16638 POST THIS CARD NEAR FRONT OF BUILDING .
I PER M IT NUMBER '
,� •- .CIT*OF CUPERTINO
INSPECTION DIVISION 16638
JOB INSPECTION RECORD
PERMIT EXPIRATION 1
JOB ADDR ESS UNIT# _LOT# '
'PERMIT•EXPIRES IF WORK '
OWNER /If fL -O'U'T CONTRACTOR' �� sj - ''� IS NOT, STARTED' WITIN
H
INSPECTION. ATE INSPECTOR INSPECTION RECORD 1180.DAYS OF PERMIT ISSU: I
FOUNDATION - .r ANCE OR 180 DAYS FROM"
NOTE: LASTCALLE 'INSPECTION.`;
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED A
.PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITYyOF - PERMIT ALDATIDN
-CUPERTINO STANDARDS. '
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED r'• ]
UNDERGROUND /SLAB
PLUMBING. pp:''� ..
ELECTRICAL - - - N (1(AqUANCE DATE -
MECHANICAL ELEcr. _PLC. L MECN
��°� ' ❑ LEI ,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR
INFORMATION '
..
PLUMBING ^ VA.L1U-�A.TION . s(ET
.. cC
MECHANICAL
' ELECTRICAL PERMIT TO
1 FRAMING - 516—A j 7
INSULATION STORIES. TYPE CONSTR.
'OCC.GROUP RES..UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
5D FT.FLOOR AREA TOTALACP FACE'
NOTE:NO FINAL INSP.SHALL BE MADE BEFORE • '
. DIAPHRAGM THE CONSTRUCTION TAX IS PAID _
BUILDING USE
ROOF SHEATHING RES .IND , CON PB O"..•.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH" SANM •ASSESSORS PARCEL NO.
PLUMBING ELECT,ENERGY
TUBS 8 SHOWER PAN '- PLUMBING ENERGY, TRACT NO PARCELING.
MECHANICAL, - MECHENERGY
ELECTRICAL - BUILDING ENERGY Acc.DATE acc,FILE NO
FRAMING " ELECT.FINAL TEST
ZONING ENG,SITE NO. '
INSULATION PLUMBING-
, GAS TEST GAS • ' '
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING .. _ Y �' ."❑ °A
L-' "❑
FLOOD 20NE .L-U.C.
EXTERIORSHEARELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. - Y❑ "❑. Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDINGov
,.
INTERIOR LATH TEMPORARY APPROVAL - BUILDwc
SCRATCH COAT ELECTRIC. PLAN CHECK
I. GAS FEE,
NO TAPE OR PLASTER UNTILABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ,
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. 'MICROFILM j
h
ARRANGE FOR INSPECTION BY PHONING 252-4505, 4 . ' ELECTRIC a '
Iw-• ONE WORKING DAY BEFORE REQUIRED INSPECTION.. , PLUMBING - - '
O PLEASE GIVE JOB ADDRESS WHEN PHONING. '
MECHANICAL
SEE- SEE PERMIT FOR'EXPIRATION DATE
IMPORTANT! " CONST.TAX
p'
PLEASE READ REVERSE SIDE BEFORE '
CALLING FOR FINAL INSPECTION. TOTAL. C1d • }
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
,�"•�. BUILDING PROJECT IDENTI FIC -PERMIT NUMBER—au—IL—Mill APPLICATION & PE ,IT+poOREss
Zd! BUILDING—ELECTRICAL—PLUMBING—MECHANICAL +. 16638
O NER'S
PLAN CHECK VALIDATION
NAME
—�. L QTY. ELECTRIC PERMIT FEE
T ej 5 PHONE
CONT ACTORY UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No, LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
�f PHONE PANELS 10.00 DATE OF APPLICATION. h
ARCHITECT PLAN CHECK FEE C.:NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO. SIGNS TRANS. 3:00 a—
ADDRESS ENG. SPECIAL CIRCUIT S.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20
APPLICANT'6
ADDRESS MOTORS SEE FEE SCH.
3 SERVICE CHANGE `t) �G!
wo o LICENSED CONTRACTORS DECLARATION
a i n I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE ...
4 (Commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG: MECH.
H m i Professions Code,and in )license is in full for a ICCLL ❑ ❑ ❑
Oz 0 0 ' License ClassL=ysLe_Lia Number 4' .� LEI I
_ Date �Q�/Y'- Contractor__si_! _
P: L~ J
4 Y s BUILDING PERMIT
M ¢O n D OWNER-BUILDER DECLARATION INFORMATION
E ; LL m I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD '
1° u O 4 Law for the following reason,(Sec.7031.5,Business and Professions VALUATION $/FT.
H - PERMIT ISSUANCE y6:0B pl — rI
Code:Any city Or county which requires a permit to construct,alter, K
2 Q'< improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ) ,,,,11.... /
G LL requires the applicant for such permit to file a signed statement that TOTAL q Vo'_. PERMIT TO
n w$ he is licensed pursuant to the provisions of the Contractor's License �C f+
Law(Chapter 9(commencing with Section 7000)of-Division 3 ofthe S 6-J
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
IS I-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR,
i ; - by any applicant for a permit subjects the applicant to a civil penalty gLTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S500).1:
❑ 1,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,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 6.00 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-11 NC.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 am- BUILDING USE
Prove for purpose of Sale.). INDUSTR IAL WASTE-1 NTER. 30.00 RES IND CON PB Door
❑ I,as owner of the property,am exclusively contracting with El El 1:1licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I 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 1'or such projects with a contritatr(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ftl10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sea ,B.&P.C.for this WATER HEATER WlVENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORKERS'COMPENSA'TION DECLARA'T'ION WATER TREATING EQUIP, 5.00
1 hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
COPY thereoffsec.3800,Lab,C.1�H��G
Policy No. _ CompunY �s
Q ❑ Cert py is hereby furnish d. �-T FIRE SPR INK ENERGY T-24
Z 2 rtified copy is filed with the city inspection division. MISC- REFER TO ORD.
O Indicant _ Y❑ N❑ Y ❑ No
~ nn, PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C.
LU CE RTII%GATE E EXEMPTION INS FROM WORKERS'
CL 1 COMPENSATION INSURANCE the PLG.CONTR, LIC.NO, PLG. Y❑ N❑ Y ❑ N❑
Z) Z Lend
re section need not he completed if the permit is for one TOTAL
hundertify tars IS 100)or less.)
U O 'I certify lhm in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued, I shall not employ any person in any manner so as to
OU become subject to the Workers'Compensation Laws of California.
to
Date Applicant FER
S
} a Pp ALTER OR ADD TO MECH. 5.00
N emptioNOTICE you should
become
'. II',after making this Certificate sa Ex-
♦— ? emvision you shouldbecomee, you must
Workers'Compensation APPLIANCE 5.00 K
provisions of the Labor Cit shall
you must forthwith comply with AIR HANDLING UNIT(TO 10
. U such provisions or this permit shall he deemed revoked. ,000GF.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 E S�
I hereby affirm that there is a construction Icnding agency for EXHAUST HOOD(WITH DUCT) 5.00 the perlonnance of the work for which this permit is issued(See.3097,CiC.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender'sNaHEATING UNIT(OVER 100,000B.T.U.)9.50 (�
Lender's Address
I certify that 1 have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 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 BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(WC) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Caper tino against liabilities,judgments, costs amd Cx Penses which CONST.TAX
ma any wkpit.
crue nst said City in consequence of the PERMIT ISSUANCE , 10.00
nli Of hyMECH.CONT. LIC.NO. MECH.
TOTAL TOTAL Oare o A / ontra Date
OFFICE COPY