11879 POST THIS CARD NEAR FRONT OF BUILDING,,
F�M
R
CITY OF CUPERTINO 79
r INSPECTION DIVISION
JOB INSPECTION RECORD
yy��ff11 ,,QQ�1 7//,J ,� //, '�/1� , ATION
JOB ADDRESS&ee •/OteV A-1A /1 �G�11 NIT# LOT# pERM1T EXPIRESIF WORK
OWNER G CONTRACTOR IS NOT STARTED.WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION I
ANCE OR 180 DAYS FROM
L —$ ��' !~'•` ! '�'�' LAST CAL LED I NSPECTI ON.
LIFER
PREGUNITE - PERMIT VALIDDAAATTIIONN I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED � "O +W
UNDERGROUND /SLAB L`I•. '
PLUMBING ,.
ELECTRICAL ' ISSUANCE DATE
- 'MECHANICAL BLDG. ELECT. PLc. MECH.
a•
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ILDING PERMIT
WOOD FLOO - INFORMATION
VALUATION $/FT.
PLUMBING -
MECHANICAL 1 '
ELECTRICAL' MITT
PERo�7'')'
FRAMING ], _ A 177, D/12
`/
INSULATION
STORIES TYPE CONSTFI.
,
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- ROOF SO FT,FLOOHAREA TOTALACREAGE
DIAPHRAGM
_ BUILDINGUSE '
RES IND CON PB 00-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 1:1 ' O ❑ 1:1
ROUGH ASSESSORS PARCEL NO
`
F PLUMBING
GAS TESTg2e-7
TRACTNO. PARCEL NOMECHANICAL c ELECTRICAL FINALS DATE INSP. 14ncc.DATE Acc.PILE No
FRAMING P SAN #
PLUMBING � ZONING
INSULATION ENG.SITE N6.
.��g .
GAS .
MECHANICALE�.�. FIRESPRINK ENERGY T.24
COVER NO WORK UNTIL ABOV H BEEN SI HEATING Y [] "F] Y F] "0
LATH—INTERIOR �D ELECTRICAL ( �I ,PL000 ZONE A,L.UC, -
LATH-EXTERIOR' ' FIRE DEPT. 2�/ S' Y[:] '"❑ -� 0 NE]
SHEETROCK,, ,Z GRADE FEESUMMARY
SHEAR INTERIOR BUILDING _
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING u +
FIREWALLS ELECTRIC PLAN CHECK
GAS. FEE
NO TAPE OR PLASTER UNTIL'ABOVE HAS BEEN SIGNED JOCCUPANCY I SEISMIC FEE d
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, r- ELECTRIC U
F ' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL r ,
` IMPORTANT! coNsr.rnx
i '
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
I± OFFICE COPY -
I
APPLICANT TO FILL IN.INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUI LQJ NGQROJECT I DENTI FICATION PERMIT NUMBER
R 1INs - -1e APPLICATION & PERMIT 7
AA BUILDING-ELECTRICAL-PLUMBING-MECHANICAL - 118
9
OWNER'S
" NAME PLAN CHECK VALIDATION
-�
15ftef 4' /�f'(3
5;0 QTY. ELECTRIC PERMIT FEE �sa
F-�+ �.l vrW uPHONE .
coNTRAcroRs
NUTLETS
AME -SWITCHES=RECEP 10.00/1.00 ,3d �7
p'
uc.No LIGHTING.,FIXTURES 10.00/1.00 O
T CONTRA TOR'. -a /P
7ADDRESS PPLIANCES-RESIDENTIAL 4.00
PANELS 10.00 DATE OF APPLICATION
ARCH CT F� PLAN CHECK FEE P.C.NO.
!�
OR;rvEER PANELS (OVER 200 AMP) 20.00 S
Lie NO, SIGNS TRANS. 3.00 1J -_
ARCH.OR ENG. PERMIT-VALID ATION
I SPECIAL CIRCUIT 5.00 �
6. &fti 12 koe, n 2 EMP.METER OR POLE INS. 20.00 c
APPLICANT'S
ADDRESS MOTORS SEE FEE SCH. /1
SERVICE'CHANGE 20.00
Foo LICENSED CONTRACTORS DECLARATION _ )
a v I hereby affirm that I am licensed under provisions of Chapter 9 a sl w ISSUANCE DATE
aa,<n (commencing with Section 7000)of Division 3 of the Business and y, BLOC. ELECT. PLG. MECH.
F m z Professions Cod id my license is in lull for e. of ect. 1I PLG IEC
License Class Lia Number/96re � y,: Irmh
ILIA L.YI
Date d/ Cm.lmctor 9
¢ ¢ w ¢. OWNER-BUILDER DECLARATION BUILDING PERMIT
E:
;LL y 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
INFORMATION
u
004 Lathe following reason.(Sec.7031.5,Business and Professions D VALUATION $/FT.
r - wERMIT ISSUANCE 10.00
� w� 2 C.V.CodeAny mulish cor n pair any structure,
a tune,esa prior to consu a ce,also ��
¢ ¢ a 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N QU
A w m, requires the nppllcant for such permit m file a signed statement that TOTAL
he is licensed pursuant to the provisions of the Contractor's License ��11 P�ERMIT TO 11
FZQ Law(Chapter 9(commencing with Section 7000)o(Division 3 ofthe
f 4 0 Business and Professions Code)or that Ire is exempt therefrom and QTY. PLUMB I G PERMIT
¢ H $ the basis for the alleged exemption.Any violation of Section 7031.5 BTORIES
w. E by any applicant for a permit subjects the applicant toacivil penalty TYPE CONSR.gCTER-DRAIN&VENT-WATER (EA.15.00 'T7u-
their sof not Rome than five hundred dollars(S500).1:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4,00
Side 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-FLOORROOF,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 work FIXTURES-PER TRAP 5.00 s¢FT.FLOOR AREA TOTAL ACREAGE
himself through his own employees,provided that such
mems arere int not intended or offered tar sale.If,however,the buildingilding
GAS-EA.SYSTEM-1 INC.4OUTLETS 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.). INDUSTRIAL WASTE INTER30.00 RFS IND CON Pe Other
.
0 I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,BusinessWS
LERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves thereon,and whoLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contramtoos)licensed pursuant to
the Contractor's License Law. ARY-STORM EA,200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,ILAP.C.for this
r' reason ER W/VENT 6.00 '
1 ' Owner Date EM_ 5.00
^ ! — ACC.GATE ACC,FILE NO,
WORKERS'COMPENSATION DECLARATION TING EQUIP. 5.I
I hereby affirm that I have a certificate of consent m self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.0 L .i -
Policy No. Company _
O ❑ Certified copy isherebyfurnished. FIRE SPRINK ENERGY T-14
Z O Certified c p rs fiI�" a try insperYion division.
Appeant IMISC.- REFER TO ORD. VV_ Y ❑ N❑ 1 v ❑ NE]CGRTIIFFI`CATT'E/O'F�ESE
MPTION FROM WORKERS' PERMIT ISSUANCE 10.00 Q FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. - LIC.No. IEG. 7
CL 0 - (This section need not be completed if the permit is for one TOTAL - p y❑ N❑ Y ❑ N❑
:) Z hundred dollars($100)or less.)
U O .I certify that to the performance of the work for which this per- QT,. MECHANICAL PERMIT FEE FEE SUMMARY
LL f mit is issued,I shall not employ any person in any manner so as to
Q W become subject to the Workers'Compensation Laws of California.
} y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING '3 13
aOL-
N NOTICE: TO APPLICANT: If,after making this Certificate of Ex-
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
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1OPM C:RM.) 6.00 SEISMIC FEE >�d0
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
Lender'sr's Name
).me HEATING UNIT(TO 100,000B.T.U.) 8,00
Lender's Address HEATING UNIT(OVER100,000 B.T.U.)9.50 ELECTRIC 3—t�
1 certify that I 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 PLUMBING �� �/
ordinances and state laws relating to building'consrruction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives forms of this city to enter upon the BOILER-COMP (0 or 100,000 BTU)SEE FEE SCH. MECHANIC / �' Gro
above-mentioned property tativsp of
ection purposes.to.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
' Cupertino ag' s[ liabilities,judgments, costs and expenseswhich - oy CONST.TAX
may in way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
gran[i0 this permiL may' MECH.CONT. LIC.NO. MECH.
TOTAL /p(� TOTAL °/ -r-0
S7(;na[ure o Appbcan[�/Contractor—�w� r Dale � a
OFFICE COPY