16180 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO,
INSPECTION DIVISION 5180
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADD ESS D _(iY IA'I,SN �I`[�NI,T,'# _LOT#
D(/1�, PERMIT.EXPIRES IF WORK
OWNER Ce U�Lf- CONTRACTOR IS' NOT STARTED WITHIN
IN PECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAI_I NATION
CUPERTINO STANDARDS.
GARAGE SLABS:
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - , •/
UNDERGROUND /SLAB �
PLUMBING - ' - 914
ELECTRICAL
IS ❑q iE
MECHANICAL `BLDG ELECT. PLG. I MECR
'❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR INFORMATION
-PLUMBING
VALUATION SIFT.
_ - -
MECHANICAL
ELECTRICAL - PERMIT TO
FRAMING . .'
INSULATION STORIES TYPE CONSTR.
"
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS-BEEN SIGNED
5O.IT FLOOR ARE. TOTAL AC.EACE
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING - RES IND I, CON usePC Go—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP: ❑ • ❑ X ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.# '
PLUMBING - ELECT.ENERGY
.
TUBS 8 SHOWER TRACT NOPARCEI_NO PAN � � 'PLUMBING ENERGY "
MECHANICAL - MECH.ENERGY
ACC DATE ACG FILE NO
ELECTRICAL - BUILDING ENERGY -FRAMING, . ELECT.FINAL-TEST
INSULATION ZONING ENG.SITE NO.
PLUMBING '
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T.)E
'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING, - 'Y ❑ "❑ Y ❑ NC]
"
EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD LONE A U,C.
INTERIOR SHEAR FIRE DEPT. "Y N❑ Y ❑ No
SHEETROCK - - GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING vz
INTERIOR LATH TEMPORARY AP ROVALS BUILDING ; �„
SCRATCH COAT ELECTRIC PLAN CHECK
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEENSIGNED JOCCUPANCY •SEISMIC FEE _
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 2574505, ELECTRIC
uj ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR,EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE.BALL POINT PEN ONLY >'
• BUILDING PROJECT IDENTIFICATION - -PERMIT NUMBER
sD{�REEDIRG - APPLICATION & PERMIT
AN ,. rC 1.O�o
02� 30� �T�/ iQrB aL(q BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 1 I"v I o
D.N ECL'TI TLsn R'sr,V�irn�0 `'! ..
�y PLAN CHECK VALIDATION
QTY. - ELECTRIC PERMIT FEE i - ,,/':•7 ��i', �': ()
CONTRACTORSH
T
OUTLES-SWITCES-RECEP' 10.00/1.00
NAME 1,
LIGHTING FIXTURES -> 10.00/1.00
"
At-61z a1D.ND.�9r77� r3 ,5
CONTRACTOR'S
ADDREss LR r,pu! Q/1 APPLIANCES-RESIDENTIAL 4.00
26&0 rM PHONE W_r73"ro PANELS` ° 10.00 DATE OF APPLICATION•
ARCHITECT PLAN CHECK FEE P.C:NO.
ORicINEER PANELS (OVER 200 AMP) 20.00 So
uc.NO. SIGNS TRANS. 3.00
ARc H.OR ENG. PERMIT VALIDATION
ADDREss �.,/)"� SPECIALCIRCUIT - 5.00
222 rpc-•v $ g/l/ ZIP EMP.METER OR POLE INS. 20.00 _ ' 5' _ O
ADDRESS MOTORS SEE FEE_ SCH. 1,
i¢MPp . f SERVICE CHANGE - 20.00
0 S LICENSED CONTRACTORS DECLARATION -
<.�u I hereby affirm that I ant licensed under provisions Of Chapter 9
2 i ISSUANCE DATE
y .w (commencing with Section 70007 of Division 3 of the Business and - . , BLDG. ELECT. PLG. MECH.
r y z Professions Code nd my license is i,full fore tnd effey�t. ❑ ❑
o m - Lice, ss Lic.Num her 7 /� - -
° r Dole _ Conlractor� '
¢ ¢ w a OWNER-BUILDER DECLARATION 'BUILDING PERMIT,
° d ° 'MISC.- REFER TO ORD INFORMATION
X 3 ¢ r I hereby affirm that'l am exempt from the Contractor's License -
F LL o j Law for the following reason(Sec.7031.5,Businessland Professions PERMIT ISSUANCE .SD�O I VALUATION .$/FT.
Code:Any city or county which requiresa permit to construct,alter,
¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. S Q 0 O O
° LL requires the applicant for such permit to file a signed statement that TOTAL
a �I J�
wm he is licensed pursuant to the provisions of the Contractor's License- r ,V PERMIT TO -
r z i
Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe
- a Business and Professions Code)or that he iaexentpt therefrom and QTY. PLUMBING PERMIT FEE -
X .o
¢ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
Ec by any applicant for a permit subjects the applicant to a civil penalty'' ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(5500))',
❑ I,as owner of the property;or my employees with wages asBACK FLOW PROTECT.DEVICE. ' 4.00
' their sole compensation,will do the work,and the structure is not OCC.GROUP RFS.UNITS
intended or offered for all(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 does such work FIXTURES-PER TRAP 5.00• SQ FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE,
prove for purpose ofsele). - INDUSTRIAL WASTE INTER "3000 RES IND CO PB orae
It ,
1,as owner of the property,am exclusively c . .
rmtractmg wills _ .F 0
licensed contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply '
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1100
contracts for such projects with a contractor(s)licensed pursuant to • -
the Contractor's License Law. SEWER-SANITARY-STORM EA:200ft/10.00 TRACT NO: PARCEL No.
- ❑ tum exempt under Sec. ,B.&P.C.for this11.1.11 WATER HEATER W/VENT :6.00 -
Owmar Date WATER SYSTEM , 5.00 ACC.DATE ACO.FILE NO.
WORKER3'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
.I hereby,affirm that I have a certificate ofconsent to scINnsure, -or a certificate of Workers'Compensation Insurance,or u certified ZONING ENG'SITE NO.
copy thereof-(Sec.3800,Lab C I
Policy NkEkZ#_tVTompany A"It 2A&?Me Rtna�-ra
O ❑ Certified copy is hereby famished.• - FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy-is Bled with the city inspection division.
FO Applicant MISC.- REFEFETOORD. Y� it Y ❑ NO
= N CERTIFICATE OP 1 XEMPTION FROM WORKERS' PERMIT ISSUANCE 110.00 FLOOD ZONE - A.L.U.C.
UJ > COMPENSATION INSURANCE PLG.CONTR. - LIC.No. - DLG.
d O (This section need not he completed if the permit is lot 0ne TOTAL Y❑ N C] Y❑ N
Z hundred dollars($100)orless.) EJ
U O ['certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any manner so as to '
U - become subject to the Workers'Compensation Laws of California. C
0. Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING - 9 's'
•} m NOTICE TO APPLICANT. If,after making INS Certificate of Ex- - C�
2 , emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK ��
provisions of the Labor Code, you must forthwith cofnply with
CJ, such provisions or(his permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 FEE �Z
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1C.F.M.) 6.00 SEISMIC'FEE, ;79
' 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 .•
the performance of the work for which this permit is issued(Sec. MICROFILM.,,
r 3097,Civ.C). HEATING UNIT(TO 100,000 B.T.U.),;8.00
Lender's Namc
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC ' n�
I certify that l'have read this application:unit state that the above VENTILATION FAN (SINGLE)- 4.00
information n correct.I agree to comply with all city and county BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state'lawsA re to c to building construction, and
above-herebymentioned
authored,representatives ec this city to enter upon the BOILER-COMP (Over 100,006 BTU[SEE FEE SCH. MECHANICAL' - -
above-mentioned property for inspection purposes.
'•(Wo) agree to save, indemnity Did keep harmless the City of _ MISC.- - REFER TO ORD.
Opertioo against liabilities,Judgments, costs and expenses which PERMIT ISSUANCE[ -10.00 CONST.TAX
may in any way true against Slid City In consequence of the
ra f gof[his pC [. - - MECH.CONT. 'LIC.NO.. MECH.
yy2 / TOTAL TOTAL
61ynatureol' ppl ant/Contractor Date ` 1 Zf,1S
OFFICE COPY