12868 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINOR
INSPECTION DIVISION 1286
8 '
JOBANSPECTION RECORD
-�I nnpp f� Y PERMIT EXPIRATION
JOB ADDRESS 03 d Gl UNIT# LOT#
PERMIT EXPIRES EXPIRES IF WORK
OWNER L S CONTRACTOR e4A-�— IS NOT STARTED.WITHIN'
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OFPERMIT ISSu-
FOUNDATION ANCE OR 180 DAYS FROM
- LASTCALLED INSPECTION:
UFER
PERMIT VALIDATION
Pfl EGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED-
UNDERGROUND /SLAB -
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL I,BL❑ .DG,. EL6;I .PL❑G. , LM�V
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
PLUMBING
WOOD FLOOR VALUATION $/FT.
' - -
\Y
MECHANICAL
ELECTRICAL PERM ITT
FRAMING
INSULATION _ STORIES TYPE CONSTR.
a .
OCC.GROUP •RES.UNITS'+-
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF -
SOFT.FLEO RAREA TOTAL ACREAGE
DIAPHRAGM auILDING USE
` RESIND CON PB •Olh,'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ E] E:l ❑ El
ASSESSORS PARCEL NO.
ROUGH .
PLUMBING
GAS TEST, 0. TRACT EL NO,
I V
MECHANICAL
ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS DA . I SP.
FRAMING SAN # 1
ZONING ENG.SITE NO.
INSULATION PLUMBING -
GAS
MECHANICAL / %A-FIRESPRINK ENEREIT24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "❑
LATH—INTERIOR ELECTRICAL FLOOD ZONE A,L.U.C.
LATH—EXTERIOR FIRE DEPT. v E] "❑ v C] "0
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY 7 SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR: MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING. `
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
t:' .,tea BUILDING PROJECT I DENTI FICATION PERMIT NUMBER
.BUILDING APPLICATION & PERMIT ,
ADORE55
03 13 SDU7 44 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 286
OWNER'S
NAME PLAN CHECK VALIDATION
L & a- PHON 'I(] OTY. ELECTRIC PERMIT FEE
E � eZ
NAMERAOTORl77/YSr OUTLETS-SWITCHES-RECEP 10.00/1.00
ec LIC.No.7LIGHTING FIXTURES 10.00/1.00
1 no TI Tons PPLIANCES-RESIDENTIAL 4.00
I- - PHONEa PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO,
OR PANELS (OVER 200 AMPI 20.00
NGINEER
sec.
NO ISIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S ^
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
Foo LICENSED CONTRACTORS DECLARATION
av v I hereby affirm that 1 am licensed under provisions of Chapter 9
w ISSUANCE DATE
¢ N (commencing with Section 7000)of Division 3 of the Business and BLDG., ELECT. PLG. MECH.
H 7 z Professions Co}1 and my tic•nse is in full fore and effect - ❑ ❑ ❑
zo z W License ClassC_11n Lic.Number
qH Dale>.//l/�1/YY Contractory�
ar a,cr < 7 l BUILDING PERMIT
I[ a,w ¢
OWNER-BUILDER DECLARATION WN
wO A
; I- I hereby affirm than I am exempt from the Contractor'sINFORMATIONctor's License MISC.- REFER TO ORD
H u o m Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
g PERMIT ISSUANCE 10.00
� mj� Code:Any city or county whichrequiresa permit to construct,alter,
a; rc¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO.
al wo u requires the applicant for such permit to file'a signed statement that TOTAL
m he is licensed pursuant to the provisions of the Contractor's License PERMIT T
tza Law(Chapter 9(commencing wi HE Section 7000)of D lvision 3 of the /,r
4 D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE A
M 1- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
> 3 - by any applicant for ive handled
subjects SSOO).he licunitoscivilpenalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(my em:
O Las owner at the property,or my employees with wages as BACK FLOW PROTECT:DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will(S the work,and the structure is not
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
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 60.FT.FLOOR AREA TOTAL ACREAGE
himnncr ire througende own employees Provided that such improve
or nnerovn°/ibteoded oitlii red foryear
completion,
t the olding GAS-EA.SVSTEM;I INC.40UTLETS, 8.00
or Improvement ;sold within one year of be dill non,the owner I
prove
will rhavEpre.tileof ale.). `of proving that he did not build or Ira- GAS'EA.SYSTEM-OVER 4(EA.)' 2.00 BUILDING USE
prove 1,as owner
of theJ. l INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB oma.
❑ d as owner of the property,he exclusively contracting with 0 0 0 ❑ ❑
licensed contractors to construct the project(Sec. does Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cade:The Contractor's License Law does not apply
to anowner of property who builds tr improves thereon,and who LAWN SPRINKLERS•OVER 5(EA.) 1.00
contracts for such projects with a contmdorts)licensed pursuant to
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
reasonWATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1
1 hereby affirm that I have a vartifclim orc.nlcnt to self-insure,
or a cerci Ncate of Workers Compensation Insurance,or a certified ' S ZONING ENG.SITE NO.
copy there I See. 0,Lab.C.Z- _ ,
Policy No. - pan
0 ❑ Ce Ie cop is erebyfurnis - '\ ESPRINK ENERGY TZO
Z Z p C i0ed copy filed wit t city mspecti division
F O ApWIma - � MISC.- REFER T D, Y � N 0 Y❑ No
lr w CERTIP EOF Ex. PT N FROM WORKERS' PERMIT ISSUANCE 1O. FLOOD ZONE A.L.U.C.
W > COMPENSATE INSURANCE PLG.CONTR, LIC.NO, PLG
CL O (This se tion need not be completed if the permit is for one TOTAL Y[] N Y❑ N❑
L0 Z hundred dollars IS 100)or less.)
) 0 1 certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
IL F not is issued,I shall not employ any person in any manner so as to
O W become subject to the Workeri Compensation Laws of Califomia.
OL Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with
L..1 such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10,000C.F.M.) X00 p;e FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,000C-F. .00 SEISMIC FEE
I hereby affum than 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
Lender's Address HEATING UNIT(OVER 100,000 ,50 ELECTRIC
I certify that 1 have read this application and slide that the above VENTILATION FAN (SINGLE) 4.00
information is
correct. 1 agree to comply with all city and county BOILER-COUP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby tiirepresentatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH, MECHANICAL
above-mentioned
property for inspection purposes. (�
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. c/u
Cuperti liabilities,judgments,,costs and expenses which CONST.TAX
mo any way accrue against s ' yin consequence of the PERMIT ISSUANCE 10.00
gr ling of this •rm' . MECH.CONT. LIC.NO. MECH.
TOTAL ' TOTAL
igna[ an
ct/C Iracto Dale
OFFICE COPY