13553 • .. .?• *_- POST,•THIS CARD NEAR FRONT OF BUILDING ,: ,
Pf RA`IT NUMBER "
CITY, 0F;;CUPERTIN0 .'':. 13553
INSPECTION DIVISION "
JOB INSPECTION RECORD
PERMIT EXPIRATION
1/
J08 ADDR ESS �
,/0/e • 041,ONfh- .''1✓C •UNIT# LOT# •" "
PERMIT EXPIRES IF WORK
F
OWNER e/2.y aG-- �Af'fTL�T CONTRACTOR 1 IS NOT STARTED, WITHIN
" INSPECTION DATE INSPECTOR INSPECTION RECORD,. I 180 DAYS OF PERMIT ISSU- ' ^
ANCE OR 180 DAYS FROM
IFOUNDATION, I LASTCALLEDINSPECTION.
UFER
PREGUNITE PERMIT VALIDATION ,
'I ,,. I ,. • _ I ,
I POUR NO CONCRETE UNTIL ABOVE HAS B.:EN SIGNED ,
I . . UNDERGROUND /SLAB
IPLUMBING
(ELECTRICAL 1 I ISS ANCE DATE
IMECHANICAC . BLDG., ELECT. PLG. MECR
I
. I DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED � ,w � " ' � auaDlnic PERMIT
WOOD FLOOR I' 1 INFORMATION
ATI
LU ON F
I PLUMBING VA... . � - - ,^ S/ r.
IMECHANICAL
IELECTRICAL I .. PERQM/I/TTO
(FRAMING
INSULATION, • , . .I' STORIES TYPE CONSTR.
//(,,�,] OCC GROUP RES,UNITS
I PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I ,1. ' /9Y_ GJ— -�'9.1,Lf m FT,FLOOR AREA ToTALACReACe
... ROOF. "
DIAPHRAGM . ` Y
aulLOb'G USE
FILE INO CON P0" OIftor
I APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED I ❑
� . '� ,`• I / � /���,L� ,.��p ASSESSORS PARCEL NO.
ROUGH
IPLUMBING . I .. JI I'•,IA/9 /"- tGa.�IGLC[� . ' I ,
(GAS TEST, I „ - I ,• �� TRACT NO, PARCEL NO
MECHANICAL
(ELECTRICAL, I I I FINALS pDAqTEn INSP. I.—#CC.DATE ' ACC FILE NO
FRAMING I ' I ISAN #,/O'-/ 9�Z� ' 4-
��/ I ZONING ENG SITE NO.
INSU LATION PLUMBING� I
� I
IGAS I '
(MECHANICAL.., I FIRESPRI IN ENERGY T;'N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED IHEATING I I Y N❑ •.L "0
FLOOD ZONE 0.L U C.
(,LATH-INTERIOR" . ELECTRICAL �
ILATH7 EXTERIOR , (FIRE DEPT. '( ' I YE] N 10 N❑
ISHEET,ROCK _ GRADE „I •I, FEESUMMARY
"ISHEAR INTERIOR ' (BUILDING I
ISHEAR EXTERIOR I TEMPORARY APPROVALS, BUILDING
IFIREWALLS (ELECTRIC PLAN CHECK'
' `.I . IGAS' FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IoccuPANCV ,• I SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM I 5
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
,o� ONE WORKING-DAY BEFORE REQUIRED INSPECTION. PwMawG. w.
PLEASE GIVE JOB ADDRESS WHEN.PHONING.
Zr„ MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
- CONST.TAXI I -
IMPORTANT! a
PLEASE READ^REVERSE SIDE BEFORE I ('; _ TOTAL
CALLING FOR FINAL INSPECTION.
• 'Er " OFFICE COPY' - "— -
_ AP?J.ICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
j BNILmNG , APPLICATION & PERMIT
AOUEESa Cc�t �I � 1'3553
O.NE/0125/ AOe/RNA �iVE/ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
NAMER� / l'I�'�J, PLAN CHECK VALIDATION
. YKJ OTY. ELECTRIC PERMIT FEE
0,F r,57-F7-raa PHONE
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 '
NAME
IIC No LIGHTING FIXTURES 10.00/1,00
0 NTRACTORS APPLIANCES-RESIDENTIAL ,4.00 '
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE I PC NO
On
ENGINEER
uc NO - SIGNS TRANS. 3,00
ADDRESS ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
TIP TEMP.METER OR POLE INS. 20.00
APPLICANTS S ' MOTORS - SEE FEE SCH.
ADDRESS `-
SERVICE CHANGE 20.00 �7
D o o LICENSED CONTRACTORS DECLARATION - 11,7
< U u I hereby affirm that 1 am licensed under provisions of Chapter 9 I ISSUANCE GAT
F z i 1'rn(moos Code and mY h`0001's�n Division
fon3 nfdthffB`smess and I - i - BLDG ELECT, PLG. MECH.
Z o w- License Class Lie.Numb,
m w Date rantractor I El Ez
BUILDINGPERMIT i
¢ ¢ OWNER-BUILDER DECLARATION
S 0. " MISC.- REFER TO ORD INFORMATION
X ;U. w I hereby off ilo ,that I am exempt from the Contractor's License VALUATION' $/FT.
F LL U.¢ Law for the following reason.(See 7031.5,Business and Professors ?ERMIT ISSUANCE 10.00
Code Any city or county which requires a permd to construct,after,
w F ELEC CONTR. LIC.NO.
¢ ¢ ¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.
LL requires the applicant for Such Permit 10 file a signed statement that TOTAL • PERM O
n w$ he is licensed pursuant to the provisions of the Contractor's License _
rZi
Law(Chapter 9(Commencing with Section 7000)of[)]Vision 3 ofthe
4 0 Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ H$ the basis for the alleged exemption.Any violation of Suction 7031.5 1 1 STORIES TYPE CONSTR
c ; _ by any applicant for a permit subjects The applicant to a civil penalty ) ALTER-DRAIN& VENT-WATER (EA.) 5.00 '
of not more than five hundred dollars 185001 1'
❑ 1,as owner of the property;or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC CHOUP RES UNITS
' their sole compensation,will do the work,and the structure is not
intended or offered for sale (Svc 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Cod,The Contractor's License Law does not apply to an owner of
property who bwlds or improves thereon,and who does such work FIXTURES.PER TRAP 5.00 ED FT.FLOOR AREAI TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-I 6.00
�J• ments are not intended or offered for sale If,However,the buildme
or improvement is sold within one year of complenon,the owner- GAS-EA.SYSTEM-OVER 4(EA,) 2.00 BUILDING uSE
budder will have the burden of proving that he did not build or hm- RES IND CON PB Omer
ptoje for purpose of sale). INDUSTRIAL WASTE INTER. 0^ 30.00 11 0 � . 0 ❑
I�. 1,us owno of the property,um exclusively contracting with 16`J
licensed contractors To construct the project(See 7144',Business LAWN SPRINKLERS-1 IN�.B. 6.00 ASSESSORS PARCEL NO
and Professions Code:The Contractor's License Law does not apply
to an owner of property who holds or improves thereon.,end who LAWN SPRINKLERS-OVER 5�EAJ-\A=
contracts for such projects wilt,a conlrEgUE0 licensed pursuant I. A. Py
the Contractor's License Law. SEWER-SANITARY-STOq 200ft/10.
-�i \`'l"•'� 'YSJVO -{ TRACT NO. PARCEL NO
❑ Iumexemptunder Sec. ,B.&P C.Inc Nlsh WATER HEATER W/VENT tCtV ',0
- reason er S A
-Own \ C1i', L� .Date I WATER SYSTEM (`���t S.00 ACC.DATE ACC FILE NO
WORKI;RS'CONIPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsenl to self-insure,
or a certificate of Workers'Compensation Insurance,or a ceffitte' - I ZONING ENG SITE NO.-
copy thereof(See,3800,Lab C.1. 1 /J' �i9a v3,z:' -
I'ohcy Nu. Company '
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T24
_Z Z ❑ Certified copy is filed with the city mspecllon divulom MISC- REFER TO ORD. 111
0 -Applicant 1 YE] IN Y N�
F-' T ' PERMIT ISSUANCE � 10.00
LU CERTIFICATE OPF.XEMIN INS FROM WORKERS' �Q�-"�' FLOOD ZONE A.L.U.C.
_ W CONII'IiNSAT10N INSURANCE PEG CONTR ' ' LIC.NO I PLG. .-Aar Y❑ N❑ Y❑ N
G- O (This section need not he completed If the permit a for one TOTAL OC
� Z• -hundred dollars fS 100)or 16 SS,I
U O 1 certify that in The performance of the work for which Ilus per- OTY. MECHANICAL PERMIT FEE I FEE SUMMARY
LL I- Out is issued, I shall not employ any person in any manner so i s m
U became subject to the Workers Compensation Laws of California
0. -Dude Apphcanl I BUILDING l i
} N NOTICE TO APPLICANT If,after making this Certificate of E+ ALTER OR ADD TO MECH. 5.00
F Z cmption,you should home subject to the Workers'Compensatmn APPLIANCE 5.00 ' PLAN CHECK
provisions of the Labor Code, you must forthwith cmnpdy with FEE
.U 1.0h provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LFNDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 f .
the performance of the work for which this permit rs issued(Sec. MICROFILM
3097,Civ C.) HEATING UNIT(TO 100,000 B.T.U.) 8.00 '•
Lender's Na-, I HEATING UNIT(OVER 100,000B.T.U.)9.50 I ELECTRIC
Lender's Adar••==
" I certify that I have read this application and slate that the above I VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COW(3H.P.Or100,000B.T.U.) 6.00
hereby nuthorice representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU1SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MRSC.'w REFER TO ORD. f
Cupertino against liabilities,judgments, costs and expenses wine PERMIT ISSUANCE 10.00 1+ CONST.TAX
may in ny way acerne against said City in consequence of the
Bran f this P - MECH.CONT. LIC.NO MECH.
TOTAL f , I TOTAL
:11gn fore of p cant/Conhactor Date ! ,
OFFICE COPY -