16049 POST THIS-CARD NEAR FRONT OF.BUILDING
% P ,PERMIT NUMBER
,CITY 'OF CUPERTINO 16049
INSPECTION DIVISION
• l a' ; JOB INSPECTION RECORD
/ PERMIT EXPIRATION
JOB ADDRESS /0 -3 /V k)OLFr . —UNIT# - LOT.#
PERMIT EXPIRES IF WORK ;
IN - v2- q-I •�S'TUa��0 co NTRACTOR �
OW _ IS�INOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 18oDAvsoFYERMIT:.IssU-,I
FOUNDATION - - ANCE,OR 180 DAYS FROM '
NOTE: -LAST CALLED LLINSPECTION. ,
UFER
ALL GRADING AND.DRAINAGE SHALL BE INSTALLED ,
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF - PERMIT VALIDATIONS
CUPERTINO STANDARDS.
GARAGE SLABS_
POUR NO CONCRETE UNTIL ABOVE HAS SIGNED
'UNDERGROUND'
/SLAB � ' Y
PLUMBING
ELECTRICAL ISSUANCE DATE i
, BL ELECT. —PLG. MECH.
MECHANICAL :
%
OO-NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED4 BUILDING PERMIT
%VQNFORMATION
',WOOD FLOOR VALUATION 's/FT.
PLUMBING ''
MECHANICAL
ELECTRICAL' �• - - - - - ...may--PERM rrr ��,,((
FRAMING
INSULATION - - STORIES, TYPEGDNSTR
OCC.GHOUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT,FLOORAREA .TOTAL ACREAGE', ,
`ROOF. - NOTE:NO FINAL INSP,SHALL BE MADE BEFORE.
• DIAPHRAGM THE CONSTRUCTION TAX IS PAID"
ROOF SHEATHING`- - : BuagiOuse.
RES INp, CONN - •O:ne,
APPLY.NO ROOFING UNTIL'ABOVE HAS BEEN SIGNED FINALS DATE INSP. '�
ROUGH, SAN.N nsSESSORS PARCEL NO
PLUMBING % ELECT:ENERGY
,TUBS&SHOWER PAN - - - PLUMBING ENERGYTRACT o:- PARCEL No:
MECHANICAL •<'. . - _ MECH."ENERGY
ELECTRICAL - BUILDING ENERGY ACC.DATE Acc.FILE NO,•.,,
FRAMING ELECT.FINAL TEST '
IN - PLUMBING ZONING �ENc^srt E.No.
GAS TEST GAS - - -
MECHANICAL FIRE SFRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y.❑.' "'E] - ' ° ❑ - "EI
h - FCOOD ZONE AL UC. , t
EXTERIOR SHEAR ELECTRICAL RELEASE 1 . 1
INTERIOR'SHEAR FIRE DEPT.' Y L P,O' ' Y L ^��
SHEETROCK ". GRADE a FEE SUMMARY
EXTERIOR LATH, BUILDING
BUILDING �a
INTERIOR LATH: E ' - TEMPORARY,APPROVALS' •�='•i
SCRATCH COAT ELECTRIC . PLAN CHECK -
t GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY : ' - SEISMIC FEE ' '
''. OCCUPANCY OF BUILDINGIS NOT PERMITTED UNTIL BUILDING FINAL IS'SIGNED BY BUILDING INSPECTOR. MICROFILM ,
LU ARRANGE•FOR INSPECTION BY PHONING 252=4505, , :, ELECTRIc'
ONE'WORKING DAY.BEFOREREQUIRED INSPECTION. Rt PLUMBING
I o�. - PLEASE GIVE JOB ADDRESS WHEN PHONING. „x _
I' zSEE PERMIT FOR EXPIRATION'DATE'—` ' $„ . T" 'MECHANICAL
»> .
,, IMPORTANT! CONST.TAx,
PLEASE READ REVERSE SIDE BEFORE £� .
" CALLING FOR'FINAL INSPECTION. Al
TOTALoZS'
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES ='USE BALL POINT PEN ONLY "
` BUILDING PROJECT IDENTI FI ATI O - ' - � ' ' PERMIT NUMBER '•
1
is D,ND Li �/F i/I� W APPLICATION &PERMIT 1`6049
. O /� (1 <_
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OW ER'a - •. '.
NA PLAN CHECK VALIDATION..
QTY. 'ELECTRIC PERMIT FEE 'S
PH NE
NAM QRAcroR s._. OUTLETS{SWITCHES-RECEP 10.00/1.00 "
LIGHTING FIXTURES " 10.00/1.00 '
CONTRACTOR S - - -
A ! APPLIANCES-RESIDENTIAL 4.00 ' -
'�1ONEQ �'YIO PANELS 10.00 " GATE OF APPLICATION"'
RCRITECT PLAN CHECK FEE P.C.NO.
R PANELS (OVER 200 AMP). 20.00 -
ENG INEEy�� �r
' / •'�Nf uc.No. ;/ SIGNS TRANS. .'3.00
ARCH.OR ENG. - PER MIT VALIDATION
ADo ES �q SPECIALCIRCUIT ie, 5.00
-
1 1fA�• O II EMP.METER OR POLE INS.' 20.00
PPUCANTs MOTORS. , SEE FEE SCH.
ADDRESS �' ,
SERVICE CHANGE 20.00
O O '. LICENSED CONTRACTORS DECLARATION
a i w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
V,¢ (commencing with Section 7000)of.Division 3 of the Business and - BLDG:'. ELECT. PLG. MECH.
H w w Professions Cod my license is in full for / ❑ ❑ ❑
oi m License Class Lic.Number--�
Date Contractor�rYJAt�_
a x M - " BUILDING PERMIT
¢ . ¢ OWNF.WBUILDERDECLARATION
a w w 1 .• INFORMATION
`x 3 u H I hereby affirm that I am exempt from the Cowan al Po License MISC.- - 'REFER TO ORD
w VALUATION - $/FT.
H .. OJ Lawforthefollowingreason(Sec. uires a,ermit tocnd Professions ,PERMIT ISSUANCE 10.0 rA
w Code: e,demyor wu npair any structurep rior ttownsuanc ,also
> �i
¢ ¢ ¢ improve,demolish,or repair any structure;prior to its issuance,also ELEC.CONTR.- LIC.NO. ELEC. A �v•`v
to
wo u requires the applicant for such permit to file a signed statement that TOTA ` PERMIT TO
he Is licensed pursuant to the provisions of the Contractor's License 'al
Law(Chapter 9(commencingwith Section 9000)of Division 3 ofthe /0 MB,K
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT F -
M r $ the basis for the alleged exemption.Any violation ofSection7031.5 •QI'�U STORIES -TYPE CONSTR.
a3 by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN IEA.) 5.00
of not more than five hundred dollars($500).): "
❑ I,as owner of the Property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 occ.GROUP RES.UNITS
their 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,GOND. 5.00 ,
Code'.The Contractor's License Law does not apply to an owner of -
propertywhobuildsor.improves thereon,and who does such work FIXTURES-PER TRAP 5.00 so.FT.FLOOR AREA TOTAL ACREAGE
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.40UTLETS 6.00 '
^ or improvement is soldwithinone year of completion,the owner- - -
,., builder will have the burden of proving that he did not build or ar- GAS-Ed.SYSTEM. OVER 4�(EA.) .,2.00 BUILDING USE
prove for purpose of sale.). - ' INDUSTRIAL WASTE INTER.' 30.00 RES [NO - CON PB `Other
❑ I,as owner of the property,am exclusively contracting with
❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec 7044,Business• LAWN SPRINKLERS;1INC.5 V.B. :6.00 ASSESSORS PARCEL NO.
- and Professions Code:The Contractor's License Law 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 contmctons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Seca - ,B.&P.C.for this WATER HEATEfl'W/VENT 6.00
reason
Owner _ Date WATER SYSTEM 5.00
ACC.OATE ACC.FILE NO.
' WORKERS'COMPENSATION DECLARATION. WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, - -
or a certificate of.Workers'Compensation Insurance,or a certified s ZONING ENG.SITE NO.,
copy thereof(Sec.3800,Lab.CJ.
Policy No. Company
A ❑ C ified Ce s hereb fu niched.- ,d
(L p y - - FIRESPRINK , 5NERGYT-24 -
z_'Z 1\ ertified'Pop ty}Pr„flty inspection division. MISC.-. REFER TO ORD. O ❑ ❑ ❑
Applicant ' Y N - Y N
~ H PERMIT ISSUANCE _ 10.00
� CERTIFICATE OF.EXEMPTION FROM WORKERS' FLOOD ZONE A.L.u.a"
W > I 'COMPENSATION INSURANCE - PLG_.CONTR. LIC.NO. PLC.
CL 0 1'rhis section'need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ .N❑
D Z hundred dollars IS 100)or IcrsJ -
U O 1 certify that in the performance of the work for which this,per- DTV. MECHANICAL PERMIT' FEE FEE SUMMARY
LL t, mil is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
Date Applicant -BUILDING .
-}�y ALTER OR ADD TO MECH.. 5.00
NOTICE TO APPLICANT. If,after making this Certificate of Ex '
F'? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
-U such provisions or this permit shall be deemed revoked.. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY A18 HANDLING UNIT(OVER 10=C.F.M.) 6.00 _ SEISMIC FEE oZ, s
I 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-
' 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name _ HEATI NG UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I have read thus application and state that the aboveVENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county - PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000B.T.U.),6.00
hereby authorize representatives-of this city to enter upon'theBOILER-COM P;(Over 100,000 BTU)SEE FEE SCH. MECHANICAL .
above-mentioned property for inspectionpurposes.
(We) agree to save, 'indemnify and keep harmless the City of MISC.- REFER TO ORD,
uperthin against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ay in a y way I acerae against said City in consequence of the
rami MECH.CONT. LIC.NO. MECH:
_; ! TOTAL 1
r TOTAL
Signet a of Applicant/Contractor Da - I
OFFICE COPY