10944 POST THIS-CARD NEAR.FRONT OF BUILDING
PERMIT NUMBER '-
CITY` Of -CUPERTINO •
10944
INSPECTION
. DIVISION' ,
JOB INSPECTION RECORD
• ' / 'n j^ + - PERMIT EXPIRATION '
JOB ADDRESS / I I Y' ' UNIT# _ LOT#' I;
PERMIT EXPIRES IF WORK
OWNER Co TRACTOR `t 'IS„NOT'.STARTED, WITHIN
" INSPE TION DATE 'INSPECTOR INSPECTION'RECORD =1180-DAVS.OF PERMIT ISSU• _
FOUNDATION ;ANCE OR 180 DAYS FROM
LIFER ' . . 'LASTCALI� I .ACTION.;
PR EGUNITE f PERMITVALIDA ION
. �;` " `' :MAR•6'- 1996'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB C1fYOf.C0
• - PLUMBING P.BfflOO
ELECTRICAL - r IssuANCE GATE' I
MECHANICAL �, BLDG„ �LECT. ..PLc. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED r. BUILDING PERMIT
WOOD FLOOR - - - , INFORMATION
-PLUMBING VALUATION $/FT. '.
MECHANICZT - '� �� .`•"I f;/.Ci .
ELECTRICAL, -
�FRAMING
INSULATION MFIES TYPE CONSTT
OCC;GROUP', „RES.UNITS
PLACE NO'SUBFLOORUNTIL ABOVE HAS BEEN SIGNED ' . EXP i RED -
J ' 'ROOF ,' �. SO.GLT.FLOOR AREA TAL ACREAGE
i DIAPHRAGM'
BUI LDING USE
” - r • - H t IND- CON PB OJxr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED �; �. ❑'" ❑ '❑
ROUGH , - 111,5 ON PARCEL NO.
• PLUMBING - ?
GAS TEST- ' _ TRACT No, PARCEL NO., + .'
MECHANICAL•
ELECTRICAL. + FINAL$ ;DATPEINSP. ACC.DATE, ACC.FLLE NOFRAMING i 'INSULATIONPLUMBING . 'y, "� 20NING " 'ENG:SITE No.
GAS,
MECHANICAL" FIRE SPRINK ENERGY P2E
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATINGY ❑�-=1..
NLATH—INTERIOR ELECTRICAL' .U.C.
LATH—EXTERIOR FIRE DEPT. N❑
SHEETROCK� - GRADE - '
SHEAR INTERIOR - FEE SUMMARY -
BUILDING
SHE
AR EXTERIOR TEMPORARY APPROVALS euloowc 4_ Li f J
+' ELECTRIC PLAN CHECK
.
FEE
TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPNSEISMIC FEE
UPANCY OF BUILDING ISNOT PERMITTED'UNTIL BUILD ING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR.INSPECTION BY PHONING 252-4505, ' ELECTRIC'
o� ONE WORKING DAY,BEFORE'REQU.IRED INSPECTION. PLUM.BING ' '
•_ z
PLEASE GIVE-JOB ADDRESS WHEN PHONING.
— SEE'PERMIT FOR EXPIRATION DATE'= MECHANICAL
IMPORTANT! coNsr:TAX
PLEASE READ REVERSE SIDE;BEFORE l+
CALLING'FOR FINAL INSPECTION.. TOTAL f:,+rte;
'° OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN'RED LINES -.US.E BALL POINT.PEN ONLY
BUI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER- '
" BUILDING APPLICATION & PERMIT
A°GRESB 10944
�1 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
NAME B
. COA
��9a8 I ` , ' PLAN CHECK VALIDATION
sA 11 '' CITY. ELECTRIC PERMIT FEE
- 1.11 � Q PHorvE lJdd , -
/ NAME acTDR's OUTLETS,-SWITCHES-RECEP 10.00/1.00
Clc,No. LIGHTING FIXTURES - 10.00/1.00 '
ADDRESS ons, - - APPLIANCES-RESIDENTIAL 4.00
CONTRC _
' t PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE, D.C.NO.
on PANELS (OVER 200-AMP) • 20.00 P
., ENGINEER
LIQ NO .l - SIGNS TRANS. : 3.00
ADDRESS ENG. - . - - - PE NLIDATION
aooREss - .SPECIAL CIRCUIT , � ,5.00 J�A�^.f-
ZIP EMP.METER OR-POLE INS. 20.00 I\\ J
ADDRESS - - MOTORS -+ SEE FEE SCH. CI}rr Of,CBpBlEI00
AODRE55'. - •7
SERVICE CHANGE
o¢i
'F o o LICENSED CONTRACTORS DECLARATION
¢ v 1 hereby a
ffirm that am licensed under provisions of Chapter 9 ISS CE•DATE '
'y < y (commencing witli Section 7000)of Division 3 of the Business and, _ ... BLDG. ECL '�PLG. MECH.
F y z Professions Code,and my license is in full force and effect. - - - _ - ❑
z O w - License Class _ Lic.Number - - -
o r w Date Contractor
re Y re J -
¢ ¢ w � OWNER-BUILDER DECLARATION � BUILDING PERMIT-
E:
ERMIT
w0,w 0 I hereby affirm that l am exempt Irom'theContractor's License - MISC.- ' - -REFER TO OR INFORMATION
F LL o j Law for the following reason.(Sec 7031 5 Business and Professions PERMIT ISSUANCE J 'VALUATION $/FT. ,
wi Code:Any City or county which requiresapermlt to construct,alter, ., 10.00
ac re Q2, improve, or repair any structure,prior to its issuance,'also ELEC.CONTE. LIC.NO. ELEC.
u S o u requires[he applicant for Inch permit to file a signed statement that TOTAL
w ,A heContractor's License PERMIT TO
H z L`av(Chapter 9(commencing with Section 7000)of Division 3 of the -
E et Business and Professions Code)or that he is exempt therefrom and OTY.1 PLUMBING PERMIT FEE
ce t- m ' the;basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTIIii.
sc 3 by.any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER'(EA.) 5.00 '
❑ I,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 RES.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,arid!who does such work�. FIXTURES-PER TRAP,',: 5.00
himself or through his awn employees,provided that such improve- - sO�ET.FLOOR aRBa TOTAL ACREAGE
prove- --
mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM'11NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-- 4 (EA.) -- 2.00
builder will have the burden of proving that he did not build or am- BUILDING USE
pefor purpose of sale.). x -,: INOUSTRIALWASTE'I NTER. , 30,00 , lO ONO �Or"
I,as owner of the property,am exclusively contracting with
li cal c6ntracton to 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(toes 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 contraetorls)licensed pursuant to
the Contractor's License Law. - - SEWER-SAN ITARV-STORM EA.200tt/10.00' -TRACT NO. PARCEL NO.
'❑ I ons exam [under Sec. - �,B.&P.C.for this WATER HEATER W/VENT, ,- 6.00
on
Ow er Dat,4 WATER SYSTEM 5.00 1
ACC.DATE ACC,FILE NO.
WORKS S'COMPENSATION DECLARATION WATER TREATING EQUIP, - 5.00 - -
I hereby affirm that I have a certificate of consent to self-insure, - -
' on a certificate of
Workers'Compensation Insurance,or o certified - .ZONING ENG.SITE NO. a�
copy thereof(Sec.3800,Lab.CJ: -
PolicyNo. Company - -
0 O Certifiedcopy is hereby furnished FIRE SPRINKENERGV T-P4 -
Z 2. - ❑'Certified copy Is filed withlthe city mspe ton division. MISC- 'REFER TO ORD.
O Applicant ., _ I V❑ N❑ Y ❑ N❑
y CERTIFICATE OI EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
CL CICL CI COMPENSATION INSURANCE - PLG,CONTR. LIC.NO. PLG. -
. (This section needLnot be completed if the permit is for,one _ TOTAL - v❑ N❑ .V❑ N❑
hundred dollars 100)or les,)
U,O I mrify that in the performanre of the work fur which,this per-` OTY. MECHANICAL PERMIT " FEE FEE SUMMARY
"I LL isissociLl.U . become subject tloathe Workms'Compe.,yany e.ti,, [Laws of Califon a'o x
•0 i Date i Applicant - - - ' ALTER OR.ADD TO MECH. 5.00 BUILDING
NOTICE TO APPLICANT: IC after making this Certificate of Ex
Z emption;you should become subject to the Workers Compensation - APPLIANCE 5.00 _
provisions of the Labor Code, you must forthPLAN CHECK
with comply with FEE -'
U such provisions or this permit shall be deemed revoked. AIR.HANDLING UNIT(TO 10=C.FJV0 4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.F.M.) 6.00 - SEISMICFEE
1 hereby affirm th.i there is a construction,lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the wark`for which this permit is issued(See. - - MICROFILM
3097,CicCJ. , - HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name - ',HEATING UNIT 100,000B.T.U.)9.50
Lender's Address - ' ELECTRIC.. ' '
I certify that 1 have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply'with:III city and county BOILER-COMP(3H.P.Of 100,000 B.T.U.) 6.00 PLUMBING 'r
ordinances and state laws relating to building construction, and
hereby enauthorize representativesofthis city to enter upon the BOILER-COMP (Dver 100,000 BTU)SEE FEE SCH. 'MECHANICAL
hereby
mentioned property forinsp ofthi purposes. .
(We) agree to save, indemnity and keep harmless the City of MISC.-. . - REFER TO ORD.
Cupertino against liabilities,judgments,'costs and expenses which CONST.TAX"
may in anyy accrue against said City in of the PERMIT ISSUANCE 10.00 -
• Boor of I 's permit. - MECH.CONT. LIC.NO. MECH.
8� ' TOTAL TOTAL
Si nature of ¢ - /
'� B P resat/ ontractor are -