16368 POST THI ARD NEAR FRONT OF BUILDING • PERMIT
.•CIW OF CUPERTINO
16368
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS' / D 12-J A). - V� d (Y-C' UNIT# LOT# "
'yv rd� C W`� PERMIT EXPIRES IF WORK
OWNER
CONTRACTOR ,� r„( '; IS NOT STARTED WITHIN
INSPECTION 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 PLA4*.gft2TY OF PERMIT VALIDAnON
CUPERTINO STANDARDS.
GARAGE SLABS - t
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �,n ✓'y44
UNDERGROUND /SLAB .
PLUMBING ellv at cuppyto_ 9 -/,-7
ELECTRICAL - ISSUANCE DATE
MECHANICAL - - BLRc ELECT PLG. ME
E ❑ � !
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
7•
INFORMATION
WOOD FLOOR - yVALUATION 9/7
PLUMBING
MECHANICAL r
ELECTRICAL PERMII TO
FRAMING ViL in '`�eC I
INSULATION - STORIES TYPE CONSTR.
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sO.ET,E LDORRREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID I
BUILDING USE
ROOF SHEATHING RES IND CON PB . Up-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.N
PLUMBING ELECT.ENERGY
TUBS B'SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO,
_ MECHANICAL - MECR ENERGY
ELECTRICALACC DATE ACC ERE NO
BUILDING ENERGY-.
FRAMING ELECT.FINAL TEST -zowrvc ENG.SITE No
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY T 2
MECHANICAL
YE] N[:] [�--1 y LJ. N❑
COVER NO.WORK UNTIL ABOVE HAS BEEN SIGNED HEATING '
ELECTRICAL RELEASE FLOOD zorvE ALL U
EXTERIOR SHEAR "
INTERIOR SHEAR SIRE DEPT. Y❑ N❑ Y C N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC - - PLAN CHECK
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. SEISMIC FEE
` OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING252-4505, ELECTRIC .2-2_ov'
LU
ONE WORKING DAY BEFORE REQUIRED INSPECTION. �',. PLUMBING
z� PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR,EXPIRATION DATE - MECHANICAL
d`I CONST.TAX
�• IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL ZD!'
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTI FI N -PERMIT NUMBER
kooABU /�1� APPLICATION & P IT n (h�^S rn R
✓f- I BUILDING-ELECTRICAL-PLUMBING-MECHANICAL �+�+�+ `+
NAMER' s,` PLAN CHECK VALIDATION
•
NAME L��-7- ,��� O�� OTV. ELECTRIC PERMIT FEE
PNONE
CONTRACTOR'S ��dry -- �T',J y
Elden IVC✓I L/LI1� �{{ OUTLETS-SWITCHES-RECEP 10.00/1.00
uC.NoF-I• 103 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'SQ n pPLIANCES,-RESIDENTIAL 4.00
aooREss
I�fVd CJ�'CIPJP PANELS 10.00 DATE OFAPPLILATION
0.CRiTECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.,NO.
ENGINEER
uc,Nm, SIGNS TRANS. 3.00
ADDRESS ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP rrEMP.METER OR POLE INS. P.00
APPLICANT MOTORS SEE F
SERVICE CHANGE 0.
Gw
'02 LICENSED CONTRACTORS DECLARATION
W. I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N z w (commencing with Section 7000)of Division 3 of the Business and
Q y BLDG. ELECT. PLG. MECH.
r Professions Co e,a license is Nj full for City of yrt�-
Zo i F' Licens- 1' s Con Number IUEJ
Date Contractor_
a m pj )^j BUILDING PERMIT
¢ ¢o
OWNER-R-BUILDER DECLARA'T'ION INFORMATION
w g¢ H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
m VALUATION
FUDa Law for the following mason, 703 L5,BusinessandProfessions PERMIT ISSUANCE 1A00 �1to
Code:Any city or county which requacta permit to construct,Sher,
ar au f FO improve,demolish,of repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ��11 ��yy '
C u requires the applicant for such permit to file a signed statement that TOTAL �,�rtP PERMIT TO
K
$ he is licensed pursuant to the provisions of the Contractor's License _
H z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe C > QC.-.
Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
at r $ the basis for the alleged exemption.An
g p he violation t Section malty STORIES TYPE CONSTR.
v3 _ by any applicant fora permit subjects 5000.licanttoacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(my employees
❑ Las owner at the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will(S the work,and the structure is not
Code:The
offered for sale(Sec. doe Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 5.00
Code:The Contractor's License Law docs not apply to an owner of
himself or th buildsorimproves
emploeereomand who does such improve-
taints
work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided that such improve-
memsarenot intended oroffered for sale.IF,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Orion
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
71I,as owner of the property,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
contracts 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 run exempt under Sec,-.B.&P.C.I'or this WATER HEATER W/VENT 6.00
reason
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
A ��
copy thereof(Sec.3800,Lab.C.),,3-
�I����
piM
Policy No Company ]] '
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY,7-24
Z ��p ❑ Ceni�a'L•d��cp��Iv�fl th c ct t sp tslon.
OJ- A J.�C37CJCf'1 1\15�c - _ MISC.- REFER TO ORD.
ppliCanf V ❑ N❑ V ❑ N❑
~ mPERMIT ISSUANCE 10.00 FLOOOZONE A.L.UC.
LU COM
- CERTIFICATE OF EXEMPTION PTION INS PROM WORKERS'
� I'F:NSANSURANCI> PLG.CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y.E] N❑
Z) Z hundred dollars IS 100)or le..)
U O I certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
U. U mil is issued,1 shall not employ any person many manner so os to
0
become subject to the Workers'Compensation Laws of California. BUILDING
Go Datc Applicant I ALTER OR ADD TO MECH. 5.00
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F.. ? eruption,you should become subject to the Workers'Co n,catwion 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 AIR HANDLING UNITIOVER 10,000C.FM.) 6.00 SEISMIC FEE .
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 Na
Lenders me Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 2,2„011
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
• information is correct 1 ogme to comply with all city and countyBOILER-COMPI3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
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.
4ay
pertino against liabilities,judgments, costs and expenses which CONST.TAX
any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
of thisMECH.CONT. LIC.NO. MECH.
TOTAL TOTAL Z,Z-d0 ature of Applic nt/Contractor Date✓ ( ,V
OFFICE COPY