13671 PS CA
OST THIRD NEAR FRONT OF BUILDING
1' _r 'PERMIT NUMBER
A •CITY,. OF CUPERTINO 1367
'INSPECTION DIVISION.
JOB;INSPECTION RECORD
PqRMIT EXPIRATION `
JOB ADDRESS ' rL ,UNIT# - 'y LOT# -
: PERMIT EXPIRES IF WORK -
'oWNER LC— ' 't IV .L NTRACTOR•r �J'�.`f L IS NOT STARTED'WITHIN'
INSPEC I N D ,E� -=,INSPECTOR, *,a`,INSPECTION;RECORDa � , '�Bo;DArsoFPERM^ITISSU.,'
FOUNDATION? .. : _ ^, ANCE OR. IOU DAYS FROM
LAST;CALL'EDINSPECTION.
LIFER- _ } .�.
.PR EGUNTE - . ,�• - PERMIT VALIDATION
-POUR NO-CONCRETE UNTIL ABOVE=HASiBEEN SIGNED' -✓
UNDERGROUND'
/SLAB
PLUMBING= 4 w 1
F ) N.
:; ELECTRICALISSUANCE DATE
M - _ „ , ` •p�12 ,`�r/SV `+ t I
C' Y
' ECHANICAL': :". .eLOc. .ELECT. . PLG. mECR.
nEl E
`w
00 NOTPOUR FLOOR UNTIL,ABOVE'•HASIBEEN SIGNED, aMBUIUD. GwPERMIT 7>-.
� WOOD FLOOR i ilNBopndanoN? `.;a
VALUATION _.$SFT.
'
PLUMBING. - � '
MECHANICAL
ELECTRICAL " . PERMIT TO
FRAMING eZ.C•C.R� -
a
INSULATION - .r STORIES, TYPE CONSTR,
- - OCC.GROUP RES UNITS' -
PLACE NO SUBFLOOR UNTIL:ABOVE'HAS BEEN SIGNED
t• I. ROOF I ., 50 FT,FLOOR AHED .•TOTAL ACREAGE
DIAPHRAGM ° c
• -BUILDING USE
- ♦ ,Hes- IND CON PB, Otl,er ,
AP;PLYINO.ROOFING'UNTILABOVEHAS'BEENSIGNEO; ❑ ❑ ❑ ' 'El ❑
ASSESSORS PARCEL NO.
ROUGH'
PLUMBING _
GAS TEST TRACT NO. , PARCEL NO.
MECHANICAL
ELECTRICAL' ' _ " y n ,wF,INAL$x' ACC.DATE ACC FILE NO
I DATE INSP::
.FRAMING SAN Jk
.INSULATION PLUMBING - _'ZONING ENG.SITE NO.
r - GAS. ,
SPRINK ENERGYJ 24
MECHANICAL _
COVER'NO WORKVNTILABOVE�HAS BEEN SIGNED• ' HEATING. , " ❑ "❑ ❑ N❑
LATH ,INTERIOR - .'ELECTRICAL- '�.FL000 ZONE .: aL.0 c.
' LATH-EXTERIOR FIRE DEPT. ? - Y❑ N❑ ° L_I -N❑
SHEETROCK" Y GRADE + Mm R, sir
_ I a+"yFEE SU
SHEAR INTERIOR,: BUILDING
TEMPORARY APPROVALS
SHEAR EXTERIOR' BUILDING .
FIREWALLS \ ELECTRIC 'PLAN CHECK
GAS FEE
NO.TAP,E OR,PLASTER UNTIL ABOVE HAS BEEN SIGNEG: OCCUPANCY _.; SEISMIC FEE
OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL,BUILDING F INALIS SIGNED BY BUILDING IN .MICROFILM '
Lu
ARRANGE FOR„INSPECTION BY PHONING 252-4505, . ELECTRIC 1�7703
ONE.WORKING DAY'BEFORE REQUIRED INSPECTION
.-
DA
PLEASE GIVE JOB'ADDRESS'WHEN PHONING. PLUMBING .
SEE PERMIT FOR EXPIRATION DATE —, MECHANICAL
IMPORTANTI CONST.TAX
PLEASE READ REVERSE SIDE'BEFORE - TOTAL
CALLING'FOR FINAL INSPECTION. • '
OFFICE COPY r
APPLICANT'TO, FILL.IN INFORMATION WITHINAED LINES - USE BALL POINT PEN ONLY
�-IJUI LDING PROJECT IDENTIFICATION PERMIT NUMBER
am-Ulom - '.APPLICATION & PERMIT -
AOanE55 13671 A 1
N L�' 'DQr BUILDING-ELECTRICAL-PLUMBING-MECHANICAL -I -'V}l
Uw�NN+I_�R'S _ , ' PLAN CHECK VALIDATION
N,µ//PLG QTY. " "ELECTRIC PERMIT"" FEE '
CONTTTRACTOCCRS�— l�fl T dbluEe .
NAME .d10-q���1313 UTLETS-SWITCHES-RECEP 10.00/1.00 ¢"
CLre:,/j<-Elie�ltY�' j$0 LIGHTING FIXTURES 10.00/1.00 ,
F.ONTRACTOR'S '
ADDRESS
" APPLIANCES-RESIDENTIAL4.00
eE � i � 'PANELSO :
10.00 DATE OF APPLICATION
ARcwTEOT PLAN CHECK FEE P.C.NO,
' - OR - PANELS (OVER 200 AMP) ,20.00
ENGINEER,'
LIC.NO, SIGNS TRANS. - 3:00
ARCH.OR ENG.
ADDRESS ' SPECIALCIRCUIT - 5.001 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 VV
AVPLIDSNrsMOTORS SEE FEES r SERVICE CHANGE 20.00r oo LICENSED CONTRACTORS DECLARATION
U v I hereby affirm that I am licensed under provisions ofChapter 9SSUan (commencing wi(h$edion 7000)of Division 3 of the Business and OLDG. ELE2Professions Cod a J y license is in full for d tL�N z O m - Lwrons las Luc Number -J J2 u H w Date - Contractor�l -¢wOWNCRBUILDER DECLARATION - - IL•DMISC.— REFER TO ORD INFORMATION{ at
X ;n m I hereby affirm that I'am exempt the Contractor's License '
uO¢ Law for the fallowing reason(Sec.7031.5,Businessand Professions VALUATION $/FT.
t - u, PERMIT ISSUANCE oZ
m Cade:Any city or county which requires permit to construct,alter,
2 W¢ ¢Q improve,demolish,or repair any structure,prior to its issuance,also FVC.CONTE. LIC.NO. J J '
y w m u requires the applicant for such permit to file a signed statement that l�Y-\l E'2 GC'T �f� 1 4 EOTAL 7 (fes PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License "�r/�•- tl Ali �l
HiQ Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe "" } "pP 'yr =°.a� "'y
m c Business and Professions Code)or that he is exempt therefrom end QTY. 1p � PLUMBING PERMIT 1, 6 t B
M I- 0 the basis for the alleged exemption!Any violation of Section 7031.5 x k _ ' ',,m " F< *"b x s a, . FE t STORIES TYPE CONSTR."
a3 - by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN IEA.)'+
of not more than five hundred dollars($500).): 5.00
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP EES.UNITS
intended or offered for 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
• property who builds or improves thereon,and who does such workFIXTURES-PER TRAP 5.00 $O.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsalelf,however,the building GAS-EA:SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM.-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). RES IND . CON PB Other
INDUSTRIAL WASTE INTER, 30.00
❑ d is owner of the construct
he exclusively contracting with ❑ ❑ ❑ t ED ❑
licensed coions Cod to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL ND-'
and Professions Code:The Contractor's License Law does not apply
to ancontracts
owner of property who bands t boomers thereon,and who LAWN'SPRINKLERS-OVER 5(EA.) 1.00
the
for such projects with a co [ cror(s)Ii n pursuant to '
the Contractor's License Law" �^� SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL No.
❑ I am exempt under Sec. ,B.S.BC.for this -
reason WATER HEATER W/VENT 6.00 '
Owner - Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPEI SATION DECLARATION WATER TREATING EQUIP. 5.00
hereby affirm that I have a 'ertificale of consent to self-insure,or a certificate of Workers'Cam 'nsation Insurance,or a certified ZONING. ENG.SITE NO.
copy thereof(Sec.3 gCo pang ): i1J f,-✓ , k/1_�
Policy ere Company 11�r .(AL'L(.Th"� W'F u '
O Certified copy is hereby furnished FIRE SPRINK - ENERGY T 24
Z Z rt�if}�yd,��opy,�s f tl it spection Division.
H O A plIrani K1�`'�L2KR"u UL ' c �& MISC.- REFER TO ORD. Y Q N Y ❑ NE]
cc to CERTIFICATE,OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
k1.1 > (This section need not be compION INSURANCE.
eted it he Lpermit is for one PLG.CONTE. LIC.NO. TOTAL - YE] N V ry
a ❑
:� Z hundred dollars 1$100)or less.) u
U O .I certify that igthe.performance of the work for which this per QTKi s MECHANICAL,PERMIT FEE'" FEE SUMMARY
LL F mil is issued,I shall not employ any person in any manner so as to - # v
O become subject to the Workers'Compensation Laws of California:
Q. Datc Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE 'f0 APPLICANT: If,after making this Certificate of Ex- - '
F ? emption,you should become subject to the Workers'Compensation APPLIANCE, - '5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with v FEE such provisions or this permit shall be deemed revoked" AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM,)'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 fSee. MICROFILM,
' 3097,Civ.CJ. HEATING UNIT(TO 100,000B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 - ELECTRIC '77�
I certify that 1 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 gO1LER-COMP13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize repres ).rives of this city to enter upon the BOILER-COMP (Over 100,000 BTUI SEE FEE SDH.
above-mentlonedprop y or inspection purposes. MECHANICAL
(We) agre o se e, i emnif and keep harmless the City of MISC.- REFER TO ORD..
Cupertino , ainst sabl'los,jents, eosts'and expenses which CONST.TAX
may/im y ay a Ue t said City in consequence f the PERMIT ISSUANCE 10.00
g. it f p nit. _ MECH.CONT, LIC.NO. MECH,
TOTAL TOTAL
Siqatury6f Applt nt/Contras - Dare
OFFICE COPY ��