16087 ,POST-THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO ' 16087
INSPECTION DIVISION
JOB INSPECTI/Nn}RyECORDD
• r h� /1 ��J•E 'OII 1 • 7PERMIT•EItPI RATION
JOB ADDRESS UNIT/# LOT#
��!A �(� PERMIT EXPIRES IF WORK
OWNER eOf 1�I o RnCTOH " IS NOT STARTED WITHIN
INSPE TION DATE I 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
Pq EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED f6A F-eQYpt
UNDERGROUND /SLAB '
PLUMBING - -
ELECTRICAL .PAI
_ _
ISSUANCE.OAtE
MECHANICAL ,�+11�p ELECT. PLD. MECH,
SEP 1 �DL07p ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED City Of C pertin DIIRMATIONT
WOOD FLOOR
PLUMBING ,vALDA ON M aiFr.
. . -
MECHANICAL - •°.y�,-I�{.S
ELECTRICAL PEHMD.TO
FRAMING LI
INSULATION - - STORIES TYPE CONSTR.
• UCC.GHOUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE $O FT.FLOORAREA TOTALACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING INBUILDING USE,
- HCS D 'CDN PB m
C ,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE" INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.N ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY -
, .
TUBS&SHOWER PAN, � PLUMBING ENERGY TRACTNOPARCEL NO,
MECHANICAL - MECH.ENERGY - r
ELECTRICAL _ BUILDINERGY ACC DATE ACC.FILE No
NG E
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING - - ZONING ENG.SITE NO,
GAS TEST ' - GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING O `' Y N❑ • v ❑ "❑
EXTERIOR.SH EAR ELECTRICAL RELEASE p_ FLOOD ZONE A.L UC.
INTERIOR-,SHEAR F.I RE DEPT. Y ❑ N❑ •Y ❑ , 'N❑,
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH, BUILDING -
NTERIOR' LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC !I_F-y^ PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE v I .
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, :, ELECTRIC
ILL! ONE WORKING DAY BEFORE REQUIRED INSPECTION.
z PLEASE GIVE JOB ADDRESS WHEN PHONING.. u` 'PLUMBING
�I. - SEE PERMIT FOR EXPIRATION DATE =
MECHANICAL
8t ,
IMPORTANT! ,` CONST.TAX
x}
PLEASE READ REVERSE'SIDE BEFORE } TOTAL z- • "r
CALLINGTOR FINAL INSPECTION.'
OFFICE COPY
Aft ICANT TO FiLL III INFORMATION WITHIN RED LINES - USE-BALL POINT PEN ONLY,'
10UILDING PROJECT IIDENTIFICATION PERMIT NUMBER
BUILDINGAPPLICATION & PERMIT '
-
ADDRESS
- 1 0 7,
. /D/a3 P¢ ® 6 8� BUILDING-�ELEC7RICAL=PLUMBING-MECHANICAL � � �" V VV
OWrvER'S PLAN CHECK VALIDATI N
ry E OTY, ELECTRIC PERMIT FEE
l ONE 6
/�� (
CONTRACTOR'S - . - -
.I NA / OUTLETS-SWITCHES-RECEP 10.00/1.00
6 �1� LIGHTING FIXTURES 10.00/1.00 '
t-o TRAC"DRE Srons - APPLIANCES-RESIDENTIAL 4.00
Ni ^ J PANELS 10.00 DATE OF APPLICATION
ARCHITECT - P.C.N0.
OR ^ - - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE_ -
.. ENGINEER - -
SIGNS TRANS.
ARCH.on ENG. - PERMIT VALIDATION
ADDRESS'�x SPECIALCIRCUIT r� 5.00
'LC f f� zlc EMP.METER OR POLE INS. 20.00
APPLICANT'S
ADDRESS MOTORS SEE FEE SCH.
AOp /+ �f
- _ `Cx /�3T SERVICE CHANGE 20.0
woo - LICENSED CONT ACTORS DECLARATION U
ri n I hereby affirm that I am.licensed under provisions of Chapter 9 �• ISSUANCE DATE
¢ (commencing with Section 7000)of Division 3 of the Business and BLDG ELECT. PLG. -MECH,
r y z Professions Code,and my license is in full force and effect. ❑ ❑ ❑
Zo i y License Class Cmn Number City f IOUpP.Il BIJ-M'
r Date Contractor
BUILDING PERMIT
ec ¢O M u, OWNER-BUILDER,DECLARATION INFORMATION
w ; N I hereby-affirm that I am'exempt.from the Contractor's License MISC.'- REFER TO ORD
LL o¢ Law for the following reason.(Sea.7031.5,Business and Professions, PERMIT ISSUANCE 10.00 _ VALUATION $/FT:
2aj� Code:Any,cily or wanly which reyuiresa permit focons[ruct,alter,
Q Q Q Improve,demOIIS11,Or repair any structure,prior to Its ISSuanee,8150 ELEC.CONTR. LIQ NO. ELEQ'
a w m u requires the applicant for Such permit to file a signed statement that TOTAL ntnmlor's' PERMIT TO
he is licensed pursuant to the provisions of the CoLicense
FZi
Law(Chapter 9(emnmeneingenth Section 7000)of Division 3 ofthe 1111'1-_Ip- Ir� �-
Q
f Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEEi-
i D
¢ H m the basis for the alleged exemption.Any violation of Section 7031.5I STORIES TYPE CONSTR.
c3- <a PPllCant fora permit subjects the applicam toacivil
penalty
ALTER-DRAIN&VENT-WATER (EA.) 5.00
oas, than flue hundred dollars(my em):
rrrras owner of the property
,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
e as,
will(S the work,and the structure is not
Cole:
or offered for sale(Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONIC, 5.00
Code:The who
buildsH s License Law does no,apply to an owner work
{
himself or
buildsis improves who does such improve.work FIXTURES-PERiTRAP 5.00 SQ FT.FLOOR AREA rorALACREAGE
• mems are not hrough
ownemployees,for sale,
if,ed however,
the
improve- -GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
mems are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS a EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or iris- BUILDING USE
I. prone for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 'RES IND CON PB Omar
❑" I,as owner of the properly,am exclusively contracting with ❑ "❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 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
contacts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I and exempt under Sea ,B.&P.C.for this
WATER HEATER W/VENT 6.00 _
reason
Owner a WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
- Ar-
WORKERS'COMPE. D. A WATER TREATING EQUIP. 5.00
.4 1 hereby affirm-runt I have a certiflcate'of consent to self-insure, - ZONING
or a certificate of Workers'Compensation Insurance,or a certified .ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ.t - -
Policy No. Company
0 O Certified copy is hereby furnished FIRESPRINK ENERGY T-24
Z Z ❑ Certified copy-is filed with .the city inspection division. MISC.-- REFER TO ORD.
O Applicant Y ❑ N❑ V ❑ N❑
N CERTIFICATE OF EXEMPTION FROM WORKERS' ' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. . LIC.NO. PLG.
CL D (This section need not be completed if the permit is for one TOTAL V,❑ N O Y❑ N❑
D Z hundred dollars IS 100)or IussJ
L) O 1 certify that in the performancemf the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL mit is issued',1 shall not employ any person in any manner so as to
bew su Workers' mpirf 'o f al'forn' z!
a. Dale A,plican ALTER OR{ADD TO MECH. 5.00 BUILDING
} m - NOT Cb O APP LICAN'f: ,after, mu g us Certi icate of 8x-
?- caption;you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK.
provisions of�he Labor Code, you must forthwith comply with - FEE . -
(J such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0MC.RM.) 6.00 SEISMIC FEE .5t
1 hereby affirm4hat 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 No - HEATI NG UNIT(OV ER 100,000 B.T.U.)9.50 -
Lender's Address`' ELECTRIC,
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
• information is ebrrect. 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 100,000 B.T.U.) 6.00
hereby,authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. ' MECHANICAL
(We),agree to save, indemnify and keep harmless the City of Misc- REFER TO ORD.
' upertino against liabilities,judgments, costs and expenses which - CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ranting of this permit. MECH.CONT. LIC.NO. MECH. '
TOTAL TOTAL - q^
Signature of Applicant/Contractor Date
OFFICE COPY