11589 POSTTHIS CARD NEAR FRONT OF BUILDING - -
,�. PFRMIT NUMBER, '
CITY, OF CUPERTINO115$9
INSPECTION DIVISION
JOB INSPECTION RECORD
• f. .�/�y,,,/ • - PERMIT EXPIRATION
JOB ADDRESS 7L/ LA' UNIT# - LOT#
p� PERMIT EXPIRES IF WORK '
OWNER CONTRACTORr-M I V'MI-TL - LO Si_ IS NOT STARTED WITHIN
180 ISSU-
INSPECTION DATE INSPECTOR INSPECTION RECORD ANCE OSOFP DAYS
FROM
ANCE OR 780 DAYS FROM
FOUNDATION, a - - LAST CALLED INSPECTION.
UFER -
PERMIT VALIOATIO
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING "
ELECTRICAL - ISSUANCE DATE
BLDG. ELECT, PLG. MECH..
MECHANICAL _ I • 0 !] 0
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT '
INFORMATION
-WOOD FLOOR vALUATION sIRT.
PLUMBING V
MECHANICAL - PERMIT TO
ELECTRICAL
FRAMING - t
F
TYPE CONSTR. ,
INSULATION ,HES.UNITSPLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED TOTALACREAGE
ROOF
DIAPHRAGMONUS[ON -PB 0",IAPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑•
PARCEL NO.
ROUGH
PLUMBING —
TRACTNO. PARCEL NO,
GAS TEST I ' ;
MECHANICAL - • -
' ACC,OATE ACG FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING _ SAN a zoNlNc ENG.SITE No.
INSULATION - PLUMB G
GAS
FIRE SPHINK ENERGY L]A
' MECH NICAL. Y N0 Y O NO
COVER NO WORK UNTIL AB VE HAS BEEN SIGNED HEATI G '
LATH—INTERIOR ELECT ICAL RL000 ZONE aL.u.c.
LATH—EXTERIOR, FIRE DEP .v� N� vI] N❑
SHEETROCK - GRADE FEE SUMMARY
SHEAR INTERIOR - BUILDING -2 —
SHEAR EXTERIOR . TEMPORARY APPROVAL BUILDING. - _
FIREWALLS ELECTRIC PLAN CHECK
FEE
- . GAS-
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM•
ARRANGE FOR-INSPECTION BY PHONING 252-4505, ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
t• 0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
- ' CONST.-TAX
IMPORTANT!.''
PLEASE READ REVERSE SIDE BEFORE
TOTAL
CALLING FOR FINAL INSPECTION.
OFFICECOPY -
kIPPLICANT TO FILL IN INFORMATIONWITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
lA BUIeDiNG / APPLICATION & PERMIT
z BUILDING -ELECTRICAL 115 89
-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
II
NAME QTY 09 ,41 NE 1`,13'-029 QTY. ELECTRIC PERMIT FEE
,��iC K Y
CONTRACTORS
� rvAME rOUTLETS-SWITCHES-RECEP 10.00/1:00
W"OQ r.ICn FPvi CW7-uC.rvO. Z(p7 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS SOh',rsyi APPLIANCES-RESIDENTIAL 4.00
ADDRESS t• /-
�t+Cfyr-7t. 1 �1 PHONE:21C7'-/1Y PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE D.C.NO.
ENGINEER
LIC,NO, SIGNS TRANS. 3.00
ADARCDRESSBea SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S
MOTORS SEE FEE SCH.
ADDRESS
�y/c u"Wr-
SERVICE CHANGE 20.00
D ¢ z311`'73/
r O o LICENSED CONTRACTORS DECLARATION t
G Z W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
G rt T (commencing with Section 7000)of Division 3 of the Business and BL G PLG. MECH.
H O 2 Professions Clyo rrttyy license is in full forr�nl(�( PI.
C El 11 El
O v`"i License ClassK`J Lic.Number -
o w 1- w Date 1 iik& Contractor
BUILDING PERMIT
¢ ¢ a OWN 11 R.B U I LDI:R DTIC LA RAT ION .
o w u INFORMATION
w ;LL w 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
LL O ¢ Law for the following reason.(See.7031.5,Business and Professions VALUATION SIFT.
R - ih PERMIT ISSUANCE 10.00 /�rO
Code:Any city or county which requires a permit to construct,alter,
se a, ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /
DLL requires the applicant for such permit to the a signed Statement that TOTAL PER TO
d w m he is licensed pursuant to the provisions of the Contr.¢tor's License
riQ
Law(Chapter 9(commencing with Section 7000)of Divisiol3ofthe
4 O Business and Professions Code)or Dalt he Isexempt therefrom and QTY. PLUMBING PERMIT FEE
¢ $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
va by any applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not mom than five hundred dollars(S500).)a
❑ I,as owner of the property,or my employers with wages as BACK F LOW PROTECTDEV ICE 400
their sole compensation,will do the work,and the St
. .
income is not OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors License Law does not apply to an owner of
. property who builds or improves thereon,and who does such work FIXTURES-PER TRAP - 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare not intended oroffered For sale.if,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA) 200
builder will have the burden of proving that he did not build or im- - . . .
BUILDING USE
RES IND CON PB Other
prove for purpose of tireJ. INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,he exclusively. 7044,Bu with
licensed contractors' m construct
ra the Project Lo 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Codeproperty who
o improv s tit does not apply
to contracts
owner of property who builds t r improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
the Contsforsuchprojectswith acontradorts)licensed pursuum to SEWER-SANITARY-STORM EA.200ft/10.00
the Contr'actor's License Law. TRACT NO. PARCEL NO.
❑ l In,exempt under Sol,-,B&P.C.I'or mss WATER HEATER W/VENT 6.00
reason
Owner Date - WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO,
WORKERS'COMPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsent to sell-insure, ZONING or cer il'icate ul'Workers'Compensation Insurance,or a certified ENG.SITE NO.
reefQ X00,Lab-c.). sTIr W IZ 111 10
P c Company
0 ❑ Cerliliedcopyls 11 b tornis]led. FIRE SPR INK ENERGY 24
Z 2 K Certified copy,i %Ie Ilm city inspection division.
O Applicant `I (,;�.� MISC.- REFER TO ORD. YE] NE] Y ❑ N❑
� y CEhriFICA'FEUPEXEMPIION FROMWORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.O.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL v❑ N❑ Y [:] N[]
hundred dollars(5100)or less.)
U 0 I certify that in the performance of the work I'or which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U not is issued, I shall not employ any person in any manner so as to
0
become subject to the Workers'Compensation Laws of California. `I
i Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE 'TO APPLICANT: If,after making this Certificate of Ex-
♦- Z 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
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,ODOC.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction 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's Name
Lender's Address I HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
• I certify that I have read this application and state that the above 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-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOI LER-COMP Ores,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against listed 'es,judgments, costs and expenses which CONST.TAX
In
in y acct against said City in consequence of the PERMIT ISSUANCE 10.00
grant' 9ofl perms MECH.CONT. -LIC.NO. MECN. /--
Signature of Applica t/Contracto Date TOTAL TOTAL �J ��
OFFICE COPY