12539 d. d,;,
14 lo qr,
I' rf.r !1 IIIfI POST THIS
I CARD NEAR FRONTOi. F,.R: UyrryI;L
BER
I PERMIT NUMCITYOFiUPERTI �
.
1 -N: :
�[�
'INSPECTION DIVISION ''': < ���7�7.
'• i nl 1 i I JOB INSPECTION RECORD '/ ' +. G -It' t %�' 3,I' 1+
x
`6NI,ItP
I I +
�IPERMIT EXPIRATION
JOB ADORE SS CL/JAt=.CT/1/'O UNIT#
t t qt A h ,PERMIT EXPIRES,IF WORK
�:},, ' f�'I� u,LY 7 y,'I +z r-
i OWNER'• �1 G�-2.SU CONTRACTOR J SI R?: ''Y+ 4o;- !'K' P# >o IS;iNOT'STARTEO WITHIN
i; tilt+`tisaIINSPECTI01M4!.",}'}s: T,,DATE INSPECTOR I I ''INSPECTION4RECORD$r +fl °�I"fi `�jBO.DAYSOFPERMITISSU-
i� rj. FOUNDATION + '' ATTO'd �( / �(/ T ANCE-ORi180 DAYS FROM
•I .'k1 WEER+ il:if,"+ + . ' I• ' Sl7OGE�BF/ oVAfI^j Di • { LAST,I. I INSPECTION.
�Irlei Y E a
PREGUNITE_ I,PERMIT vnuownoN -
�
iPOUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED O'",?
UNDERGROUND /SLAB
PLUMBING
It .; ELECTRICAL + + ''' II`" WIN ' +� 'ISSUANCE DATE
I . MECHANICAL eLoc ELECTPLG CK_ ' I sl In �b{ Int ,I )!;E]
'E] t. 1
� AIL''+�SpI.�II�II'I ' t
'00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
rBUaowG PERMIT
"I :t:`,INFORMA
• WOOD FLOOR
PLUMBING - .. i + I IV II il 'n" - vnwnnoN
'i vi rlF�.: .r
MECHANICAL
PERM O
;I' ELECTRICAL ^I( + i �; t t - I:, ,J IrT .,
> FRAMING ..r
+ INSULATION: STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,FT,FLOORAREA TOTAL ACREAGE
ROOF •, �' Ii '�.� ,a
r. DIAPHRAGM
$ BUILDING USE
,•RES IND. .CON PB ,I. DIRr1,,
PAPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNE L���It}t , tS El ❑ ❑ I❑
1 )I I
GrASSESSORS PARCEL NO !
ROU I'
-. r � ti I h4 �xr 'h '1�5Rr• .I , s'-
,- PLUMBING'I ryl 11 q ' -i1N ' I " yr +
NO - PARCEL NO
GAS TEST,,
MECHANICAL 'hl .IIIA - ril i �i { Ilj1"I?,v
,'r'• y ACCDATE I ' ACO.FILE NO
ELECTRICAL Ip : r FINALSIml+l'.i` •VJIDATEAN* - -INSPi IIt�''�il� ,?5,^ ! j'
11 FRAMING'-. ld•^":?T r SAN # - 'I: t ' 1'k'':,q. '.r 1p ,!
1 1 i�'qrt - 1,
^ I�a ZONING, P.ENG,SITE NO.
INSULATION t 7 I PLUMBING- +I r + '>` ' >A N„t,, 't cI?
,•11A:• "--'-1J,w '., f.Y.�I'.'• GAS ,> I a '
1 ti FIRE SPRINK , ENERGY :24
L
MECHANICA1?I; '' a -EI [{N; ,',t ?k• a;,� 4.n. ,,. 1
*t COVER NO WORK UNTIL'ABOVE`HAS BEEN SIGNED '• HEATING '^ v, y,l• �,m, l ❑' N :.Y,❑ :'i No
" '•'' LATH—INTERIOR;' "" ELECTRICAL :`" " ,"b' „ t, �j! �000 zoNE,." '.A,�.u.c.
1 i t
f _ �Y LATH—EXTERIOR , FIRE DEPT. ',p' '{
SHEETROCK C� GRADE �',I,
.;" FEE SUMMARY!;';1I
, ;a�'r
•'". SHEAR INTERIOR: 1' BUILDING "'+' t°' '?';�,J61tx,+P1,-fir "!'fl''1'` • i ;'
BUILDING
SHEAR:EXTERIOF "' - TEMPO RARY,APPROVALSI '''• '
FIREWALLS !' ELECTRIC p PLAN CHECK
FEE,
AS
NOITAPE OR PLASTER,UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY F. •I L jdr'+h?Sa+, SEISMIC FEE,;:,
y
OCCUPANCY OF BUILDINGIS NOT PERMITTED UNTIL BUILDING FINALIS SIGNED BY BUILDING INSPECTOR, •"
MICROFILM ,
!" ? ARRANGE FOR INSPECTION BY PHONING 252-4505;:-
LUr, m�'� k�
I, ✓ , V,ry ELECTRIC
q ONE WORKING DAY BEFORE REQUIRED INSPECTION tl'I' . " '
;III ;a, r ? Ithl PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING ei I I;h f.4, s+ ? n4ecHnwcAC
7s%I - SEE PERMIT FOR EXPIRATION DATE
r0 L.
.;i
CONST.TAX
IMPORTANT!
•a .,.
uE I�I { PLEASE READ REVERSE SIDE BEFORE TOTAL r
' + CALLING FOR FINAL INSPECTION. slpa.
APPLICANTG POSTING COPY l ,Si+d �.{,�f�llf'•�{t - _ - - ,,
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
BUILDING PROJECT lDENTIFICATION APPLICATION & PERMIT
ADDRESS
12539
v ao,2
2 � :Z � V.�iZ(2T 11/O BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'$ /+_- g}l :f' .rl-�, •• ' •i..r '-:=. " �'•=e PLAN CHECK VALIDATION
""""1 L ELE01'RIC kFiMIT j',�. xa+.'` .FEE.
it. /`{y Jvr" 130,,�:.crJ I1 •0 PHONE b:-;' 9;7C
`�, coNTflac7oRs f`Q UTLETS-SWITCHES-RECEP 10.00/1.00 C°d
NAME
�k$LdT LIC.NO, G� LIGHTING FIXTURES 10.0011.00 oLo
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 Q .�� DATE OF APPLICATION
PLAN CNECK FEE .RcrrtacT PANELS (OVER 200 AMP) 20.00 .0N0.
O
• OR
ENGINEER LIC.NO. SIGNS TRANS. 3.00
PERMIT VALIDATION
ARCN.on Etc. SPECIAL CIRCUIPAID 5.00
ADDRESS
ZIP EMP.METER OR.POLE INS. .. 0.00 �..J
APPLICANT'S MOTORS .` ' (' - I. '_¢E FEE SC
ADDfl EES l
E H N 20.00
Woo LICENSED CONTRACTORS DECLARATION ern
w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, PLG. MECH.
F N i Professions Code,and my license Is in full force and effect. ❑ f✓-1
S o sP- License ClassLic.Number- DATE
Q Z L w Data Cool Inc for
i xIt:s BUILDING PERMIT
¢ ¢ w a OWNER-BUILDER DECLARATION INFORMATION
REFER TO ORD
WO A 1 hereby affirm that I am exempt from file Contractors License M46C'-'" VALUATION $IFT.
> u o Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 v
Code:Any city or county which requires a permit in construct,alter,
G 5 Q 0 improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC.NO. ELEC. /
i y O¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO I
X ve he Is licensed pursuant to[he provisions of the Contractor's License _-Lt;c_-/' -PL dG -,012
so Law(Chapter 9(commencing with Sect ion 7000)orDivision 3ofthe r,_ly:
a Business and Professions Code)or that he is ex em it Ihetefrom and V. PLUMBING.PERMITj 'FEE
¢ the basis for the alleged exemption.Any vlolalloa o(Sect ion 7031.$ ` STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not marc than five hundred dallars($500).1:
❑ I,as owner of the properly,or my employees with
wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.-UNITS
their sole compensation,will do Ilse work,and the 11R.Iure is mol
intendedor offered for sale(Sec. 7044. Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 .�' o IT FLOOR AREA TOTAL ACREAGE
himself or linugh his own employees,provided that such imp rove 8.00
•, meals are nal Intended or offered for sale.If,however,He,hbudding GAS•EA.SYSTEM-1INC.4OUTLETS
s\L or improvement Is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im. RES IND CON Pe Omer
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 0 ❑ [3''gT� I,es owner of the properly,ant exclusively contracting with
IiCerlseit convectors 10 construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSEssoRS PARCEL No.
and Professions Code:The Contractors License Law does not apply
to an owner of properly who builds or improves thereon.and whoAt
LAWN SPRIN VER 5(EA.) 1.00
Contracts for such projects with a contractors)licensed pn6uallt la SEWER-SANITARY-STORM EA.20011110.00
the Contiac[or s Igens ay+. (J TRACT NO. PARCEL NO.
❑ lam ex p u er Sec. 7 ,B.&P.C.for this WATERATjE sW(.V I!17J 6.00
reason 1 70
J. .Owne! _ Date jt. WATERSYSTEM' 5.00 ACC.DATE ACC.FILE-NO.
/ WORKERS'COMPENSATION DECLARATION WATERT 9. T (�ILwO 5.00
I hereby affirm Ilial I have a Certificate of consent la seirits.c. ZONING ENG,SITE NO,
or a certificate of Workers'Compensation Insurance.or a certified
copy thereof(Sec.3800.Lab CA
Policy No. Company.
0 ❑ Certified Copy is hereby furnished. FIRE SPRINK ENERGY T-$A
Z Z ❑ Certified copy is Filed with the city inspection division. MISC.- REFER TO ORD. Y C] NC] Y Q NC
O Applicant
H - PERMIT ISSUANCE 10.00 U FLOOD ZONE A.L.U.C.
Cr
CERTIFICATE 01:EXEMPTION I7ROM WORKERS'
UJ COMPFNSATION INSURANCE PLG.CONTR. LIC.NO. PLG. �'yp � Y� N0 Y0 N
H1H, section need not be completed if the permit Is for one TOTAL IzI
Z hundreddollare(1100)orlcss.)
CJ O 1 certify that in the performance of the work far which this per. GT:Ie `I'• MEC HANIICAL PERMIT - FEE - FEE SUMMARV v:•
IL 1- mit is Issued.I shall not employ any person in any manner so as to lG hr . ', `'
Ow become subject to the Workers'Compensation Laws of California. BUILDING
Date Applicant ALTER OR ADD TO MECH. 5.00
wf 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 Willi qIR HANDLI 1Op00GF.M) 4.00 FEE
V
such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 100MC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there Is a construction lending agency for EXHAUS 05)D IWIT +;DUCT) 5.00 S�
the performance of the work for Which this permit Is Issued(Sec. MICROFILM
3097,CN.C.). HEATIN UNl (TO
700,000 B.T.U.) 6.00
fenders Name HEATING OB.T.U.19.50 ELECTRIC �Q
Lender's Address
I certify that I have read this application and stale[hat the above VENTILAT FAN (SINGLE) 4.00 PLUMBING
Inlain,.[on is correct.I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
ordinances end state laws relating to building construction, and
• hereby authorize representatives of this city to enter upon the BOILER-COMP lover 100,000 BTU)SEE FEE SCH. MECHANICAL 3'S
above-mentioned property for inspection purposes. REFER TO ORD.
(We) agree to save, Indemnify and keep harmless the City of MISC.- CONST.TAX
Cupertino a alITS liabili[Ius,judgments, costs and expenses which PERMIT ISSUANCE 10.00 Q
may In n w rue aeq��nsl aid City in consequence of the
/ graatl permit. // / MECH.CONT. LIC.NO. TOTAL , TOTAL i
•^ F It •C//ll ��.a/!J_
SignatmEo Applicantli-onlmclor Dale
OFFICE COPY