13907 t
POST THIS CARD-NE AR FRONT OF- BU,ILDING
PERMIT NUMBER
't-CITY. OFA CUPERTINO 139Q7
INSPECTION D'IVISION.'
JOB INSPECTION RECORD
^�/`�/',y�,�//y�yy,• j " ��/� � PER MIT EXPIRATION "
• JOB�ADDR ESS" l .li(Al! l.�W� yl. V'"/ -"'UNIT# 'LOT#
.. PERMIT. EXP.IRES.`IF WORK'
owNER cONTRACTOFS - IS NOT.-STARTED'WITHIN
S EC ION '_ '" DATE :INSPECTOR,' ,_ -;INSOECTION,RECORD .`':h,`;:w 180 DAVs OF PERMiT,ISSU
FOUNDATION - -.. , . " ANCE OR 180 DAYS•FROM'
LIFER �- '
LAST CAL LED INSPECTION.
" PREGUNITE 77, PERMIT VALIDATION.•.
<POUR NO CONCRETE UNTILABOVEMASiBEEN SIGNED;-
UNDERGROUND /SLAB
PLUMBING / •.+' �'
'9 -30-, 7,
ELECTRICAL a ISSUANCE DATE
MECHANICAL :. - .BLDG. ELECT. .PLG. MECH.
OO'NOTPOUR`FLOOR'UNTW ABOV,E,HASBEENSIBNED's. w9UILDING PERMIT ;•,
WOOD FLOOR ',: s+�=d ,',INFORMATION e PLUMBING ,. _. . . "..�
JW VALUATION -SIFT. {"
MECHANICAL
ELECTRICAL - ""��a '• -PERMIT TO ,
FRAMING4tL.1110".. w...
INSULATION _ %J TORIES - TYPE CONSTR.
I
a - DEC.GROUP, RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVEMAS'BEEN SIGNED
ROOF ,- SG.FT.FLOOR AREA TOTAL ACREAGE
s DIAPHRAGM _
BUILDING USE
RESP BIND CON BE O,ne,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN'SIGNED i ❑ ' ❑ Q' ❑'
ROUGH 7 ASSESSORS PARCEL NO
PLUMBING - -
L,.
GAS TEST, 'rRAcr No.., PARCEL NO:. .. '
MECHANICAL -
ELECTRICAL - .'."sFINA LS'"ul'^ .";;DATE INSP. Acc.GATE " ncc wLF
[INSU
AMING SAN n
LATION PLUMBING zowmcs, ENG,SITE No.
:30,
GAS
MECHANICAL'" ' ',EIRE SPRIN K- 'ENERGY T24
`. COVER NO WORK`UNTIL ABOVE HAS'BEEN°SIGNED.,, HEATING °'❑ -El ❑ NE)
! LATH-INTERIOR4 _ +. .L.u.0
ELECTRICALFLOOD ZONE A
LATH—EXTERIOR' FIRE'DEPT. Y{❑ -"❑ `' ❑ �❑
SHEETROCK +
ARV
GRADE " �p, fr%„FEE"BUh1M
SHEAR INTERIOR eBUILDINGF'' _
SHEAR EXTERIOR` TEMPORARY APPROVALS BUILDING ..
FIREWALLS," ELECTRIC . ' ` PLAN CHECK '
GAS' - FEE
NO,TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY; SEISMIC FEE
OCCUPANCYOF BUILDINGIS NOT PERMITTED UNTIL'BUILDING FINALISSIGNED BY BUILDING INSPECTOR_ MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, "ELECTRIC
ao� ` ONE WORKING.DAY BEFORE.REQUIRED INSPECTION {
z 'PLEASE GIVE JOB ADDRESS WHEN.PHONINGPLUMBING
- SEETERMIT FOR EXPIRATION DATE,- MECHANICAL
"
a ' I
IMPORTANT! CONST."TAz
PLEASE READ REVERSE SIDE
BEFORE'
TOTAL
'CALLING FOR FINAL INSPECTION: .
^'` OFFICE COPY - - "
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES- LISE.BALL POINT PEN ONLY
1. BUILDING PROJECT IDENTIFICATION ' PERMIT NUMBER
Go
OR
! GILOIN6 APPLICATION & PERMIT ^O
OEas I y
�, BalNrt,& BUILDING- ELECTRICAL-PLUMBING-MECHANICAL A
OWNER'S • `n, yt Y - 7' +' s a PLAN CHECK VALIDATION
"nme t PTY.=y"r `ELECTRIC PERMIT*,;N,. FEE -
a GN
CONTRACTOR'S t OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
LIC.No, LIGHTING FIXTURES 10.00/1.00
CONTRACTORSAPPLIANCES-RESIDENTIAL X4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
' LIC.NO. ' SIGNS TRANS. - 3.00
ADDREss ENG' SPECIALCIRCUIT - 5.00 PERMIT VALIDATION
i ZIP EMP.METER OR POLE INS- 20.00 -
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS
� 1IIJ..JI J
SERVICE CHANGE 20.00 ' \ �9N�•��"/�/�G�"
ca o o LICENSED CONTRACTORS DECLARATION / j O 7
a u u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
N Q %- (commencing with Section 7000)of Division 3 of the Business and. - BLDG. ELECT. PLG. MECH.
H D z! Professions Code,and my license is in full force and effect. ❑ ❑ ❑ _
Z o ,"� - License Class Lic.Number
o y- w Date Contractor
a m f • r'rBU1LDING PE MIT
¢ O o' OWNER-0UILDF.R DECLARATION 'b^,INFORMI ON "axr'Jl
w ; u I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
Fuoa Lawforthe following reason,(See.7031.5,11usinessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT:
w m Code:Any city or county which requires permit to construct,alter,
K K Q O improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. .
o. o u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w m he is licensed pursuant to the provisions of the Contractor's License
�•ii Law.(Chapter 9(Commencing with Section 7000)ofDlvision 3 ofthe A= xi;
•'� i Qo Business and Professions Code)or that he is exempt therefrom and OTNo. a r "PLUMBING PERMIT= -xa" "_FEEa'
OF I-$ the basis for the alleged exemption.Any violation of Section 7031.5 ' F * . y ' ` STORIES ,TYPE CONSTR,
by any applicant for a permit subjects the applicant toacivilpenalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 Dec.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 work FIXTURES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTAL ACREAGE
menta are not hrough
ownemployees,for sale.
If,howevered that ,
the
improve- GAS=EA.SYSTEM-11 NC.4 OUTLETS 6.00
cents are not intended or offered for sale.If,however,the budding 1
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- - BUILDIN11 G USE
RES IND .CON - PB ' Other
prove for purpose ofSale.).pINDUSTRIAL WASTE INTER. 30.00
❑ I,as owner offthe property,am exclusively contracting with ❑ ❑ 0 ❑ ❑
licensed contractors to construct the project(Sec:7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply ,
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) ' 1.00
contracts for such projects with a,ontraclor(s)licensed pursuant to SEWER-SANITARYV-STORM EA.200ft/10.00
the Contractors License Law. -TRACT NO. PARCEL NO.
,❑ Iamexempt'under Sea ,B.&P.C.for this WATER HEATER �V 6,00
reason
• �[ Owner .Date WATER SYSTEM 5.00
N 'lU,�.r " ACC.GATE ACC.FILE NO.
O ERS' MPF.NSATION Dli LARATION WATER TREATING_, QUIP', , 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified - ��Q ZONING, ENG.SITE N0,
copy thereof(Sec.3800,Lab.C.).
Policy N.. Company - =
,Q ❑ Certified copy is hereby,furmahed' FIRE SPRINK ENERGYTY4
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD,
O Applic5nt- Y O N E] YEJ ' ry E]
00
LU - CERTIFICATE OI°EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.
FLOOD ZONE A.1-M.C.
CL > COMPENSATION INSURANCE. PLG.CONTR. LIC.No. PLG. ' ti�Jy)
� Z (This section aced)or be completed if the penult is for one ' TOTAL O - Y N� V N�
hundred fy thatlars in the
pe less) '
U O 1 certify that h the performance of the work for which this per. QTY.'` MECHANICAL PERMIT FEE FEE SUMMARY
U, F mil is issued,e I shall not employ any person in any manner so is W .r ,' ,r d ,. - ,
O W become subject to the Workers'Compensation Laws of California.
a Date Applicant BUILDING
} y. NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
2 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 i0=4-F.M.) 4.00
CONSTRUCTION LENbINO AGENC)' AIR HANDLING UNIT(OVER 10=C.FM.) 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 - HEATI NG UNIT 100,000 B.T.U.)9.50
Lender's Add,SS ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building,construction, and BOILER-.COMP(3H.P.Dr100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE PEE SCH. ,MECHANICAL
above-mentioned property for inspection purposes. : ,
(Wei agree to sav demnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against i es,judgments, costs and expenses which .PERMIT ISSUANCE - 10.00 CONST.TAX
ma any wa so City in consequence'of the -
nti gof
this
MECH.CONT. LIC.NO>• MECH. I
TOTAL TOTAL
Sig arm ofAppl an actor Date
IF .OFFICE COPY