9152 POST THIS CARD NEAR FRONT OF.BUILDING
• - PFRnnir Nuromel�
CITY OF CUPERTINO ; [+�
INSPECTION-DIVISION
9152
�A1 w?ii
JOB INSPECTION RECORD
ryA� y�{,e/� PERMIT EXPIRATION
JOB ADDRESS �b (a > eryiJi l7-�C. M1 UNIT# - LOT# ,pERMIT,EXPIRES IF WORK
OWNER rU��(� .J/1�a yt.l coNTRAcroR CJe,I'� `' IS'NOT•STARTED WITHIN
- INSPECTION 0 DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
- FOUNDATION - i - ANCE OR 180 DAYS FROM
LIFER
, - - �LASTCALLED INSPECTION.
PREGLIN ITE ; PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB +k•
PLUMBING
ELECTRICALI `-ISSUANCE DATE
'MECHANICAL eL a ELECT. I PLG. MECH.
.DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED i - BUILDING PERMIT
WOOD FLOOR INFORMATION
,VALUATION $/FT.
PLUMBING - . <
MECHANICAL - •I- -�
ELECTRICAL - „ PERMIT IU - -
FRAMING.
INSULATION - :, - 4- tSTORIES. -1 TYPE CONSTR.
- OCC.GROUP• ' RES.UNITS'
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' - ROOF .. SQ FT.FLOOR AREA •TOTAL ACREAGE ..
. DIAPHRAGM •�
BUILDING.USE
• •� . RES 'IND 'y CON PB Orae,
v.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED O ❑ ❑
ASSESSORS PARCEL NO..
ROUGH
PLUMBING - - •'I
.` GAS TEST - TRACT NO. - PARCELND.
MECHANICAL '
ACC.DATE ACC.FILE NO!
ELECTRICAL: +' FINALS DATE INSP. ' ' ..
. :FRAMING i_• _ SAN -
INSULATION PLUMBING - ZONINGENG.SITE NO.
GAS' -
' MECHANICAL 'FIRE SPRINK ENERGYCOVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING • Y "0LATH—INTERIOR ELECTRICAL FLOOD ZONELATH—EXTERIOR - FIRE DEPT. Y❑ N
SHEETROCK , - , GRADE FEE SUMMARY
SHEAR INTERIOR s BUILDING -
SHEAR EXTERIOR - TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK.' • :I
GAS - FEE f r,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY k SEISMIC FEE
UCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR: MICROFILM
r
ARRANGE FOR INSPECTION BY PHONING 252-4505, . ELECTRIC
Z� ; ' . :ONE WORKING DAY BEFORE REQUIRED INSPECTION.. PLUMBING . '•
PLEASE GIVE JOB ADDRESS WHEN PHONING.
•} .'.MECHANI CAL
- SEE PERMIT FOR,EXPIRATION DATE =
IMPORTANT! CONST.TAX.
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR-FINAL INSPECTION. -
• ` OFFICECOPV •• . -
,APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
13UI LDI NG PROJECT'I DENT(FICATION - . PERMITNUMSER -
BUILDING I APPLICATION & PERMIT
aooREss /
1 BUILDING-ELECTRICAL-PLUMBING -MECHANICAL 9152
iL PLAN CHECK VALIDATION
J,Wn 1vf/t'S Nf/'Yl J' PHONdJ`?`7J0 nTV.I t ELECTRIC PERMIT t (S ca 4FEEk i
CONTRACTOR NAUTLETS-SWITCHES-RECEP 10.00/1.00
Lc.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTORSADDRESS PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION (I
ARCHITECT PLAN CHECK FEE P.C.N0.
OR - PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
AR. FNG. - - PERMIT VALIDATION
ADDRESS
'SPECIAL CIRCUIT 5,00 '
ZIP EMP.METER OR POLE INS. 20.00 ^
'ADDRE55Ts MOTORS SEE FEE SCH.
SERVICE CHANGE 2000.
o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 I 1�Cp J
c v I hereby affirm that 1 am licensed under provisions of Chapter 9
i w (SSU NCE DATE
¢v Prommeael ng with Section 700e)i of Divfull for 3 of the Business and ELECT. PLG. MECH.
r w i Professions Code,and my license is in Cull force and effect. - yyWpD
Z o u, - License Class Lin.Number El [3 E
E y H� Uole Contractor IIJJ �I
¢ m M < OWNER-BUILDERE-v -JUL k S4 rDING,'PERMIT'
X 0 w u DECLARATION K 5
E
3 0_y 1 hereby affirm that I am exempt train the Contractor's License MISC.- REFER TO ORD _ MATO_ I ;.
LL
LLo ¢ Low for the following reason(Sec mmsa,ermit to
Professions - n VA4UA?ION b/FT.
r - Code:An cit or count PERMIT ISSUANCE _ 10.00 f9)PEVS 1�1
Y Y Y it my structure permit to construct, also -
¢ <,O improve,hdemolish,
applicant
forms anystructure,priortod its.atemnt also ELEC.CONTR. LIC.N4 ELEC.
n
o u requires the dp pursuant
for such permit to fie a signed statement Li that TOTAL PERMIT TO
w$ he is licensed pursuant to the Provisions of the Contractor's s License t
r a a Law(Chapter 9(commencing with Section is exe of t theref 3 of the ' „ 4 1 y's„x¢
a o Business and Professions Code)or that he is exempt therefrom and OTY7.. ."4PLUMBING;PERMIT,"' "T r r $?FEE
X H o the basis for the alleged exemption Any violation ofSection 7031 5 ` r v a y k X x A b`d STORIES PE CONSTR
aim by any applicant for a permit subjects the applicant to a civil penalty Jia/I
of not more than five hundred dollars($500)J: ALTER-DRAIN&VENT•WATER (EA.) 6.00
❑ I,as Owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 400
their sole compensation,will do the work,and the structure is not . .
OCC.GROUP RES.UNITS
intended or offered dor sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
himspropelf
ywho builds hhisivo employeeson,and,provided
providwlmdoes t such
work FIXTURE$-PER TRAP 5.00 SQ FT,FLOOR AREA TOTAL ACREAGE
himself m nor into his own employee a,provided that such improve
or improvement is soldorthinoffered
onefor
year
o ((,however,the the oding' GAS-EA.SVSTEM-I1NC.40UTLETS 6.00
or improvement is a bur i n o one year of completion,of the owner
builder will have the burden of proving that did not build or am- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
prove 1,as owner
of tare property, INDUSTRIAL WASTE INTER.- 30.00 'RES IND CON PB Omar
❑ d as owner of toe he exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors t0 construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to owowner of property who builds or improves thereon,and LAWN SPRINKLERS-OVER 5(EA.) 1.00 _
contracts for such projects with a contraofots)licensed pursuantt to t0
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO,
.❑ 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.
WOR ERS'COMPEN A'fION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure,
of a certificate of Workers'Compensation Insurance,ora certified ' 20NIN0 ENG.SITE NO.
copy lhereof(Sec.3800,Lah.CJ. -
- Policy No. Company
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGYTY4
Z Z ❑ Certified copy Is filed with the city inspection,division. ,
F.O Applicant MISC.- REFER TO ORD. Y [-] N❑ Y NF
it LO CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD
' LU > COMPENSATION INSURANCE !i&i
LIC.NO. PLG.
1 (This section need not be completed if the permit is for OneTOTAL Y N Y ry
Z hundred dollars($100)or I.S.) '
U I certify that in the performance Of the work for which this per. MECHANICAL PERMIT, sv FEE "-PEE SUMMARY
LL F- mit is issued,I shall nal employ any person in any manner so as to * (, : a ¢Owbecome subject to the Workers'Compensation Laws of California.Dem Applicant BUILDINGW NOTICE TO APPLICANT. If,after making this Certificate of EADD TO MECH. 5.00emption;you should become subject to the Workers'CompensationE 5.00 PLAN CHECKprovisions of the Labor Code, you must forthwith-comply withFEE
such provisions or this permit shall be deemed revoked. ING UNIT(TO 10,000GF.M.) 4.00CONSTRUCTION LENDING AGENCY ING UNIT(OVER IO,000C.EM,) 6,00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performanceof the work for which this permit is issued(Sec, MICROFILM
3097,nder's am HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name '
Lender'sAddross - HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC '
Icertify that Ihave read'Tax application and state that the above VENTILATION FAN (SINGLE) 4,00
information is correct. I egret,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 ins et, this city to enter upon the BOILER-COMP(Ower 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property forins*oft ipurposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- "REFER TO ORD. -
Copertino against liabilities,judgments, costs and expenses which - CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
/ grand of this permit hZ 3- MEG..DONT. ' LIG NO.. T TAL ( . 74
Signature pplicant/Conlrad ate
TOTAL
OFFICE COPY