9048 POST THIS CARD NEAR FRONT OF BUILDING
PFRMIT NUMBER
CIT`.` .OF CUPERTINO 9 48
INSPECTION DIVISION
JOB INSPECTION RECORD
• ����� CD✓V ^
JESS UNIT
_ PERMIT EXPIRATION
OB AD RI/ L # LOT# PERMIT EXPIRES IF WORK
DINNER r CONTRACTOR e (1�'1� IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD - 180 DAYS OF PERMIT ISSU-
FOUNDATION AN OR 180 DAYS FROM
LIFER -� 1) J LAS ebINSPECTION.
PREGUNITE ^LIU PERMIT VALIDATION
,-a- S ,- rf 1 1af�C
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED City Of CUDBft100
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG" ELECT. PLG. MECR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' BUI ING ERMIT
INFORMATION
WOOD FLOOR VALUATION
PLUMBING -a/_
MECHANICAL .�.
PERMIT TO
ELECTRICAL
FRAMING
IN SUL ION STORIES; TYPE CUNbTH.
OCC., OUP RES uNiTt
14)
PLACE NO SUBFLOOR UNTIL ABOVE AS BEEN SIGNED '
SO.FL FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM I"
BUILDING USE
RESP �IND CON Pe Omu
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED Q '
ASSESSORS PARCEL NO.
ROUGH r '3 S-'9-0 `�6 01
PLUMBING 6 6
TRACT NO. PARCEL NO.
GAS TEST ( /817 "
MECHANICAL
ACC.DATE ACC.FILE N0.
ELECTRICAL -/S= FINALS DATE INSP.
FRAMING SAN # ZONING ENG.SITE NO.
INSULATION 1 D PLUMBIN
GAS
MECHANICAL FIRE SPRINK ENERGY T.24
Y IND Y
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH-INTERIOR 3-1'S ELECTRICAL FLooD zoNE A.Lu.c
LN1]
.
LATH-EXTERIOR _a FIRE DEPT. (J / Y0 N[3 Yo No
SHEETROCK GRADE - FEE SUMMARY
SHEAR INTERIOR .. �j$7 BUILDING
SHEAR EXTERIOR - �6 TEMPORARY APPROVALS/ BUILDING
FIREWALLS b ELECTRIC PLAN CHECK -
GAS FEE /
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE ;
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING �1
. PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL "
CALLING FOR FINAL INSPECTION. y
OFFICE COPY
"APPLICANT TO FILL IN INFORMATI N WITHIN RED LINES - USE BALL POINT PEN ONLY
-. .
' - PERMIT NUMBER
BUI LD1 NG PROJECT I DEN_T_I FI_CAT'-N c APPLICATION & PEFi�. T
BUILDING �f�s 9048
ADD �2. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWN s (// l/�#L1
,r •'1 "�' qti f PLAN CHECK VALIDATION
_ NAME llPTY.. ` ELECTRIC'PERMIT�'�`;�gr• tt;"aFEE`•'/
PHO "
CONTRACTORS
NAME (a, UTLETS-SWITCHES-RECEP ^10.00/1.00
CG ICC. '2„� LIGHTING FIXTURES 10.00/1.00
C NTRACT R'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS
2 PANELS IOM
OO, / DATE OF APPLICATION
ARCHITECT �- PANELS (OVER 20PLAN CHECK FEE P.C.NO.
OR acD3aa
ENGINEE - - //�g�
LIC..O.• SIGNS TRANS. -�'gg�
PERMIT VALIDATION
ARCH.OR NG. - SPECIALCIRCUITADORESB . 1UG 1 O •IpCIPre � ) EMP.METER OR0 .L s/ IJE�UAPPLICANT'S MOTORS .ADDRESSr A5 C lL IAT' OL fluC(.-1 SERVICE CHANGaJ 1 {a pertinoLICENSED CONTRACTORS DECLARATIONTEMP.POLE0I hereby affirm that I am licensed muter provisions Of Chapter 9ISSU I DATE
2 w (commencing with Section 7000)of Division 3 of the Business and BLDG. EC PLG. EC
uaoi i Professions Cod and my license is in full Con; J d of 4
o M License CI ss Lie.Number
Z, 1
- o Dale Contractor
L S j 'u;'-11 BU LOING"PERMI .';F,i",z;
o " OWNER.BUILDER DECLARATION
^i'� ;"'`•' (, I n�
MISC.- REFER TO ORD ,t,1','e.+iINFQRMATION...£ ,n.
`x ;,• y I hereby affirm that 1 am exempt from the CDntrucmr s License - VALUATION S/FT.
w A.04 Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 - -
Emss� Code:Amycityorcounty which requires a permit townstrucLalter, '
R < improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC, n/'���rrr
DLL requires the applicant for such permit to file a signed statement that TOTA , PERMIT TO
W$ he is licensed pursuant to the provisions of the Contractor's License 1
F z r Law(Chapter 9(cummencingwitb Section 7000).1 Division3.l'the `•! V
4 Business and Professions Code)or that he is exempt therefrom And PLUMBING PERMIT
m
X.
O the basis for the alleged exemptiPTV.on.Any violation.I Section 7031.5 ' .. " •• STORI TYPE ONSTR,
byanyapplicant Cora permit subjects the applicant toa civil penally .,� ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollen(S5001):
❑ I,as owner of the properly,or illy employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.OR UP REST N TS
their sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions GRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner o1' r
- • property who builds or improves thereon,and who does such work 1 Z FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACHEAGE
himself or through hu own employees,provided that such improve eL GAS-EA.SVSTEM-11NC.40UTLETS 6.00
menta are not intended or offered for sale.If,how..,.the building
or hnprovement 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 Ile did not build or int- ES IND CON Pe CO.,
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 0
❑ I.as owner of the properly,am exclusively contmchng with
licensed contractors to construct the project(Sec. 7044,Bminess _ LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCE L NO.
and Professions Code:The Contractors License Law does not apply
to an owner of property who builds or improves there.n.Ind who ILAWN SPRINKLERS-OVER 5(EA.) 1.00 S-� -
contracts for such projects with a contracrorls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10TRACT NO. PARCEL NO.
the Contractors License Law. .0 ///j
O lam exempt under Sec..,B.&P.C.for this WATER HEATER W/VENT 6.00
Mason
Owner Date + WATER SYSTEM 5.00 ACC.D E ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING y�EQUIP. 5.00
1 hereby affirm that I have a certificute of ei l to self-insure, ✓� �rs� lY-- ZONING ENG.SITE NO.
or a certificate of Workers'Compensatio<nyI^nsurance.or a certified
Copy thereof(Sec.3800,Lab.C.).
Policy No. Company. JY
Q (]Certified copy is hereby furnished, FIRE SPRINK ENERGY T-24
_Z Z l Cc r if,ay0 u CJs filed with the city inspcoiun division. MISC.- REFER TO ORD. Y 0 N� y E] No
H yAp CJIIE X 4'f'�I
PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
I - CERTIFICATE OF EXEMPTION FROM WORKERS' '
LU > COMPENSATION INSURANCE PLG.CONCH. LIC.NO. PLG. / Y N Y N❑
CL O (This section need not be completed if the permit is for one TOTA
2 hundred dollars IS 100)or less) -/i+n
C.> O I certify that in the performance of the work for which this per PTV M,ECHANICACPERMIT r 7, FEE'1 <, IFEE+SUMMARY
ly F mit is issued.I shall not employ any person in any manner so as to d.. ,. „
O W became subject to the Worked Compensation Laws of California. BUILDING
Date t �-- AL .
} N ApplicanTER OR ADD TO MECH. 500 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 must forthwith comply with FEE
' C.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is A construction lending agency for EXHAUST HOOD (WITH DUCT) 6,00 MICROFILM
the performance of the work for which this ennit is issued(Sac. HEATING UNIT(TO 100,000 B.T.U.) 6.00
3097, 'a Ad). DY•IVI fl. 1'1L__,� ,
Lender's Name Lam_ HEATING UNIT(OV ER 100,000 B.T.U.19.60 ELECTRIC l Z,
Lender's Addre }Q.tffa l Y s
Icertify that l have read this application and stale that the Above VENTILATION FAN (SINGLE) 4.00 PLUMBING /
information H correct. I agree to comply with all city and county BAILER-COMP 13 H.P.or 100,000 B,T.U.1 8.00
ordinances and slate laws totaling to building construction, and
r �S
hereby authorise representatives of this city to enter upon the BOILER-COMP (Over t00,000 ITIL EFEESCH MECHANICAL •G
abave•mentioned property for inspection purposes.
(We) agree to use, indemnify and keep harmless the City of MISC.- REFER TO ORD. l CONST.TAX
Cupertino against liabilities,judgments,costs slid expenses which PERMIT ISSUANCE 10.00
may in any way accrue against mid City in consequence of the
granting of this ptrmMECH.CONT, LIC.NO. MECH, .;
5 c TOTA ./ :'•:TOTAL
L
Signmure of A 4
tic rat/Conlraclor Uate
OFFICE COPY