16424 ^, POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 16424
INSPECTION DIVISION
JOB INSPECTION RECORD
�I- I yyy PERMIT EXPIRATION
JOB ADDRESS Cp1C'l� SIC Ill 1e0 �I-[7 \'S 1 yrIT# _LOT#
lEX4 S`IF WORK
OWNER C7PVG V CONTRACTOR 1 IS NOT(STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE:
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALL ED INSPECTION.
PREGUNITE COMPLY WITH THE APPROVE4RLAN$BND CITU OF PERn+I*VALIDATIONCU
• CUPERTINO STANDARDS. PH�LJ
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED OUT '41988
,UNDERGROUND /SLAB J-�, C(, .t'�&.V,..ce
PLUMBING City of Cupertino -
ELECTRICAL - 'ISSUANCE DATE
MECHANICAL BLDG ELECT I PLG. MECR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING INFORMATION
PERMIT
WOOD FLOOR
PLUMBING VALUATION $/FT,
� � -
_MECHANICAL
��.
ELECTRICAL � PEI+M I TO
FRAMING
INSULATION STOR s TYPE CONSTR.
OCC.GROUP RES UNITS
JPLACE NO SUBFLOOR UNTIL ABOVE•HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE oR An LA rorAL,ncn EAre —
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING Res IND CON PB ow,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.. I] 1:1 1:1, 1-1ASSESSORS PARCEL NO.
ROUGH SAN.p .
PLUMBING ELECT.ENERGY.
TUBS 8 SHOWER PAN PLUMBING ENERGY iHwCi NO PARCEL NO
MECHANICAL MECH.ENERGY
.
" ELECTRICAL BUILDING ENERGY ACC DATE ACCFILE NO
FRAMING ELECT.FINAL TEST `
INSULATION PLUMBING - ZONING ENG.SITE NO.
GAS TEST GAS
• MECHANICAL FIRE SPRINK ENERGY 1, ;
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING' Y 0 N❑ I] N❑']
�Loou mNe n,L a a. !
EXTERIOR SHEAR ELECTRICAL RELEASE '
INTERIOR SHEAR - FIRE DEPT. Y❑ N❑ ' r ❑ "❑
SHEETROCK , GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING a -'
• SCRATCH COAT ELECTRIC - PLAN CHECK / 7
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE I
OCCUPANCY OF BUILDING IS NOT,PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING I NSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
4WA H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING-'
.Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
p. is
— SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT! CONST.TAX,
PLEASE READ REVERSE SIDE BEFORE 7
CALLING FORTINAL INSPECTION. TOTALX2:2(
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
I -PERMIT NUMBER
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT A A
BUILDING G f.r
ADR USE 7 sFAV�LDING - ELECTRICAL-PLUMBING-MECHANICAL '
7W'�M7►+� fl PLAN CHECK VALIDATION
owrvER's OTY. ELECTRIC PERMIT FEE
VIA
PHONE
II C rv*RACTOR S OUTLETS-SWITCHES-RECEP 10.00/1.00 ^Q�
N �U
_ fr LIC.NO. L1 I0 LIGHTING FIXTURES 10.00/1.00
.f roerRAcmRs �� 4,. APPLIANCES-RESIDENTIAL 4.00 1
A' Aa1tt
PHONE^1�i5�1"I' PANELS
10.00 DATE OF APPLICATION "
ARCHITECT - - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P NO.
OR
EENGINEERu3.00
c.No. SIGNS TRANS.
ARCH.OR I NG. S.00 PERMIT VALIDATION
SPECIAL CIRCUIT -
ADDRESS
ZIP EMP.METER OR POLE INS. 20.00 '
APPLICANT SA-7A9 {�as�ost•+&� MOTORS SEE FEE SCH.
ADDRESS /V�
LIJsa*��e.tqt556 SERVICE CHANGE 20,00
O¢ Z D t.7 'e
au
r o o LICIiNS1iD CON'TRACT'ORS DECLARATION .-
aw 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y rt a lcommencinR will,Section 7000)of Division 3 of the Business and a / BLDG. ELECt. PLG. MECH.
1 r y so I§ofesslons Cor a I Ilcense is in full for ��ytrdL,�Gf yy" V 1 (A � ❑ ❑
License�,�lass Lic.Num herI 5 L�1� Cf�u
o H o Date!12 Contractor 'ti (�b nt•.w....
a y f Clfy of CU a BUILDING PERMIT
E ¢w u OWNER-BUILDER DECLARATION, REFER ORD INFORMATION
w3 u 1 hereby mffirm that I am exempt from the Contractor's License MISC.- VALUATION TFT,
3 Law for the following mason. 7031.5,Busamaxand Professions PERMIT ISSUANCE 10.00'. ^ �D,
w - :2
( Code:Any city or county which requiresa permit to construct.alter, LIC.NO.
¢ ea a improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. ELEC.
La - O u mquires 1110 upphcunl for such perOtit[a file a Signed statement that TOTAL - PERMIT TO ,
•`*d w m he is licensed pursuant to the provisions of the Contractor's License
u,z u, Law(Chapter 9(commencing with Section 7000)of Division 3 of the
s E 4 a Business and Professions Code)or Hutt Int is exempt therefrom and OTV. PLUMBING PERMIT FEE STORIE TYPE CONSTR.
¢ H o the basis for ire alleged exemption.Any violation of Section 7031.5
3_; by by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than fivehundred
(_ ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
mu 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
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SD.FT,FLOOR AREA TOTAL ACREAGE
/ ablid.larelhrontende owncmred for
Provided ileal such improve- GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
menu are nor intended or offered for sale.If,however.su he building
or Tmprovement is sold within one year of completion,the owner- MNE
YSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burdmi of proving that ha did not build or int- RES IND CON PB Other
prove for purpose of sale.l. L WASTE INTER. 30.00 �El ❑ [1 O D
❑ 1,as owner of the property,am exclusively co oraeting with
licensed contractors to construct the project(Sec.7044,Business NKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not applyto an owner of property who builds or improves thereon.and who NKLERS-OVER 5(EA.) 1.00contracts for such Pmjucls with a contrmtods]licensed pursullNIn ITAR V-STORM EA.200ft/10.00 TRACT NO. PARCELNO.
the Contractor's License Law.
❑ lam exempt under Sec. ,BAP.C.far this ATER W/VENT 6.00reasonOwner Date STEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm Thar 1 have a certificate of cansent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a 7,m�
_
P copy th ry�I�Oy�yb.C.) -
PolicY�F•'s-RbNA`anY idned -IY7-'1"---'-�O ❑ Ctl it ted copy is hereby furnished FIRE SPRINK ENERGY TZ4
Z Z "�` Certilied copy rue Q waft the city i : tie s MISC.- REFER TO ORD. V []• N� V [] N�
F 0 Applicant_"-�C./-I-MpT�I{pa't6 NCIiR1IIICA'I'EOP IiXBh1PTION PROM WOItKIiRPERMIT ISSUANCE 10.00 FLOODZOrvE A.L.U.O.
>_ COMPF'.NSATION INSURANCEONTR. LIC.NO. PLG. ❑ ❑LU 1 0TOTAL, V N V N
1'I'his secsion Iced not be completed if the permit isZ) Z hundred dollars IS 100)or less) FEE SUMMARY
U 0 1 certify that in the performance of the work for which MECHANICAL PERMIT FEE
I7 mil is issued, I shall not employ any person in any manner so us to
OW become subject to the Workeri Compensat ion Laws of Cali fornia BUILDING
Date Apvlicunt ALTER OR ADD TO MECH. 5.0ol
s-
} y NOTICE TO APPLICANT: If,after making this Certificate 0f Ex-
F.? emption,you should become subject to the Works'erCompensation APPLIANCE 5.00 PLAN CHECK /• 7 J
Provisions of the Labor Code, you most forthwith comply with FEE (O
V such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO t0,000GF.M.) 4.00
CONSTRUCTION LENDING AGI7NICY AIR HANDLING UNIT(OVER J0=C.lFM.) 6.00 SEISMIC FEE ej-O
I hereby infirm that then is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the perfort nce of the work lot which this permit is issued(Sec. MICROFILM
a
HEATING UNIT(TO 100,000 B.T.U.1- 8.00
3097,Civ.C.1.
Lender's Name HEATI NG UN IT(OV E R 100,000 B.T.U.)9.50 ELECTRIC
` - Lender's Address -
�v 1 certify trot I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
PLUMBING
Information is correct. I agree to comply wi0t all city and County
ordinances and state laws relating to building construction, and BOILER-WMPI3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)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. CONST.TAX
- upertino against liabilities,judgments, costs and expenses which - PERMIT ISSUANCE 10.00
y it any way accrue vmst said City in consequence of the '
mnl' of this pe Tor Q MECH.CONT, LIC.NO. MECH.
.� .� TOTAL TOTAL oZ oZs
at f App cant/ of roc or Date
OFFICE COPY