16591 (2) POST THIS CARD NEAR FRONT QF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 16591
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS /6933 N WOLrE k./3 UNIT# #_LOT
- PERMIT EXPIRES IF WORK
OWNER C1-cd y i Ll.la-C,-c= CONTRACTOR -U .-T_ IS NOT STARTED WITHIN I
INSPECTION - DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHAIIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB ,
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG- ELECT I PLG. MECH
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
r INFORMATION
WOOD FLOOR EVALUATION S/FT.
PLUMBING QTR QQ
MECHANICAL 9
7 PEHMIT TD
ELECTRICAL
FRAMING Jeo
STO+If.S CJ TYPE CONSTR
INSULATION � G��y
OCC.GROUP. RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS B N SI -
/ ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SD.ljiPLOO.ARLA TOTALACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
aull.DlO use
ROOF SHEATHING I+Es irvO CON Po 00-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. - El 0 ❑ 0 ❑
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY"
FRAMING ELECT.FINAL TEST .ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY 7-24
MECHANICAL Y [] No Y ❑ NE-]
I COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.L UC
EXTERIOR SHEAR ELECTRICAL RELEASE '
INTERIOR SHEAR FIRE DEPT. v ❑ NY L7 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
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505ELECTRIC
,
Lu ONE WORKING DAV BEFORE REQUIRED INSPECTION. PLUMBING
z 0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! ' CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATI ON PERMIT NUMBER
RDILDING APPLICATION & PERMIT 16591
ADDRESS ,,s/
93 3 vy Q/ Ol. BUILDING — ELECTRICAL—PLUMBING—MECHANICAL
OWNER'5 PLAN CHECK VALIDATION
rvAME OTY. ELECTRIC PERMIT FEE
V6ZJJ 1114- PHONE
CONTRACTOR, IF NAME UTLETS-SWITCHES-RECEP 10.00/1.00
P!v / Y cUc No. Q adz LIGHTING FIXTURES 10.00/1.00
CONTRACTOR Dofla
APPLIANCES-RESIDENTIAL 4.00
ADDRESS (�/
OO oY ROrvE �(�- 563 PANELS 10.00 DATE OF APPLICATION. '
ARLRiTECT
on PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE - P..C,NO.
ENGINEER
LIC.NO. ISIGNS TRANS. 3.00
ARCH.OR ENG' SPECIAL CIRCUIT S.OQ PERMIT VALIDATION
ADDRESS
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT N $ MOTORS SEE FEE SCH.
ADDRESS
SERVICECHANGE 20.00 /
o o LICENSED CONTRACTORS DECLARATION
< U u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w w
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PL MECH.
H �i Professions Cody a�J I sc ,Nm full for��,eyy•an e e t.
z o= License Glass—C.-,J_ Lin. camber_������jjjjjyyy,�� ❑ ❑ I ❑
P z F we Dale Contractor
Q y E JI I IL
¢ ¢ w ¢
OWNER-BUILDER DfiCL, NA N BUILDING PERMIT
o A D MISC.— REFER TO ORD INFORMATION
w3 LL N 1 hereby affirm Rwt 1 am exempt frons the Contractor's License VAWATION $/FT.
m .. og Law for the followingrcason.(Sec.7031.5,Businessand Professions RMIT IS ANCE 10.00
Code:Any city or county which requires a Permit to construct,alter,
rtQ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC. O TR. LIC.NO. ELEC, E�
— O¢ requires the applicant for such permit to file a signed statement that TOTAL PAA PERMIT TO
wm" he is licensed pursuant to the provisions of the Contractor's License 69
F z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe /— C,
— ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT RE�
¢ =$ the basis for the alleged exemption.Any violation of Section 7031.5 11 STORIES TYPE CONSTR.
n , by any Applicant for a permit subjects the applicant to a civil ponalty ALTER-DRAIN -WATER (EA.) 1n0
of not more than five hundred dollars($500t): Q(�
❑ 1,us owner or ale property.or my employees with wages as BACK FLOW PROTECT. DEVICE 4.0 Dice.caouH 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 docs nut apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SQ FT,FLOOR AREA TOTAL ACREAGE
meats are not hrough
ownnemred for sale.
If.ied that however,
the
improve- GAS-EA.SYSTEM-I .
menus are nut intended or offered for sale.IL however,the building
60
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not buil)or im.
prove fors owner of sure.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ L as owner of the property,he cxdusivcly. 7044,ting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the poi ien (See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions property
IymbuildsContractor's 1-iccrosc Law does not Apply
to an owner Of property lotto builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such.projects with a Contractorls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
0 I and 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.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I herchy atfinn dml'l have a crtificutc of consent to flclf-inuve' ZONING
or a certificate of Workers'Compensation Im.nourc,or a certitied ENG.SITE N0.
copy Ihen,61 y�j t LAb.C.). o.l -,Le �Il MCL
Policy N�a�UUJ! mpany— �4c6.
O Certired copy ishereby furnished. FIRE SHRINK ENERGY T 24
Z Z �( Certilie < py fled with the c ty inspection division. MISC.- REFER TO ORD.
0 nnnlmans v❑ N❑ v ❑ N❑
CC rn 1� 'PERMIT ISSUANCE .-10-00 a �' FLOOD ZONE A.L.0 C.
CE I'I PICA'I'li OF IiXE. ON PROM WORKERS'
111 > COMPF-NSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y ❑ N❑
CL o This section need not be completed if the permit is for env TOTAL
D Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers Compensation Laws of California.
W Date Applil.'ani ALTER OR ADD TO MECH. 5.00 BUILDING
} tad NOTICE'IO APPLICANT: If,after making this Certificate Of Ex-
F ? caption,you should become subject to the Workers''Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U loch provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000C.F.M.) 4.00
CONSTRUC"I'[ON LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.F.M.) 6.00 SEISMIC FEE
I hereby aft'irin that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
(he performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.C.).
Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
1 certify that 1 have read this appricauion mol state that the above VENTILATION FAN (SINGLE) 4.00
an
information is correct. I agree to comply with all city and county PLUMBING
ordinces and state laws relating to building nstruction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby min.dre represcrUtwvs of this city to oenter upon the BOILER-COMP (OWH 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purpow,,
(We) agree to save, indemnify and keep hornless the City of misc.- REFER TO ORD.
Cupertino against liabilities,judgments, costs And expenses which CONST.TAX
ay in a way accrue against said City in consequence of Due PERMIT ISSUANCE 10.00
ranting I is s•md, MECH.CONT. LIC.NO, MECH.
TOTAL TOTAL
Sig a[ a pplicahOCon r Dale
OFFICE COPY