I': If,after making Ihis Certificate of Bx-
F ? emption,you should become subject to the Workers:Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply will% FEE '
CJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO IOSMC.F.M.) 4.00
CONS'T'RUCTION LENDING AGI:Ncv AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that.theru is if construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of-tlle work for which this permit is issued(Sce. HEATING UNIT(TO 100,000 B.T.U.)18.00 MICROFILM
3097,Civ.C.). - -
Lcndcr:sName HEATI NG UN IT(OV ER 100;000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certi1, that I have read this applicalio0 and slot.r that the above VENTILATION FAN (SINGLE) •- 4.00
monnation is correct. 1 agree to comply with all city and county , BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
+
' bidinances and state.laws relating to building'construction, and ,
hereby authorize represcntatives,of this city to'emer upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above mentioned property for inspection putpons. . .
(We) agree to save. indemnify and'keephannlesx Ihe'City of Misc.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE ', 10.00 CONST.TAX
limy any way accrue against Said City in consequence of the
•m I Ill permit. - MECH.CONT. LIC.NO. MECH.•
A,�-- TOTAL Ju
Signature of Applicant/Contractor Date TOTAL I
OFFICE COPY