13072 POST THIS CARD NEAR FRONT OF BUILDING E -�' Y PFRMIT NUMBER
.....,-CITY OF CUPERTINO � '.�' 1.7
13072
INSPECTION DIVISION
JOB INSPECTION RECORD
��// PERMIT EXPIRATION
I JOB ADDRESS Z/4Z70 I
CA+II /,I UNIT# LOT#
..// - PERMIT EXPIRES IF WORK
OWNER cG s - /V/ CONTRACTOR IS NOT STARTED WITHIN
INSPECTI DATE INSPECTOR INSPECTION RECORD
180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 160 DAYS FROM ' -
LASTCALLEDINSPECTION.
UFER
PREGUNITE PERMIrvnuoanoN
�i PAID
PR NO 6ONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB AvIt; b
PLUMBING ^ { `7
ELECTRICAL I I A Aartimn
MECHANICAL BLDG.. EL T. PLG. ECH.
❑ ❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOORVALUATION $/FT.
PLUMBING . - -
MECHANICAL tea,
PERMIT TO
ELECTRICAL '
FRAMING
INSULATION - STORIES TYPE CONSTR.
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• � (��/ �/d �IL v! / Sl FT,FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM U-I BUILDING USE
'•_ IRES IND CON PB Olh.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORSPARCEL NO.
ROUGH r
PLUMBING .s
GAS TEST ._
TRACT NO.- PARCEL NO.
�
MECHANICAL - Shid-
ACC.DATE ACC.FILE NO.
ELECTRICAL. FINALS DATE INSP. . '
FRAMING p p I SAN * •ZONING ENG.SITE NO.
INSULATION I _ - L PLUMBING _
GAS r
FIRESPRINK ENERGY T-24
MECHANICAL
�r/' �� Y ❑ N❑ Y ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN S NEO,;;`, HEATING
LATH-INTERIOR . - ELECTRICAL FLOOD ZONE A,L.u.c.
z _ ❑ IN Yo N❑
' LATH-EXTERIOR FIRE DEPT. _
SHEETROCK I - (� GRADE FEE SUMMARY
SHEAR INTERIOR BUILDIN _/_v'
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC _7,. PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED, OCCUPANCv I I SEISMIC FEE !x• 9?
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
i
ARRANGE FOR INSPECTION BY PHONING 252-4505,. ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
~O�. PLEASE.GIVE JOB ADDRESS WHEN PHONING. .
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
TOTAL "Tn:"
CALLING FOR FINAL INSPECTION.• U"
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.BUI LD1 NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 13072
ADDRESS
r- 1'i47O CCI SAN LANE BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S - PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
PHONE -?-L4 1.
CONTRACTOR'S LIT LE -SWITCHES-RECEP 10.00/1.00
NAME
yy-n- LIG HTI NG FIXTUR ES 10.00/1.00
LIC.NO.
CONTRACTOR•spPUANCES-RESIDENTIAL 4.00
ADDRESS
6 PHONE 7S6 PANELS - 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No SIGNS TRANS. 3.00
ARCH.OR ENG, SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
ZIP EMP.METER OR POLE INS., 20.00 PAID
APPLICANT S MOTORS SEE FEE SCH.
SERVICE CHANGE
20,00 1( -•, ! /
2,06 LICENSED CONTRACTORS DECLARATION
,' nC/, -/
/ 1� U
<v u 1 hereby affirm that I am licensed under provisions of Chapter 9 V I Stave
A i (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH,
F 0 z Professions Code,and my license is in full force and effect ❑
z 0 G License Class Lie.Number ❑ ❑
mr w Date Contractor
a yi dBUILDING PERMIT
IE x Ic ¢ OWNER-BUILDER DECLARATION INFORMATION
wGd" MISC.- REFER TO ORD
; r I hereby affirm that 1 am exempt from the Contractor's License VALUATION S/FT.
uo¢ Law for the following mason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 // O
F ;;0J Code:Any cityor county which requires a permit to construct,alter,
Q Q¢0 improve,demolish,or repair any structure,prior l0 Its Issuance,also ELEC.CONTR. LIC.NO. ELEC.
i -0 u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
x2" he is licensed pursuant to the provisions of the Contractor's License p l
i i Law(Chapter 9(commencing with Section 7000)ofDivision 3ofthe S G(iL
1 4 o Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT 'FEE
ICH$ the basis for the alleged exemption.Any violation ofSection7031.5 STORIES TYPE CONSTR.
n ; ^ by any applicant for a permit subjects the applicant toacivilpenalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACKFLOW PROTECT. DEVICE 4,00 OCC.GROUP RES.Urv1T5
their sole compensation,will do 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 -
property who builds or improves thereon,and who does such work FIXTURES PER TRAP 5.00 56 FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve. -EA.SYSTEM-1 6.00
336
�. ments are not intended or offered for sale.If,however,the building GAS
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im. RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
.❑ ],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 r3 ad -/0 03 oL0
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL N0.
❑ I am exempt under Sec. -,BAP.C.for this WATER HEATER W/VENT 6.00 "]�!�
reason
Owner Date WATER SYSTEM 5.00 ACC. ATE ACO.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.). Sa.LL��
Policy No. Company •11--
0 ❑ Certified copy is hereby furnished. FIRESPRINK rNERGYTQ4-
Z Z � Certified co led wit th �eif�' Inspection division.
O Applicant .% + MISC.- REFER TO ORD. Y❑ N❑ Y ❑ No
~ va PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
CF.RTI FICE E MOTION FROM WORKERS'
CL COMPENSATION INSURANCE PLG.LONTR. LIC.NO. PLG. Y E] N❑ Y E] N E]LU COM
CL O (This section need not be completed if the permit is for one TOTAL
:3 Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
Iy b mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California. BUILDING '7/Q�
Date Applicant ALTER OR ADD TO MECH. 5.00
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z emption,you should become subject m the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10JD00C.EM.) 6.00 SEISMIC FEE 77
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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's No HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
1 certify that 1 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 construction, and BOILER•COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives 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.
Cupertino against liabilities,judgments, costs and expenses which' PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
granting tl�p permit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Signature of Applica ontractor ale
OFFICE COPY