16507 POST THIS CARD NEAR FRONT OF BUILDING
PFRN11T NUMBER
CITY OF CUPERTINO 16507INSPECTION DIVISION; .
JOB INSPECTION'RECORD'
'
"- T
� • "v ° QQ = 7, ) � ��',�(,,I1 F I PERMIT EXPIRATION
c F JOB'ADDRESS-I��-^'•� ,n �--' •�-• UNIT# - _`LOT# - PERMIT EXPIRES,IF WORK,1
owNER V I o 'CONTRACTOR IK(l , . , �• - ''IS NOT STARTED WITHIN'
- INSPECTION DATE INSPECTOR INS CTION RECORD180 DAYS OF:PERMIT ISSU-'.�
FOUNDATION ,ANCE OR 180 DAYS FROM'
NOTE + LASTCALLED INSPECTION.'{'
i UFER . ", ,' t - ALL GRADING AND DRAINAGE SHALL BE;INSTALLED f •+
r l TO COMPLY N/ITH THEAPPROVED PLANS AND CITY OF) e^ 'PFH NvI VALIDATION
PREGUNITE - + CUPERTINO STANDARDS. - 1 � / •�
GARAGE SLABS , .,;� I L i, ' I C
I t POUR.NO CONCRETE UNTIL-ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBINGJ.
ELECTRICAL "'• ',r•' ` ' 1SSUANCE'6ArF -
'ME HA ,.n' ' BLDG, ELEcIN ] PLc. MECH,
C N CAL
.i
r'
V IR 4
BUILDING PERMIT
DONOT POUR FLOOR UNTIL ABOVE HAS-BEEN SIGNED INFORMATION i
o ':WOOD FLOOR
VAI.uA TION " SIFT.
PLUMBING
i-
MECHANICAL • .
e = ' ELECTRICAL � ,' _ 3. a - rT TO
,{
FRAMING, ,��•• - - +CS - I f '
'STONIES TYPE'CON'TH.
1,INSULATION
OCC GROUP REB UNITS
PLACE,NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
y .. SO.FT GI.00R AREA TOTAL ACREAGE
"ROOF' '" "NOTE:NO FINAL IINSP.SHALL BE MADE BEFORE
DIAPHRAGM '+ q' ;.+,_ - THE_-CONSTRUCTION'TAX IS`PAID e
5' BUII.DING USE
ROOFSHEATHING_ .. - .u❑es IND oN 0 • oa,"I
,APPLYAO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS .. -A ,:DATE;
_Y INSP. nssessor P ceL No.
.. ''{ROUGH -SAN'g.. -
• 5 PLUMBING: " ELECT.ENERGY
'• TUBS'&SHOWEWPAN..,'_.• .. '~V - ..: 1 TRACT NO. PARCEL NO,
PLUMB ING'ENERGY,.,;' - .; ?
MECHANICAL ,, ME
CH:ENERGY - .-
ACC.DATE ACC.FILE NO ,
ELECTRICAL BUILDING ENERGY
FRAMING .ii; ^"' * ELECT.FINAL TEST
' 20rvING ENG.SITE NO.
INSUCATION - - PLUMBING
";.. GAS.T,EST'� T. ,. ,' .,' GAS
FIHE 5PRINK ,ENERGY T 24 ,
_ " j` •' MECHANICAL "
NO WORK UNTILABOVE HAS BEEN SIGNED HEATING ' � ''COVER "o Y [3 NEI '
EXTERIOR"SHEAR '• -. ELECT,RICAL•RECEASE 1 �;,L. iL00O2UNF. A.LU.c
INTERIOR SHEAR - FIRE DEPT. + v❑ ' 'N❑ YQ ' N�]
SHEETROCKl .• - - GRADE - • FEE SUMMARY '
T 1 EXTERIOR LATH - BUILDING BUILDING
INITERIOR LATH -;.TEMPORARY APPROVALS
SCRATCH COAT' �•- - '• ELECTRIC- " ' '` ' ' 'PLAN CHECK
FEE
• q GAS '
i,+"••, NO•TAPE,OR PLASTER;UNTIL-ABOVE HAS BEEN SIGNED OCCUPANCY. - SEISMIC FEE j_
. 00CUPANCY'OF BUILDING IS NOT PERMITTED,UNTIL BUILDING FINALISSIGNEDBY BUILDING NSPECTOR. .,MICROFILM -
'.I.
ARRANGE FOR INSPECTION BYPHONING.252-4505, ELECTRIC
'
. Z�. LEONE'WORKIN,G'DAY BEFORE REQUIRED"•INSPECTION PLUMBING
• PASE GIVE JOB ADDRESS WHEN PHONING.
.SEE PERMIT FOR EXPIRATION DATE. 47
— MECHaNIcaL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE'SIDE BEFORE '
CALLING FOR FINALINSP.ECTION 4•,' T07AL' "
' OFFICE COPY h-
. t1/hNJPFivV%:4-. .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES =;USE,BALCPOINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION PERMIT'NUMB FRI.^
BG,L ,tl, APPLICATION & PERMIT 1 C C
Ao.RE$s .! I.6 5 O 7 -
O. - BUILDING=ELECTRICAL—PLUMBING'—MECHANICAL :n, Ilr' V
OWNER'S / '• + :. , 1 PLAN CHECK VALIDATION
"AME, _ — DTV. .ELECTRIC PERMIT FEE i
PHONE
NAERACTMOR 's UTLETS-SWITCHES-RECEP 10.00/1.00 s .-
rueuo.G O— LIGHTING FIXTURES 10.00/1.00 -
*
CONTRACTOR
DDRESS o e - i., _T. APPLIANCES-RESIDENTIAL' ^'•400 " y
e Q(/ -.,HONE :r/ PANELS " : - .IO,OO DATE OF APPLICATION
ARCHITECT - • PLAN CHECK FEE PC.NO.'
OR - PANELS (OVER 200 AMP) 2000 '.
ENGINEER
LIC.NO - SIGNS TRANS." 3.00
P R VA ID
. � ARCH.OR ENG, E M L ATION
ADOREss . . SPECIALbIRCUIT '5.00
APPLICANT'SZIP " r " .EMP. METER OR POLE INS. :`,-�" 2000. ," t
-
'
ADDRESS � -MOTORS SEE FEE SCH. /
- SERVICE CHANGE 20.00 Cfll® I8q
wo O 'LICENSED CONTRACT ORS DECLARATION
a u I herehy:dfirm (hut 1 vn licensed under provisions of Chapter 9 y:, f;" ISSUANCE DATE
z m (Conan i ing wlth'Section ]0001[1 Division 3 of tire Busmess'c d - BLOG.- ELECT' :PLG' MECH.
a i I ofessio .,Code nd my hwns L'a lull(ore.,an 1'WTcet. '� 'I'I'I IA a`r _
'Z O T'— Lrecnse Class Lu Numher f) ,❑ .. ❑ ❑' .
9 N ea Date�� Cnnlractor�Llll/ V S
a s. s ' • . ' ' ('Rep/.Ne I 'rpt ksw t BUILDING PERMIT.
Ie o i u OWNER-BUILDER'DECLARATION �NSfA// - INFORMATION
wLL y I hereby iffirn that I am exempt fromtireContractor's License MISC. D VALUATION $/FT.
r a-o a Law for the folio mg reason(Sce,7031.5,Busm ssand I r feirmus pERMIT ISSUANCE
7 Pe Code.Any,utyo county which r piiresa permits m.trh�t,alter,. 9 ,
i¢ u,¢0 mtprovc Aeni Irh or repair.my.tri t prior h IIsi suanu also ELEC'CONTR.' _ LIC.NO; '' ELEC.
'a ¢ require.,llTiT applicant for such permit to file a Signed vial n,ent that TOTAL PERMIT TO.
w $m he is license0oilite pursuant en the will,
visions of the )o f Division
Contractor's the �r 1 i4ncQ I `
F Z > Law(Cha and
Professions
Cod ith Section is
exe I Dtheref o of the ti Cy-/ILp-
a Business and Professions Code)or that s i,exempt therefrom and OTV. PLUMBING PERMIT FEE
. ¢ _.$ the basis fertile alleged dli•Inptinn.Any violmionofticction703L5 .. - i STORIES TYPE CONSTR."
n3 — by any applicant for a pe it IT is the upplicanttoacivilpenalty ALTER-DRAIN -WATER (EA:15.00 !
of not more than five hon rad dollars(8500).1:
❑ I,as owner of the opery,or my employees wit"wages a' BACK FLOW PROTECT.DEVICE 4.00
their sole amipenwti00' "do-the work,an d the st nmt,ire is not OCC.GROUP RES.uNITs ..
'meoee'A nr o11'c�ed Cor sir c(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00 '
Code:The Contractor's Lic use Law does not apply to an owner of `
property who builds or inip oves thereon,and who docs such work FIXTURES TRAP S.00 SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own c nployees,provided that such improve-
memsarenotintendedorof •rad tarsale.IL howeveq the building GAS-EA.SV$TEM-11NC.40UTLETS 6.00i
or ImprovcmuN is sold wit hi Ain year of completion,the owner- GAS EA.SYSTEM OVER 4 (EA.) 2.00
builder will hove the burden"�proving that he did Tint huild or im - BUILDING USE
prove for purpose of sale.). i 11NDUSTRIAL WASTE INTER. _. 30.00 REs IND ON PR ' Dinar
❑ I,as uwnnr,of the property,nm exclusively.,ontrmfing with. - 0❑. ❑ _ ❑' ❑
licensed com ruetors to construct the project(Sec.7044,Business LAWN SPRINKLERS_=1 INC'5 V.B. 6.00 - ASSESSOR P HCEL NO.
and Professions Code:.The Contractor's License Law does not apply -
to an owner'ofproperty who builds or improves Thereon.and who " LAWN SPR IN KL'ERS 2O ER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SAN ITARV-STORM EA.200ft/10.00 r r
the Contractor's License Law. TRACT N0.. - PARCEL NO.
- ❑ I am exempt under Sec. ,BARC:far this WATER HEATER W/VENT . 6.00 `
reason
Owner D.ta t SYSTEM, WATER Sya 5.00 : - '
„ ,,ACC.DATE ACC.FILE NO. )
' WORKERS'COMPFNSATION DECLARATION WATER TREATING EQUIP. :o5.00
I hereby affirm that I have a certificate ofconWnt to self-insure, r '
Or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thercoflSea 3&I]B,Lab.C. .,
Policy No fc_WL ompony�e�../�ih .jA4el
O '❑ Certified Copy is hereby furnished. ANlREC9 FIRE SPRINK, ENERGYT-24
Z Z'' ❑ Certified"cop is Ilion with the'city Ispccli0n divio.d. - � ,T.
— O Apphcant_v/ .u —!—l�fti Y'o�. . " ' MISC.- REFERTO ORD. Y N❑, ;r❑ ni❑ .
3 - - + + PERMIT-ISSUANCE ": 10.00 ,_
� —. Cl:RT'I l'ICATE E SA TION INS FROM WORK 17 RS' - . FLOOD ZONE 'A.L.U.C.
CL �' COMI'ENSA'I'ION INSURANCE PLG.CONTR." LIC.NO. - PLG:' _
CL '('Phis section Sed not he completed if the permit is for One _ TOTAL ' '.V❑ N❑ .V ❑ ',N❑
Z hundred dollars(5100)or less) - -
U O 1I certify that in the performance of the work for which this per. OTV. MECHANICAL PERMIT: >FEE FEE SUMMARY
LL'r mit is issue) I sir not enTpl y' y person in any manner so as t0 - -
OW become st bleat to Worker, C ni pensatmn Lows" I'C'liloniia - -
Q. Date A el cent - ALTER OR ADD TO MECH. ', 5.00 BUILDING
} w NOTICE f0 APPLICANT. II,after making this CcHilicate'Of E.- "Y*f
♦— ? emption,you should become subject to lire Workers Compensation 'APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith c imply will FEE,
t U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10000C.F.M.) 4.00
CONSTRUCTION LENDING ACI7NCY - AIRHANDLING UNIT(OVER 10 MC.F.M.) 6.00 , 'SEISMIC FEE
hereby ulTin That there is a constnmtirin lending agency Ton . (EXHAUST HOOD (WITH DUCT) 5.00 ,
the perl'omlanceofthe work hor which this'permit is issued(Sec. MICROFILMU -
3097,Civ.C.). ,,. - - HEATING UNIT:(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 '
Lender's Address ' .ELECTRIC
1 certify that I'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
Ordmancus and state laws relating to budding construction;and BOILER-COMP(3 H.P.or 100,000B.T.U.). 600
hereby authorize representatives of this city.loyetict upon'theBOILER-COMP (Over 100,000 BTU(SEE F EE SCH MECHANICAL '
v above mentioned property for inspection tion purp s s, I , "�" -
(We) agree to save, mdemnofy and:keep her 1 .. 1he,City Of MISC. REFER TO ORD. - +
Cupertmo .,.lost liabilities;judgments: costsandexpenses which CONST.TAX
may in any way accrue .•ainst said City in consequence of the ' PERMIT ISSUANCE - " 10.00 -
pantingof lys p00Fermit' MECH CONT 'LIC NO. MECH - '
/) TOTAL TOTAL -
Signature of Applicant/Confructu7�- [)at - - 1
OFFICE COPY _ '