14269 • I
�,\s POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 14269
INSPECTION DIVISION
JOB INSPECTION RECORD
D / /� PERMIT EXPIRATION
JOB ADDRESS 0"3 O O O V 6 O . 1'C 10• UNIT# _LOT#. - PERMIT EXPIRES IF WORK
OWNER I� CONTRACTOR �aL+� C0 AFC �__ll IS NOT STARTED WITHIN
INS0—TION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION, ANCE OR 180 DAYS FROM
. LASTCALLED INSPECTION.
UFER
- PERMIT VALIDATION
PREGUNITE - - � � - '
i
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED,
UNDERGROUND /SLAB
PLUMBING _
ELECTRICAL - . ISSUANCE DATE
'MECHANICAL L LECT, PLG. MECH.
❑ '. ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED l LOING PERMIT
INFORMATION
' WOOD FLOOR VALUATION $/FT.
PLUMBING
MECHANICAL . -
ELECTRICALfV EPSP Mu•,�o ..��1, _
FRAMING - _ 1
sroRlEs TYPE CONSTR.
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
O.FT FLOOR AREA TOTAL ACREAGE
ROOF
WD
I� DIAPHRAGM _ auILOlNc USE
!J C��'�'��L �' - RES INO- CON PB OIM1er
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED E-1 0 El ID 0
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST TRACT NO, PARCEL NO.
MECHANICAL
ELECTRICAL %FINALS DATE INSP. ACC.DATE ACO.FILE NO.
FRAMING - SAN-*
ZONING ENG.SITE NO.
INSULATION - PLUMBING
GAS
"FIRE SPRINK ENERGY T 24
MECHANICAL 'v E] N❑ Y [:] N[]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNEON HEATING
FLOOD ZONE A.L.UL.
' LATH-INTERIOR ELECTRICAL
LATH EXTERIOR FIRE DEPT. Y� N� v 0 N❑
SHEETROCK DE FEE SUMMARY
SHEAR INTERIOR BUILD
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNEO] OCCUPANCY ., SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, . ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECT!ON.- PLUMBING
�I z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMITFOR EXPIRATION DATE — MECHANICAL
IMPORTANT! coNST.Tnx
PLEASEREAD REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
OFFICE COPY - '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER
ADDR1"` 14269
' ADDRE550/?5 _G 2 o e5b �V
1 �{,..yTv/ �C./1 V BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NwME/y �.��n OTY. ELECTRIC PERMIT FEE 1�-7y-
CONTRACTOR
y-
�. e/}` PHONE I l'.J. I V
CONTfl ACTOflS '/
N 0� UTLETS-SWITCHES-RECEP 10.0011,00 �rf ��
LIC.No LI GHTI NGF IXTURES 10.00/1.00
CONTRACTpOR�'S, w1 APPLIANCES-RESIDENTIAL 4.00
ADOfl ss {..711 :01k ;;I 3
PHONE PANELS 10.00 DATE OF APPLICATION
RCHITECTPANELS (OVER ZOO AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR CIS
ENGINEER
uc.rvo. SIGNS TRANS. - 3.00
ARCH,OR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
AOORESS
ZIP EMP.METER OR POLE INS. 20.00
APPLICANTls MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 /\
D o o LICENSED CONTRACTORS DECLARATION r/ d4lo
M wo w I hereby affirm that 1 am licensed under provisions of Chapter 9 P_ D ISSUANCE DATE
(commencing wnh ction 7000)of DiviA
B 5 nd BLDG. ELECT. PLG. MECH.
Nz Professions Code, my license is in full ❑i o w License lass Lic.NumbyF c Contractor -' G P
BUILDING PERMIT
¢ w u OWNER-BUILDER DECLARATION FORMATION
w ;LL t- I herebyaffirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
P VALUATION $/FT.
F u o v, Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00.x
Code:Any city or county which requires permit to construct,after, IAll ��
2 al ¢ 0O improve,demolish,Or repair any structure,prior to its issuance,also ELEL.COPITfl, LIC.IN ELEC. '7{/
i 0,
requires the applicant for such permit to file a signed Statement that TOTAL PERMIT TO
w$ he is licensed pursuant to the provisions of the Conlmelor's License //v�=R
I-zQ Law(Chapter 9(commencing with Section 7000)of Division 3 of the /z'(OCG
E 4 o Business and Professions Code)or that he is exempt therefrom aM OTY. PLUMBING PERMIT FEE
¢ r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
w. oP not morelicant than fore permit
lbjects(SSOOjj°anuoacivu penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEV ICE 4.00 OCD.GROUP RES.UNITS
their sole compensation,will.do the work,and tom 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
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving That he did not build or im- RES IND CON PB Othe,
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors 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 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 contractm(s)licensed pursuant to
the Contractor's License Law, SEWER-SANITARYSTORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.AP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofcoment to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compe Ion I Sconce certified
copy thereof)Sec.3800,Lab.C.).
A,.,
Iio. Company
OCtliOed copy is he eby FAR FIRE SPRINK ENERGY T-24
Z Zerotic co y-i. Ile with the city ' pection division. MISC.- REFER TO ORD.
Q , Y ❑ NE] Y ❑ IN C:]
CCua PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C.
CC 1 CERTIFICATE OF EXE 'TION FROM WORKERS'
LU COMPENSATION INSURANCE PLG.CONTH. LIC.NO. PLG.
1 O (This section need not be completed if the permit is for one TOTAL Y E] N[J Y E] N❑
0 Z hundred dollars(SIO0)orless.)
U O I certify that in the performance of the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ any person in any manner so as to J
O W become subject to the Workers'Compensmion Laws of California. BUILDING JQp
Date Applicant ALTER OR ADD TO MECH. 5.00
>. y NOTICE TO APPLICANT: If,after making this Certificate of lix-
? Surplice.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 10,000C.F.M.) 4.00 �I (
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE o`a"
I 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,Cir.C.). HEATING UNIT(TO 100,000 B:T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I 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 BOILER-COMP13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to budding construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 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. o
Cupertino against liabilities,judgments, casts and expenses which CONST.TAX
may in any way accrue gains) said City in consequence of the PERMIT ISSUANCE 10.00
granting of this(Lermit, MECH.CONT. LIC.NO. MECH.
d6 9 TOTAL TOTAL a 3/
Signalureo pplicant/Co actor Z plate
OFFICE COPY _-