16885 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY 01 CUPERTINO 16885'
INSPECTION DIVISION
JOB INSPECTIONRECORD lj
// SI ' ( U.l` .. PE'RMMITEXRIRATION
JOB ADDRESS U (.23 L• (J1�/ ['-(-P � UNIT# _LOT# 2•Y • �'-X
ERMIT EXPIRES IF WORK
OWNER �^-� CONTRACTOR �� .e : IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD IOU UAYS OF PERMIT ISSU.
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE:. - LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALLBE INSTALLED '
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABSppdAi
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB `
PLUMBING UN'-
ELECTRICAL .ISSUANCEOATE I
MECHANICAL . BLOO. ELECT. PLG. MECR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION,
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL - • ° ',,f
P€F MIT.TO
ELECTRICAL '1(L �
FRAMING ,I
"INSULATION
STORIES TYRICONSTR.e°
- -
OCC.GROUP RES UNITS,
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE,. ?srLPuooRn En TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING HES IND CON PB 00- .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. E] ❑ E] [D
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING - - ELECT.ENERGY - - -
TRncr No. PARCEL No
TUBS.B SHOWER PAN PLUMBING ENERGY
- MECHANICAL . MECH, ENERGY
-
ELECTRICAL BUILDING ENERGY ACC.DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST ZONING ENC,SITE No,
INSULATION PLUMBING -
GAS TEST - - GAS
• �/� FIRE SPRINK ENERGY T-7
,I
a
Y NE] v E] ' N[]COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
aooD zoNE ALu.c.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. - - Y ❑, IN Y �] N❑
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING Qom/
INTERIOR LATH TEMPORARY APPROVALS 'BUILDING
SCRATCH COAT' ELECTRIC PLAN CHECK a
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ',t ' ELECTRIC
r_.;.:y.
�� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - C, * MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE volow
TOTAL
CALLING FOR FINAL INSPECTION:
OFFICE COPY
Y, 'APPLICANT TO.ILL IN 'INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
—BUILDINGPERMIT NUMBER.
PROJECT IDENTIFICATION q p
BUILDING'p APPLICATION & PERMIT 1 6(7 5
ADDRESS V V
.;v a BUILDING —ELECTRICAL—PLUMBING—MECHANICAL
./,ee J wHe '6 t PLAN.CHECK VALIDATION
1 3 NAME O CITY, ELECTRIC PERMIT FEE
coNr cons
N UTLETS-SWITOHES-RECEP 10.00/1.00 327 'Lg .
IC.No.2 LIGHTING FIXTURES 10.00/1.00
CONT AC R' I"ct Si APPLIANCES-RESIDENTIAL . 4.00 -
ADDRE65 �/�
T/ GC -1 HONE J PANELS 10.00 DATE OF APPLICATION .t
ARDHITscr 'r PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE .C.NO.
OR
ENGINEEfl G/� la
•I - uc.No. SIGNS TRANS. 3.00
'P'H.rrn ENG. �� �—/ 5.00 PERMIT VALIDATION
>. AWREss 7 /�I Pf( W6 SPECIAL CIRCUIT
EMP.METER OR POLE INS. 20.00 /-
ADDRESS MOTORS SEE FEE SCH. (p
APPLICA
D SERVICE CHANGE 20.00 }Iy_s_ �1
o o LICENSED CONTRACTORS DECLARATION �Q � ' 1 ` ,_ u JG- `,
MCI
<u v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
H G y (commencing with Section 7000)of Division 3 of the Business andBLDG. ELECT. PLO. 'MECH❑.
Z
.{r N
Z Professions Code,and my license Is in full force and effect. ❑ ❑
, 0 m — License Class Lic.Norther
r w H w Datc Contractor
;a m i BUILDING PERMIT
¢ ¢w� OWNER-BUILDER DECLARATION Wgqm
INFORMATION
w3.H I hereby uffims IhuLl am exempt from the Contractors License MISC. - VALUATION $/FT.
H a.o; Law Cor the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires.permit reconstruct,alter,
'Q prior Q 0 Improve,demolish,Or repair any struclum,pto its Issuance',also ELED.CONTR. LIC.NO. VVYYY
ELEC.
m LL requires the applicant for such permit to file a signed statement that TOTAL PERMIJ 1O
1 A w he is licensed pursuant to the provisions of the Contractor's License
HiQ Law(Chaptert) commencing with Sect ion 7000)of Division 3 ofthe
QTY, PLUMBING PERMIT FEE \�T Vr
Business and Professions Code)or that he is exempt therefrom and
¢ 1-$ the basis for the alleged exemption.Any violation of Section 7031.5
STORIES TV CONSTR.
n3 � by any applicant for a permit subjects the applicant In a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCD,GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of -
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP S.00 60,FT,FLOOR ARE4 TOTAL ACREAGE
4' himself'or through his own employees,provided that such improve.
ments are not intended or offered for sale,l f,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
% — or improvement is sold within one year of complelion,the owner GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or int- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor i License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractorts)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 . TRACT NO. PARCEL NO.
the Contractor's License Law.
O l am exempt under Sec.—,B.&P.C.for this WATER HEATER W/VENT 6.00 ' ,
reason
Owner - Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 -
1 hereby affirm that I have a certificate col consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,ory certified
copy thereof(Sec.3800,Lab.0}. _ s I r C
Policy Nrt Cmerel, ��"�R2}tm, L
Q ❑ Certified copy is hereby funis Cd. FIRE$PRINK ENERGY T-24 '
Z Z ❑ Cerli ' is fled with the city inspection Division. MISC. REFER TO ORD.
APP( Y❑ N❑ V ❑ N❑
PERMIT ISSUANCE 10.00
� N CERTIFICATE OI'EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
n• CI ('this section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
0 Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance oIthe work for which Ihis per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
UL I- 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.
I p BUILDING (fro b
Date.Applicant 'ALTER OR ADD TO MECH. 5.00
} fait NOTICE TO APPLICANT: IL
after taking this Certificate of lix-
Z emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply will FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1I C.F.M.) 6.00 SEISMIC FEE . �Z
I hereby affirm that there is a construction Iendiag agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of-the work for which this permit is issued(Sec. MICROFILM
3097,CN.CJ, HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
1 certify that I have read this application and 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 slate laws relating to comply
with construction,nd co and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL
zbuve-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. 1
Cupertino against Eabilities,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.
I TOTAL TOTAL 322•
Ignamre of Applicant/Conlmcmr Dale '
OFFICE COPY .