9034 y POST THIS.CARD NEAR FRONT OF,BUILDING
PF,RMIT NUMBER
CITY OF' CUPERTINO
'INSPECTION DIVISION 9034
JOB I SPECTION RECORD
f PERMIT EXPIRATION
\„ JOB ADDR ESS NSC/ UNIT _LOT#
• '.L _ 'PERMIT EXPIRES IF WORK • `
OWNER
CONTRACTOR ,IS NOT STARTED'WITHIN;
INS -ECTION DATE INSP CTOR IN ,ECTION RECORD - 180 DAYS OF PERMIT ISSU- .
{` FOUNDATIO _ _ 7-3, Q
-g �nK—�V,/� ANCE OR 180 DAYS FROM .
1LASTCALLED INSPECTION,
LIFER
PERMIT VALIDATION '
PREGUNITE
e-M
POUR NO CONCRET U L ABOVMEE NV SIGNED
UNDERGROUND /'SLAB . -' •�/� ��V. ,' `.
- PLUMBING -' - - -
ELECTRICAL ISSUANCE DATE
Issu . 1
MECHANICAL - BLDG' ISSU "PLG. MEC
B. :
DO NOT POUR FLOOR UNTIL AB VE HAS BE SI EO - I - BUILDING PERMIT -
WOOD FL00 INFORMATION
PLUMBING VALUATION gjFT
ELECTRICAL
FRAMING
INSULATION STORIES , TYPE CONSTR.
y..
OCC.GROUP RES.UNITSI
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF� Ij O FT FLOORAREA TOTALACREAGE"DIAPHRAGM
BUILDING USE'-1
IND .CON . PB OJ
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED �. ❑ ❑ ❑ ❑;, .
ROUGH '' r,-, ASSESSORS PARCEL NO... ,` Y
PLUMBING' ' 815 •'� - ..
GAS TEST - TRACT No PARCEL No,MECHANICAL
R
ELECTRICAL ACc DATE ACC.FILE NO „
FINALS DATE - INSP.'FRAMING SANINSULATION Q PLUMBING zONING ENG.SITE NO.
_ GAS
MECHANICAL •' EIRE SPRINK ,ENERGY T 74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ ".❑ jP ❑ "❑ ' +
LATH—INTERIOR ELECTRICAL. , ;FLOOD ZONE A.L.U.c. .
LATH—EXTERIOR FIRE DEPT. .. Y❑' 'N❑ Y❑ ''N❑
SHEETROCK -g� GRADE " ' -
SHEAR INTERIOR.>• FEE SUMMARY
- BUILDING
SHEAR EXTERIOR - - 'BUILDING '
- TEMPORARY APPROVALS ': ...�i .
FIREWALLS ELECTRIC - PLAN.CHECK
GAS FEE '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv sElsMlc FEE .
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNEDBY BUILDING INSPECTOR:'_MICROFILM
_
w ,'ARRANGE FOR INSPECTION BY PHONING,;252-4505', ELECTRIC f
\ F� ONE WORKING DAY BEFORE REQUIRED INSPECTION:: -.. PLUMBING, '
z PLEASE GIVE-JOB ADDRESS WHEN PHONING`..
_ — SEE PERMIT FOR EXPIRATION"DATE = "MECHANICAL
IMPORTANT! covsr:rax
PLEASE-READ REVERSE SIDE BEFORE TOTAL
" CALLING FOR FINAL INSPECTION.
• ,• ,OFFICE COPY '
` s
r .., 4i, .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY,
BUILPERMITNUMBERDING PROJECT -APPLICATION & PERMIT,
xauaow�
a� L ves BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 9034
OWNER'S PLAN CHECK VALIDATION
NAMETV: ELECTRIC PERMIT FEE
M6N4 HDNE
CONTRACTOR'S (/D
NAME - UTLETS-SWITCHES-RECEP 10.00/1.00
CONTRACTORS uc.NO. LIGHTING FIXTURES 10.00/1.00
AoDRESS0
' APPLIANCES-RESIDENTIAL 4.00 `
ESS
F' KRONE .PANELS 10,00 DATE OF APPLICATION
' ARCHITECT P) PLAN CHECK FEE P.C.NO.
a- OR PANELS (OVER 200 AM20.00 ' -
ENGINEER ..
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. q n PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT IIfY
ZIP EMP.METER OR POLE INS. -20:0 PAID
ADDRESS TS LZ MOTORS' SEE( EE SCH �, _
SERVICE CHANGE -20.0
o¢ TEMP.POLE 0.0_0 !h-.0
p rfr
,02 LICRNSED CONTRACTORS DECLARATION• Gity of fs M A P#p rtmo
a u u I hereby affirm that I am licensed under provisiolis of Chapter 9 ell flit A C TE l
sow (commencing with Section 7000)of Division 3 of lire Business and
r-w ,i Professions Code,and my license is in full force and effect. LD ELECT. I PLG. MECH.
0 out - License Class Liu.Number 2_
4 a - ww Date Contractor
"
H ,
a m a a
OWNER-BUILDER BUILDING PERMIT
tl UILDNR DECLARATION
INFORMATION
o T -
wg I- I hereby affirm that I Tn exempt from the Contractor's License MISC.- REFER TO ORD
t- LL p J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION
Code:Any city or county which requires a permit to Construct,alter, � -
e ¢ improve,demolish,or repair tiny structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
n wo u requires lire applicant for such permit to file a signed statement that TOTAL .J v �� PERMIT TO
ve he is licensed pursuant In tire provisions of the Contractor's License
Fzi Law(Chapter 9(colnmmocingwilh Section 7000)ofl)ivision 3 ofthe -�'']
4 o Business'and Professions Code)or that he is exempt Therefrom and QTY. � PLUMBING PERMIT' FEE hV I /O�
¢ H $ the basis for the alleged inscription.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a3 - by any applicant for a permit Subjects the applicant to u civil penalty ALTER-DRAIN TER- NT-WATER (EA.) 5,00
of not more than five hundred cents(S500).): V AL ,S- -
❑ 1,as owner of life properly,or my em ployces with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP a RES.UNITS
their Vale compensation,will do the work,and 0m S recture'is not
intended or offered for sale (Sec. 7044, Rosiness and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
,�«+ Code:The Contractor's License Law does not apply to an owner of -
sCF Iproperty who builds or improves thereon,and who does Such work FIXTURES-PER TRAP 5,00/5- Sp.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,.provided that Such improve.Tents are not intended orol'fered formic.IL however,The buildingGAS-EA.SVSTEM-11NC.40UTLETS 6.00 W
�Q
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 (EA) 200
•u.,.n,-„/ '.builder will have the burden of proving that he did not build or ire - . - . . eWILDING USE
�11. na
or purpose ofsale./. INDUSTRIAL WASTE INTER. 30.00 E IND CON Pe Omer
as owner of the prlPerry,em exclusively contracting will) ❑ ❑ ❑ ❑
d contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- Cr V,.B. 6.00 ASSESSORS PARCEL NO.
Professions Code The Contractor's License Law does not apply owner of property who builds or improves thereon.and who LAWN SPRINKLERS- 'VER 5'(EA.) 1.00
contracts for such projects with it miumctor(s)licensed pursuant to SEWER-SANITARY TORM EA 11/10.00 the Contractors License taw. - ,1S TRACT NO.' PARCEL NO.
lam exempt under Sea. ,B.&P.C.for this WATER HEATER'W/VE'N 6.00
Cason -
Owner Dae WATER SYSTEM 5.00 ACC.DATE ACC.FR.E NO.
L- - WORKIi RS' OMPENSA'fION UIiCLA Rn TION WATER TR TE
P(° 4 " 5.00 (�
hereby afOrm tial I have a certificate ofconsenr ro sCl Ginsure, \
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sce.3800,Lab.C.).
Policy No. Company
rO ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
z Z ❑ Certified copy is filed with Ilse city inspection division.
O Applicant MISC.- REFER TO ORD. Y ❑ N❑. Y ❑ N❑
My CERTIFIGITI!OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 tN FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC:N0. PLG.
CL Z TThis sectidn need not he completed if the permit is for one TOTAL L v❑ N❑. Y F] F]
hundred dollars($100)or less.)
U O 1 cerrily that in the performance of the work for which this per- DTV MECHANICAL PERMIT FEE FEE SUMMARY
LL U. mit is issued.I she)]not employ any person in any planner so as to
become subject to the Workers'Compensation Laws of California.
ED Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT''. If,Idler making this Ceflit'icatc of Fs-
F Z emplion,you should become subject to Thu Workers'CmRpclisatl R APPLIANCE 5.00 PLAN CHECK '
provisions of the Labor Code, you mind forthwith comply with - FEE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO Dp00'GP1M.) 4.00
CONSTRUCTION I.IINDING A017NCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE 3
I hereby affirm that there is a construction Icndinµagency for EXHAUST HOOD(WITHIDIQPT) :x.00 .i
the performance of the work for which this permit is issued(See. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OV 10 OO Bat?U:)8,50
Lenders Address f ELECTRIC
Icorlily rhlG lhuve read this application and swn'thm rhe above VENTILATION FAN (SI GLE) 4.00
in
is correct. I agree to comply with all city and county PLUMBING f0
LL ordinances and State laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
P thereby authorize roperty for ins of this city In enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (]
-
above(We)mentioneda eto property for inspection keep
hes.
(We) ga to sive, indemnify and keep Imrmless the City of MISC.- REFER TO ORD.
Cupertino against acco fries,judgments, costs and expenses which - CONST.TAX
may in any way accrue against Said City In consequence of the PERMIT ISSUANCE 10.00 0
granriny.uf this ernlil. MECH:CONT. LIC.NO. MECH.
!"� Jr 8 TOTAL o2.0 TOTAL 7
Signature of Applican .ontraelor Dat 39/
OFFICE COPY {