13220 POST THIS CARD NEAR FRONT OF BUILDING
' I'f:RMIT NUMBER
CITY OF CUPERTINO 13220
INSPECTION DIVISION
2' JOB INSPECTION RECORD
JOB ADDRESS 2/ 3�" ✓ ���X��� �� - UNIT# - LOT# PERMIT EXPIRATION
_ - PERMIT EXPIRES IF WORK
I
OWNERL[DA,f ONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECtOR INSPECTION RECORD 186DAYS OFPERMIT IssU-
FOUNDATION ANCE OR 180 DAYS FROM
UFER
LASTCALLED INSPECTION.
•
PREGUNITE - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED . :
UNDERGROUND /SLAB �Q '\ t4.7..._
PLUMBING %Q
ELECTRICAL ,ie� O ('� \ ISSUANCE DATE
MECHANICAL vi• BLDG. ELECT . PLG. MECH.
t CuPe\1yn ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED L` BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL /
LCC
FRAMING C -T
STORIES TYPE CONSTR.
INSULATION
OCG GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM '
BUILDING USE
HESIND CON PB o"',APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ El
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ACC.OATE ACC.FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING � i
GAS /
MECHANICAL FIRESPRINrc ENERGY T.N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - v "� ° E:]
.
LATH—INTERIOR ELECTRICAL. FLOOD ZONE A.LU.C.
• LATH—EXTERIOR FIRE DEPT. Y[] NEI v 0 IN
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
PORARY
SHEAR EXTERIOR TEMAPPROVAL BUILDING .
FIREWALLS ELECTRIC . PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.-
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICECOPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS 13 120
'� �C�.)'Cr -,b V- BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
o NEP'S •v `v'+ PLAN CHECK VALIDATION
�5 CTL'. ELECTRIC PERMIT FEE
SJ L•L EHONE
CONTRACTORS
.AME UTLETS-SWITCHES-RECEP 10.00/1.00
N
LIC.NO. ILIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
OR
ENGINEER
LIC,No SIGNS TRANS. 3.00
AABC.DDRESS ENG. / SPECIALCIRCUIT 5.00 IT
PERMIT VALIDATION
ZIP TEMP.METER O 4lDNS. 20.00 /J
APPLICANT S MOTORS
ADDRESS _$EE FEE SCH.
SERVICE CH¢NG_EC) (sY �yll 20.00 p
0 0 o LICENSED CONTRACTORS DECLARATION -
a v v I hereby air. That 1 am licensed under provisions of Chapter 9 '.fit f Cu Q I ISSUANCE DATE
v,< y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT PLG. MECH.
r m i Professions Code,and my license is in full force and effect. ❑ ❑ ❑
a o Liccnsc Class Lie.Number
Q r w Datc Contractor
BUILDING PERMIT
¢ ¢ w a OWNER-BUILDER DECLARATION
o A ° MISC.- REFER TO ORD INFORMATION
RAX 3 u m I hereby affirm that I am exempt from the Contractor's License VALUATION S/FT.
FLL ❑ a Law for the lioil owing rcason.(Scc.7071.5.tlusincssand Professions PERMIT ISSUANCE 10.00
Code:
Any city or county which requires a permit to construct,alter,
¢ K ¢ p
d improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. (
0 , requires the applicant for such permit to file a signed statement that TOTAL /V - PERMIT TO
w m he is licensed pursuant to the Provisions of the Contractor's License _
Fii
Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe /
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE Ley-
¢ r c the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR.
to in byany applicant for a permit subjects lire applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ 1,as owner of lire property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sea 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 docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees.Provided that such improve-
mentsarcnotintendedorofferedforsale.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 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
RES IND CON Bit steer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the ,,,Perry,at,,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 docs not apply
to an owner of property who builds or improves thenen,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
Ole Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. .B.&P.C.for thl WATER HEATER W/VENT 6.00
reason
Owner r to WATER SYSTEM 5.00
A�1 ACC.DATE ACG FILE NO.
'OR i S' IPENSATION DECLA N WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certil'icR of so
o sclf-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified ropy is hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y ❑ N Y ❑ N❑
Cr �' CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C,
LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. v❑ N❑ v ❑ N❑
CL Z (This section need not be completed if the permit is for one TOTAL
hundred d.ILu(SI00)ofless.)
U Q 1 certify that in the Performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,1 shall not employ any person in any manner ser as to
Ow become subject to the Workeri Compensation Laws of California. BUILDING
a Date Applicant ALTER OR ADD TO MECH. 5.00
} W NOTICE TO APPLICANT: If,alter making this Certificate of Ex-
2 caption,you should become subject to the Workeri Compensation APPLIANCE .5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
L) arch provisions or this Permit shall be decnuvl revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
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
3097,Civ.C.). t HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 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 CONST.TAX
�ffAp�pluc
y accrue against said City in co sequence of the PERMIT ISSUANCE 10.00
ermit MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
�A� am/Contractor D lc
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
' I'f:RMIT NUMBER
CITY OF CUPERTINO 13220
INSPECTION DIVISION
2' JOB INSPECTION RECORD
JOB ADDRESS 2/ 3�" ✓ ���X��� �� - UNIT# - LOT# PERMIT EXPIRATION
_ - PERMIT EXPIRES IF WORK
I
OWNERL[DA,f ONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECtOR INSPECTION RECORD 186DAYS OFPERMIT IssU-
FOUNDATION ANCE OR 180 DAYS FROM
UFER
LASTCALLED INSPECTION.
•
PREGUNITE - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED . :
UNDERGROUND /SLAB �Q '\ t4.7..._
PLUMBING %Q
ELECTRICAL ,ie� O ('� \ ISSUANCE DATE
MECHANICAL vi• BLDG. ELECT . PLG. MECH.
t CuPe\1yn ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED L` BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL /
LCC
FRAMING C -T
STORIES TYPE CONSTR.
INSULATION
OCG GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM '
BUILDING USE
HESIND CON PB o"',APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ El
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ACC.OATE ACC.FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING � i
GAS /
MECHANICAL FIRESPRINrc ENERGY T.N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - v "� ° E:]
.
LATH—INTERIOR ELECTRICAL. FLOOD ZONE A.LU.C.
• LATH—EXTERIOR FIRE DEPT. Y[] NEI v 0 IN
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
PORARY
SHEAR EXTERIOR TEMAPPROVAL BUILDING .
FIREWALLS ELECTRIC . PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.-
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICECOPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS 13 120
'� �C�.)'Cr -,b V- BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
o NEP'S •v `v'+ PLAN CHECK VALIDATION
�5 CTL'. ELECTRIC PERMIT FEE
SJ L•L EHONE
CONTRACTORS
.AME UTLETS-SWITCHES-RECEP 10.00/1.00
N
LIC.NO. ILIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
OR
ENGINEER
LIC,No SIGNS TRANS. 3.00
AABC.DDRESS ENG. / SPECIALCIRCUIT 5.00 IT
PERMIT VALIDATION
ZIP TEMP.METER O 4lDNS. 20.00 /J
APPLICANT S MOTORS
ADDRESS _$EE FEE SCH.
SERVICE CH¢NG_EC) (sY �yll 20.00 p
0 0 o LICENSED CONTRACTORS DECLARATION -
a v v I hereby air. That 1 am licensed under provisions of Chapter 9 '.fit f Cu Q I ISSUANCE DATE
v,< y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT PLG. MECH.
r m i Professions Code,and my license is in full force and effect. ❑ ❑ ❑
a o Liccnsc Class Lie.Number
Q r w Datc Contractor
BUILDING PERMIT
¢ ¢ w a OWNER-BUILDER DECLARATION
o A ° MISC.- REFER TO ORD INFORMATION
RAX 3 u m I hereby affirm that I am exempt from the Contractor's License VALUATION S/FT.
FLL ❑ a Law for the lioil owing rcason.(Scc.7071.5.tlusincssand Professions PERMIT ISSUANCE 10.00
Code:
Any city or county which requires a permit to construct,alter,
¢ K ¢ p
d improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. (
0 , requires the applicant for such permit to file a signed statement that TOTAL /V - PERMIT TO
w m he is licensed pursuant to the Provisions of the Contractor's License _
Fii
Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe /
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE Ley-
¢ r c the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR.
to in byany applicant for a permit subjects lire applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ 1,as owner of lire property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sea 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 docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees.Provided that such improve-
mentsarcnotintendedorofferedforsale.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 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
RES IND CON Bit steer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the ,,,Perry,at,,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 docs not apply
to an owner of property who builds or improves thenen,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
Ole Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. .B.&P.C.for thl WATER HEATER W/VENT 6.00
reason
Owner r to WATER SYSTEM 5.00
A�1 ACC.DATE ACG FILE NO.
'OR i S' IPENSATION DECLA N WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certil'icR of so
o sclf-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified ropy is hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y ❑ N Y ❑ N❑
Cr �' CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C,
LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. v❑ N❑ v ❑ N❑
CL Z (This section need not be completed if the permit is for one TOTAL
hundred d.ILu(SI00)ofless.)
U Q 1 certify that in the Performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,1 shall not employ any person in any manner ser as to
Ow become subject to the Workeri Compensation Laws of California. BUILDING
a Date Applicant ALTER OR ADD TO MECH. 5.00
} W NOTICE TO APPLICANT: If,alter making this Certificate of Ex-
2 caption,you should become subject to the Workeri Compensation APPLIANCE .5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
L) arch provisions or this Permit shall be decnuvl revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
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
3097,Civ.C.). t HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 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 CONST.TAX
�ffAp�pluc
y accrue against said City in co sequence of the PERMIT ISSUANCE 10.00
ermit MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
�A� am/Contractor D lc
OFFICE COPY