16864 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO' 16864
INSPECTION DIVISION
JOB INSPECTION RECORD „
JOB ADDRESS2 PERMIT EXPIRATION
. - _L.�7 — I� .1 • .,(/���T UNIT# _LOT# PERMIT EXPIRES IF WORK
jOWNER D `��Z(l�V\(V CONTRACTOR - IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION-RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT'VACIDATTON
- CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
. UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL -BLDG ELT, I PLG. MECH
❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED .- BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION $/FT.
PLUMBING � ,` ,
MECHANICAL PAIDo
ELECTRICAL i PERMIT 1
INSULATION 'q,
FRAMING ( 7 � (/I 1'`
STORIES TYPE CONSTR
City
. of cuperting - OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SU,PT FLOOII wH[A iOTwL ACREAGE
ipI• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE I
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE,
ROOF SHEATHING I
❑ ❑ CON PB )IIIII
VE �
-APPLY NO ROOFING UNTIL ABOHAS BEEN SIGNED FINALS DATE INSP. Assessoas PARCEL No
ROUGH SAN.N r
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
MECHANICAL MECR ENERGY
ELECTRICAL - BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING zoNlNc ENG.SITENo.
GAS TEST GAS
FIRE SPHINK ENERGY T.24
MECHANICAL Y [D N� NO No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE AL uc.
INTERIOR SHEAR . , - FIRE DEPT. Y❑ NE] Y ❑ N❑
SHEETROCK I IGRADE FEE SUMMARY '
EXTERIOR ,LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRICPEEN CHECK CQ1 .,4/{^
GAS ( r ?
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM .
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
�—� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
-IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL F r
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
it .: ...
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 1686 4
ADORE55
7 Oho BUILDING -ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S. ! (�• PLAN CHECK VALIDATION
NAME, • 900 ZOTV. ELECTRIC PERMIT FEE
PNG 64taA
CONTRACTOR'S '
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 ,fD
LIC.No. LIGHTING FIXTURES 10.00/1.00 137-
CONTRAC7Ofls
ADDRESS APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10,00 DATE OF APPLICATION ^
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 _
ENGINEER
uc.NO, SIGNS TRANS. 3.00
ARCH.Ess ENG. _ SPECIAL CIRCUIT S.QQ PERMIT VALIDATION
' .•.` - ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS
MOTORS SEE FEE SCH.
A (( LcS
LZU b12 PA ' SERVICE CHANGE PAlp 20.00
o o- LICENSED CONTRACTORS DECLARATION
Fi w 1 hereby affum that I am licensed under provisions of Chapter 9 NOV I ISSUANCE DATE
<u (commencing with Section 7000)of Division 3 of be Business and DG. ELECT. PLG. MECH.
H O i Professions Code,and my license is in full force and effect ❑ E3z O - License Class ui
Fuel
UumContru Number City of.Cupertino
9 w r
a 'c ¢ a ' OWNISR.BUILDIiR DECLARAHON BUILDING PERMIT
E o o.D INFORMATION
X
3 I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
to a. u w vs Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 121,90 VALUATIONr p9 S/FT.
Code:Any city or county which requires a permit to construct,alter, O D
2rc ¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 3 0
O c regmms the applicant for such pnrlml to NIC u signed statement that TOTAL r
w $ he is licensed pursuant hs the provisions of the Contractor's LimnSe PERMIT T
H. Law(Chapter 9(commencing with Section 7000)of Division 3 of Rte 2 SK I Ir
f4 O Businim and Professions Code)or that he iscxempt therefrom and CITY. PLUMBING PERMIT FEE �L _
Ie I- �a the basis for the alleged exemption.Any violation of Section 7031.5 RIES I TYPE CONSTR.
by any applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN -WATER (EA.) 5,00
of no core than five hundred dollars(55001.)'.
I,as owner of the properly,or my employees with wages ns BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or 0ffcred for sale(Sec. 7044, Business and Professions DRAINS-FLOOR, ROOF,AREA,COND. 5.00
Code:1'he Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
matt,are not intended or offered for sale.It,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4(EA) 200
builder will have the burden of proving that b - . . .
e did not build or int- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Otbar
O I,as..net of the property,am exclusively contracting with ❑ ❑. ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Lnw does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contracroost licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sea ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dnte/ �. WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKIiRS'COMPIiNSn'f1ON D17CLARATION WATER TREATING EQUIP. 5.00 -
I hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a cerlilicd
copy Ihereof(Sec.3800,Lab.C.). -
Policy No. Company
Q ❑ Certified copy is hereby funtished. FIRE SPRINK ENERGY T-24
Z ZO ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. Y N v N
Applicant nt ❑ ❑ ❑ ❑
~ In PERMIT ISSUANCE 10.00
UJ - CISRTIFIC(70 OP SAEIO TINS FROM WORKERS' FLOOD zorvE, A.L.u.c.
W � COMPENSATION INSURANCE: PLG.CONTR. LIC.NO. PLG.
0- Z (This Section need not be-completed if the pencil is for one TOTAL Y❑ N❑ v❑ N❑
hundred dollars IS 100)or less.)
L) O 1 certify that in the performance of the work I'or which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
W 1-' mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of Califontia.
Uate - Applicant BUILDING 0 U
a ALTER OR ADD TO MECH. 5.00
} m NOT'ICIi TO APPLICANT: If,eller coking this Certificate of fix-
? eniption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE C lJ
L) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10.000CF.M.) 4.00
. CONSTRUCTION LENDINGAGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE /
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work lin which this permit is issued(Sec. MICROFILM
3097,Civ.CJ, I HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC 3D V
I certify that 1 have read this application and sett,that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply.wifh;III city unA county PLUMBING
ordinances and state laws relating to building construction, and BOILER•OWP 13 H.P.'Of 100,000 B.T.U.) 6.00 -
hereby ausho Tee representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purpous.
(We) agree to save, indemnify and keep harmless the City of IS
- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
in ling oft is IT it. SUCH.CONT, LIC.NO. MECH.
` TOTAL TOTAL
azure Applicant Contractor Uute
OFFICE COPY.