13007POST THIS CARD NEAR FRONT OF BUILDING X'
'CUPERTINO
CITY OF.
R[;IT Nu REH
,� _.
~ INSPECTION
13007
DIVISION
I JOB INSPECTION RECORD'
- ,
-•7529
BARNHARTPL' - -'-
'
PERMIT EXPIRATION,
JOB ADDR . ESS ' ;d' UNIT# - LOT#
` AL' STALIE I :- ', 4 -
PERMIT EXPIRES IF WORK
OWNER ,. ' CONTRACTOR
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM
LASTCALL E D INSPECTI ON.
INSPECTION. DATE INSPECTOR
INSPECTION RECORD''
FOUNDATION - " .'
10 2$ B% S £Q'/•' hrtlt 1 r+f1'QPeV wf
a/.T f+�owb $C - -
UFER - - -'1.. �—�
- PREG UNITE n
,.
PERMIT VALIDATION
-
8 fy
'Issu
POUR NO CONCRETE UNTIL ABOVE.HAS BEEN SIGNED
r UNDERGROUND- /SLAB'
' PLUMBING -
• ELECTRICAL' -
c A�'
MECHANICAL
ELECT
PLG/ 1
MEC
.' DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
- ..
^• -
BUILDING PERMIT
INFORMATION
'WOOD FLOOR - -
PLUMBING _
- -
YALUAnoN
- -
,S/Fr.
MECHANICAL
'
ELECTRICAL.•,'PERMIT
-' •.
To
- -
FRAMING' �/
INSU ATION'' I 87
:�
STORIE,
LYPE CONSTR.
.. .
OCC. GROUP
RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
;..'
,
SO. F FFLOOR'AREA
TOTAL ACREAGE
ROOF. ,
..
DIAPHRAGM r
ok Ov; ( 1.0 r;v N ppmNNftI {/G
p�,
pN,1 CC.
HES i INDNG USE
PB 'Onr
�.�' ❑ ❑ :❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
' ROUGH,
-
ASSESSORSP,ARCELNO. '
G�•. �.... .. f..} .
PLUMBING C !Wd-,./0-
'
GAS TEST
,INSP.
TRACT No.
PARCEL No.
MECHANICAL• i-
'.
ELECTRICAL•-. --
FINALS DATE^
"ACC: DATE
ACC FILE NO.
FRAMINGSAN
# a/
.
.' INSULATION " 1_
PLUMBING _
'ON1NO
ENG. SITE NO.
[✓�• /I—/ _ `GAS
,�
MECHANICAL
FIRE SPRINK
"''❑' -"❑
ENERGY T-14
11
, Y ❑ "❑
`COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING lJ=;
LATH—INTERIOR'ELECTRICAL
-
^FLooD zo NE
Y❑ �❑
'v A,L.U.C..
Y ❑ N❑'
LATH -EXTERIOR'
'..
FIRE DEPT. •., ..
' SHEETROCK
GRADE'
- SHEARINTERIOR
•" '
FEE SUMMARY
.BUILDINGS'
-
..' .
';�;;
SHEAR EXTERIORBUILDING
- •.
TEMPORARY APPROVALS ', •
FIREWALLS
ELECTRIC -• .'
FLAWCHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY -
SEISMIC FEE
OCCUPANCYOF BUILDING ISNOT.PERMITTEDUNTIL BUILDING FINAL IS SIGNED BY'SUILDING
' INSPECTOR.'
MICROFILM
ARRANGE FOWINSPECTION BY PHONING 252-4505, •'• "'
ELECTRIC
o� r, ONE WORKING DAY BEFORE'REQUIRED INSPECTION.
PLUMBING
-`
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -
,
SEE PERMITFOR EXPIRATION'DATE,-
MECHANICAL
' IMPORTANT!
CONST. TAX
PLEASE READ REVERSE SIDE BEFORE'
CALLING FOR FINAL INSPECTION.
TOTAL
_ QFF�CE'COPY '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
BUI LDI NG PROJECT 1 DENTI FICAT N..
"APPLICATION,&.PERMIT'
- ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
13007
a ILOING
ADDR Ss �:.' 0 :rrBUILDING
OwNER'a _
NAM[ o?SS•'03 �/ (o
-
OTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
`
PHONE
'
CONTRACTORS
NAME
NAME
UTLETS-SWITCHES -RECEP 10.00/1.00
g% LIGHTING FIXTURES, 10.00/1.00 3
LIC, eo,
DATE OF APPLICATION
CONTRACTOR'S
ADDRESSC
' PHONE
APPLIANCES -RESIDENTIAL 4.00
%a
' PANELS 10,00 'R CI
ARCHITECT
OR
ENGINEER LIC. NO. ""
t PANELS (OVER 200 AMP) 20,00PLAN
CHECK FEE. P. C. NO.
SIGNS TRANS. - 3.00
.ARCH, OR ENG.
ADDRESS
SPECIAL CIRCUIT S.00
PERMIT VALIDATION
/ EMP. METER OR POLE INS. 20.00 0 -
- ZIP.
APPLICANT -s- -
ADDRESS , ' ' ,
MOTORS - SEE FEE SCH.
SERVICE CHANGE ;20.00
,Q'OUl
LICENSED CONTRACTORS DECLARATION
"/% /d /
I hereby affirm that I am licensed under provisions of Chapter 9
ISSUANCE DATE
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect.
License Class Lie: Number
-
BLDG.
ELECT.
®_
PLG. MECH.
-
-
Date Contractor
BUILDING PERMIT
' OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Conlracmr's License
Law for thas
e following reon. (Sec. 7031.5, Busin
witless and Professions
Code: Any city or county which requires a permit to construct alter,
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law(Ch.pter9(commencing with Section 7000) of Division 3 Grille
Business and Professions Code) or that he is exempt therefrom and
INFORMATION
MISC. - - REFER TO ORD
VALUATION
^330
$/FT.
PERMIT ISSUANCE 10.00 G l
ELEC. CONTR. LIC. NQ
-
ELEC. �f
TOTAL A00
PERMIT TO
�''•y
1.7 �- z w1.- '
QTY. PLUMBING PERMIT . FEE
STORIES
TYPE CONSTR.
S '•. z4"•L„
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).):
.
ALTER -DRAIN -WATER (EA) 5.00
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: Time Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work
_
p
,S FIXTURES- PER TRAP 5.00 / F0
-
SO. FT. FLOOR AREA
TOTAL ACREAGE
himself or through his own employees, provided that such improve.
ments are notintended or offered for sale. ll', however, the building'
/
r
GAS-EA.SYSTEM-I1NC.40UTLETS 6.00 oQ
or improvement is sold within one year, of completion, the owner
builder will have the burden of proving that lie did not build or im-
prove for purpose of sale.).
O I; .s owner of the property, am exclusively contracting with
GAS- EA. SYSTEM.- OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON PB Omer
//��
01 ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5(EA.) -1.00
ASSESSORS PARCEL NO.
.3 %_3
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: flic Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
the Cont torr' is'ojec'witha iractolf sl licensed pursuant to
the Contractor' icer -
SEWER -SANITARY -STORM EA. 200ft/10.00 L9 0
"� Im-
TRACT NO.
PARCEL NO.
❑ lam a in See. ,B;&RC.to, this
reason
--pled,
WATER HEATERW/VENT 6.00 ',to'
Owner Dale ^
'WATER SYSTEM 5.00 SAe
ACC.DATE
-'ACC. FILE NO.
WATER TREATING EQUIP. 15.00
WORK ERS'COMPENSATION:DECLARAPON
-
1 hereby affirm that I have a certificate of consent to self -insure,
or a certificate of Workers' Compensation Insomose, or a cerlitied
copy thereef(Sec. 3800, Lab.C.).
Policy No. ' Company
ZONING
ENG. SITE NO.
.S'�y� !d
❑ Cetsilledcopy is hereby furnished.' -
❑ Certified copy is Filed with the'city inspection division.
Applicant - _
t t
FIRE SPRINK
Y ❑ N❑
ENERGY T-24
Y ❑ N❑
MISC. - 1 REFER TO ORD.
CliR]IFICATE OF EXI?MPTION FROM WORKERS'
PERMIT ISSUANCE 10.00 ,0
FLOOD ZONE.
A.L.U.C.
PLG. CONTR. LIC. NO.PLG.
O -A
.TOTAL //01\
COMPENSATION INSURANCE
(This section need not be•cornplcted if the permit is for one
Y [:JN❑
V [:] NE]
OTY.' ` MECHANICAL PERMIT FEE
-
-
FEE SUMMARY
hundred dollars IS 100) or less.)
1 certify that in the performance all llm work for which t11is per-
mit is issued, I shall not employ any person in any manner so as to
/�•--�-�I
BUILDING lOV'xJ"
7
become subject to the Workers' Compensation Laws of California.
Date Applicant'
NOTICE TO APPLICANT: If, atter ..king this Certificate of lie.
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
PLAN CHECK
emption, you should become subject to the Workers' Conmpensation
Provisions of the Labor Code, you must forthwith entirely with
such provisions'or this permit shall be deemed revoked.
FEE
'
AIR HANDLING UNIT (TO 10=CF.M.) 4.00
AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00
SEISMIC FEE .i
CONSTRUCTION LENDING AGENCY '
I hereby affirm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00 xi�-,
' '•
the performance of the work for which this permit is issued (Sec.-
3097, CieC.). t -
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00 Q •tis
HEATING UNIT (OVER 100,000 B.T.U:19,50ov
ELECTRICQQ
Lender's Name
Lender's Address
Icertify that l have read this application and state }hat the above
information -is correct. I agree to comply with all city and county
ordimuses and state laws relating to building construction, and
VENTILATION FAN (SINGLE) 4.00 l{rov
.'PLUMBING
BOILER- COMP(3 H.P. or 100,000 B.T.U.), 6.00
BOILER -COMP lOv4r 100,000 BTU) SEE FEE SCH.
MECHANICAL -
hereby authorize representatives of this city to emtel upon the
above mentioned property for inspection purposes.'
MISC. - REFER TO ORD.
TAX
u
(We) agree to save; indcrmrff anJ keep hornless the City of
Cupertino against d bililies, jydgmSITS, costs and expenses which
in in //l7 wa eiVE(ag'i16t said City In consequence of the
grand go thi fair- r" _
S-
'qpp
PERMIT ISSUANCE 10.00'CONST.
MECH.'CONT. LIC. NO. MECH.
TOTAL a7
TOTAL p P/
r r
Si t ontmetor Date
OFFICE COPY - r
1