16770 (2) POST THIS CARD NEAR FRONT OF'BUILDING
" PERMIT NUMBER
- CITY OF CUPERTINO
8770
INSPECTION DIVISION
JOB INSPECTION RECORD_
1,.l�..,,�y-� i^ PERMIT EXPIRATION
JOB ADDRESS-07Z1172—I1 ✓r�(-[ ^� �O 1'� C UNIT# _LOT# PERMIT EXPIRES IF WORK
owNER W \ a CONTRACTOR ev IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ` 1 - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING'AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF - PERMIT VALIDATION
GARAGE SLABS " CUPERTINO STANDARDS. PA - -
j�V ! .
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB .i'JL r< I "IM / -
PLUMBING p� �{{ - J .
ELECTRICAL - YI�Y{ ISSUANCE DATE-- C
MECHANICAL - - BLDG ELECT PLG MECH.
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION SIFT.
PLUMBING '
I
MECHANICAL
ELECTRICAL - I PERMIT To -
.FRAMING -
INSULATION - sTORIEs 9 TYPER.
OCC,GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FT FLOOR AREA TOTAL ACREAGE
ROOF OS E:NO FINAL
INSP.ON TAXALL S PBE EMADE BEFORE
TH
<� DIAPHRAGM BUILDING USE
ROOF SHEATHING Res IND CON PB oln",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 ❑ ❑ ❑
ASSESSORS PARCEL NO -
ROUGH SAN.#
PLUMBING - ELECT.ENERGY -
TUBSBSHOWERPAN,. PLUMBING ENERGY - TRA IC7 No PARCEL NO
MECHANICAL MECH.ENERGY
I
ELECTRICAL _ BUILDING ENERGY ACC DATE ACC.PILE NO
FRAMING - ELECT.FINAL TEST
TONING ENG.SITE NO
INSULATION PLUMBING ,
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T-24 '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ` ❑ N❑
FLOOLILONE A UC,
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. Y ❑ N❑ Y ❑ 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 IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU -ARRANGE,FOR INSPECTION BY PHONING 252-4505, ELECTRIC
0 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT.!. CONST:TAX
.
it
PLEASE READ REVERSE SIDE BEFORE
` CALLING FOR FINAL INSPECTION. TOTAL, r
'OFFICE COPY
lPPL'IGANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
Bl51LDING PROJECT IDENTI FICATION APPLICATION
Amon 16770
aooR 2e
/ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
Nam S k:17A OTY. ELECTRIC PERMIT FEE
PHONE
CONTRACTOR'S
pLAr�� UTLETS-SWITCHES-RECEP 10.00/1.00
.C/� uc.No. �� !i[, LIGHTING FIXTURES 10.00/1.00
CONTRACTOR S APPLIANCES 4.00
AO Ess
PHONE PANELS 10.00 DATE OF APPLICATION",
ARCHITECT - PLAN CHECK FEE .C.NO.
OR. PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG, PERMIT VALIDATION
ADDRESS-� SPECIAL CIRCUIT 5.00
puTc � ZIP EMP.METER OR POLE INS. 20.00 ^�
APPLICANT
oo EST MOTORS ' SEE FEE SCH. s ' (- Z(-
• SERVICE CHANGE amd,00
o O LICENSED CONTRACTORS DECLARATION �� `7 , 1•
a o W I hereby aflurn that I am licensed under provisions.1 Chapter 9 ISSUANCE DATE
y a a (commencing with Section 7000)of Division 3'oof the Business and
w E_, -m BLDG. ELECT- PLG. MECH.
t. i Professions CoA se is in full for�ey// y,' E] �I3L ❑ ❑
Z O y - License Clan, Lic.Number! u
d Gad
9 - D atc
DContractor
�
BUILDING PERMIT
¢ ¢ w a OW ER-BUILDF.R DECLARATION
" MISC.- REFER TO ORD' INFORMATION
I hereby affirm (hut"I am exempt from the Conlracmr's License
FLLov, Law for the following reason.(Sec.7031.5,Rusinessand Professions PERMIT ISSUANCE 10.001/ vAWATION S/PT.
Code:Any city or county which requires a permit to construct,alter,
Qm FILE D LIC.N0.
Q a Q InlplOVe,JCmUIIS11,Or repair any 6t Netnre,p110r t0 It5155nanCl`,ll1a0 _ / ELE..
i w m LL requires the applicant for such permit to file a signet statement that TOTAL 7 r PERMIT TO
he is licensed pursuant to the provisions of the Contractors License
r z aw I.ew(Chapter 9(commencingwlth Section 70001nf Division 3 of the
4 D Ilusiness and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE a C-' Lc
the basis for the alleged exemption.Any violation of Section 7031.5 -STORIES TYPE CON R.
i ; by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensmimn,will Jo 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 Low does not apply to an owner of
property who builds or 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-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM•11NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner,
builder will have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of salej. - RES IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 11 1:1 0
licensed contractors t° construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
unit Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.Ilnd who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a comracmr(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor'sxLicense Law. TRACT N0. PARCEL NO.
[ame
❑ lam exempt under Sec..,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKI?RS'COMPENSA'IION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I Rout it certificate(it consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy lhereof(Sec.3800 Lab.C.I _
Policy No. Cnmpam
❑ Ce copy
is]
urni' FIRE SPRINK ENERGY T-24
Z Z erblleJ c file c.ci(y Imh �,, ,Iision.
HO Applicant Jam' MISC.- REFER TO ORD. Y NY ❑ NC3
CCN CERTIFICATE 017 EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W COMPFNSATION INSURANCE PLG.CONTR. ❑C.NO. PLG.
Z( This section heed not be completed if the Devitt Is for one TOTAL Y E] N� Y ❑ No
hundred dollars t S 100)or less.)
U O I certify (hat in the performance of the work forwhich Itis per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL: 1-
LL: mit is issued,1 shall not employ any person in any manner s°as to
O W become subject to the Workers'Compensation Laws of California.
Date Applicant BUILDING
>_ 0 NOTIC17 TO APPLICANT: If,after making this Certificate of nix- ALTER OR ADD TO MECH. 5.00
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
✓J 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 10,000C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a cons(medon 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,Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 17, 00 0 O
Lenders Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4,00
information n correct. 1 agree 10 g to building,with all city unit county BOILER-OOMP 13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and orate laws relating to lywithall it and co and my
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)BEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep ss the City of MISC.- REFER TO ORD.
Cupertino against liabilities rIy{meats, c . 1 J expenses which CONST.TAX
may in any way ace a (st n consequence of the PERMIT ISSUANCE 10.00
rantirt
ng of(hi MECH.CONT. LIC.NO. MECH.
' Slgd or Rpp'Til, h/Contractor s fe ' TOTAL TOTAL 1700
• OFFICE COPY .