12863•
i
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
JOBADDRESS' UNIT' _LOT#
.
OWNER CONTRACTOR
PFRMIT NUMHER
12863
• PERMIT EXPIRATION
PERMIT EXPIRES IF WORK.
IS NOT STARTED WITHIN
188 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
INSPEC ION TE I INSPECTOR
INSPECTION RECORD
FOUNDATION
UFER
PREGUNITE
PER ON
FEB % & 1987
City of Cupertino
ISSUANCE DATE
BLDG. ELECT, PLJ ME H.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
. • -
UNDERGROUND/SLAB
PLUMBING -
_
,
ELECTRICAL
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT/
INFORMATION
WOOD FLOOR
PLUMBING
VALUATION
S/FT.
MECHANICAL
ELECTRICAL
j PPEERMM,ITTTTOO�,, 1
1•���1/'!' 13!•�'L`I-�1'.t
FRAMING
INSULATION -
IE TYPE c NSTR.
', G I R NITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
- -
sa. TT. rwoR ARE o
',
DIAPHRAGM
BUILDING USE
RES IND CON PB
❑ - 1:1 1:1 ❑
I�rr
❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ROUGH
ASSESSORS PARCEL NO,
TRACT NO, PARCEL NQD
PLUMBING d' ropaiir
GAS TEST
-
MECHANICAL
ELECTRICAL 3— L -b'
FINALS DATE INSP.
ACC DATE
ACC. FILE NO.
FRAMING
SAN # '
INSULATION
PLUMBING
zorvlNc
ENG. SITE No.
GAS
MECHANICAL
rFIRE SPRINK
Y ❑ "0
ENERGY T24
Y ❑ "E]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
LATH—INTERIOR
ELECTRICAL
FLOOD ZONE
Y ❑
AL.0 C,
Y ❑ N❑
LATH—EXTERIOR
FIRE DEPT.
SHEETROCK'
GRADE '•
FEESUMMARY
SHEAR INTERIOR
BUILDING
BUILDING
SHEAR EXTERIOR
TEMPORARY APPROVALS
FIREWALLS
ELECTRIC
PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE,
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
0�ONE WORKING DAY BEFORE REQUIRED INSPECTION.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
—SEE PERMIT FOR EXPIRATION DATE —
ELECTRIC.
PLUMBING
'MECHANICAL
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION\
TOTAL
OFFICE COPY
' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
BUILDING -ELECTRICAL -PLUMBING -MECHANICAL
PERMIT NUMBER
12863
BUILDING
ADpss�sp�i-s
OwNE/R'�S.'//
NAME
V. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
,EW -elLPHDNE Zs7 -z?O
OTRArHsNMEC��Bs-¢S�
UTLETS - SWITCHES -RECEP 10.00!1.00
LIGHTING FIXTURES 10.00/1.00
o.
CONTRACTOR
DR's
ADDRESS
AD0C
APPLIANCES - RESIDENTIAL 4.00
PANELS 10.00
j�
5 " HONE >
DATE OF APPLICATION
OARCHITECT
ENGINEER
LII. No,
PANELS (OVER 200 AMP) 20,00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ARCH OR E a. -
ADDRESS
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
EMP. METER OR POLE INS. 20.00
ZIP
D
APPLICANT'$
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
n U
'i A 1987
( •7
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect.
License Class Lic. Number
NCE DATE
B T. P H
Dale Contractor
OWNER-BUILUIiR DECLARATION
affirm that I Inn exempt from the Contrimetra dvr License
I herebythe
Law forAnycountyng whichccJ0res apemit tocnstruct, Sher,
Code: Any city or county which requirese permit to construct alter,
improve, demolish. or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions althe Contractor's License
BUILDIN PERMIT
INFORMATION/
MISC.- REFER TO ORD
PERMIT ISSUANCE 10.00
VALUATION
S/FT.
ELEC. CONTR. LIC. NQ
TOTAL
TOTAL
p TO
QTY. PLUMBING PERMIT FEE
Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt themtrom and
' PIA
IES TYPE NSTIl.
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars (5500).1:
ALTER -DRAIN -WATER (EA.) 5.00
BACK FLOW PROTECT. DEVICE 400
.
❑ 1, as owner of the property, or my employees with wages as
sole compensation, will do the work, and the structure Is not
ac UP 5 UNITS
DRAINS -FLOOR, ROOF, AREA,COND. 5.00
intended or offered for sale (Sec. 7044, ELI and Professions
Code: The Contractor's License Law does not apply to an owner of
-
FIXTURES - PE TRAP 5.00
GAS - EA. SYSTEM -11NC.40UTLETS 6.00
50. FT PLDDR AR A rq a PER GE
l/�
property who builds or improves thereon. and who does such work
himself or through his own employees, provided that such improve-
mems arc not intended or offered for sale IL however, the building
or improvement is sold within one year of completion, the owner-
builder will have the burden ofproving that he did not build or int-
prove for purpose of sae.).
❑ I, as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON PB mar
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project (Sce. 7044, Business
and professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves diction, and who
LAWN SPRINKLERS -I INC 5 V.B. . 6.00
ASSESSORS PARCEL NO.
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
-
teem tracts for such projects with a contractors) licensed pursuant to
tile ContractorsLicense Law.
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL No.
❑ l am exempt under Sec. ,B.&P.C. for this
reason
WATER HEATER W/VENT 6.00
Owner Date
WATER SYSTEM 5.00
ACC. DATE
AOC. FILE NO.
TER TREATING EQUIP, 5.00
WORKERS'COMPENSATION DECLARATION
I �re�y u 1 lificate of consent to selfinsure'
or e7jeli� c �(t"K'brk 4i C0 pensatmo lnsunnce. or rifled
ZONING
ENG. SITE N0.
Policy No. acpch; iY�_
❑ - titled cr - hcrchyhv shed.
Cc led opy I. I'I wits city Ilion I cion.
pelican
RE SPRINK
Y ❑ N ❑
ENERGYT-24
Y ❑ N❑
MISC. - REFER TO ORD.
: RTIFICATIi OF E. 17MPTION PROM CRS'
PERMIT ISSUANCE 10.00
FLOODZONE
A.L.U.G.
CoM PIIS ION INSURANC
('Phis section need not be completed if it permit is fol one
PLG. CONTR. LIC. NO.
PLG.
TOTAL
Y ❑ N ❑
Y ❑ N ❑
hundred deltars(5100) or IIsi.)
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in any manner so as to
OTY MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
become subject to the Workers' Compensation Laws of California.
Date Applicant
NOTICE TO AI'1'LICAN'1': 11, after making Ihis Certificate .1 E.-
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
PLAN CHECK
FEE
empliom, you should become subject to the Workers'Connpeasation
Provisions of the Labor Code. you must forthwith to nn ply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT(OVER 10PMC.F.M.) 6.00
SEISMIC FEE
' CONSTRUCTION LENDING AGENCY
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.
3097, Civ.C.L
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address
H EATI NG UNIT (OVER 100,000 B.T.U.) 9.50
ELECTRIC
I certify Thai I 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
ordinances and state laws relating to building construction, and
PLUMBING
BOILER- OOMP(3 H.P. or 100,000 B.T.U.) 6.00
hereby authorise representatives of this city to enter upon a
above-mentioned property for inspection purpous.
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
(We) agree save, indemnify and keep ha less the .j of
MISC. - REFER TO ORD.,
-
Cupertino ' just liabilities, judgments, costs ' d expo � hich
y way accrue against said City corse of the
gra this per it. /
Z
CONST. TAX
PERMIT ISSUANCE 10.00 U,
.MECH. CONT. LIC. NO.
MECH.
TOTA
TOTAL
r Dale
v OFFICE COPY
-APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
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BUI LDI NG PROJECT 1 DENTI FICATION
APPLICATION & PERMIT
UILDING- ELECTRICAL- PLUMBING -MECHANICAL
PERMIT NUMBER
1244
BUILDING
ADOREss
/
c�
OWNER'S
NAM y ( :257 8'034
TY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
CONTRACT R'S /�OS/
NA E
UTLETS-SWITCHES-RECEP 10.00/1.00 /11
LIGHTING FIXTURES 10.00/1.00
A-oNTRACTOR's ./
ADDRE- sS Oki., {CJC' �
APPLIANCES -RESIDENTIAL 4.00
PANELS 10.00
BONE
DATE OF APPLICATION
AORRCHITECT I
ENGINEER
LIC. No.
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
AARCH. 08 DDRESS ENG.
' ZIP
SPECIAL CIRCUIT, 5.00
PERMIT VALIDATION
0
TEMP. METER OR POLE INS. 20,00
A
ADDDRESSDRESS -
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSEDCONTRACTORS DECLARATION
�f// (/
I hereby affirm that 1 am licensed under provisions of Chapter 9
(commencing with Sectio 7000) of Division 3 of the Business an
Professions Code dyyfimasl i isN full fof/� yW 1W L
License Class_ Lic. Nu Der_ J `/ !
Date//1/Contr.(rl'
OW R -BUILDER DECLARATI iyI �
I hereby affirm that I .0 exempt from the Contractor's License
Lawlor Any he following unty which
Code: Any city or county which requires a permit to construct ager,
to construct,
improve, demolish, or repair any permit 1. ei prior ID its issuance, also
req isles the applicant for such permit Io ole u signed actor's nl that
he is licensed pursuant en the provisions of 00 ) ofD¢isave License
of Division 3 of the
Law (Chapter 9 (commencing with Section is exempt
Business arid Professions Code) or that he is cxcmpl therefrom and
ISSUANC DATE
P1�16
BLDG.
❑
ELECT.
PLG. MECH.
❑ ❑
IS
MH O
BUILDING PERMIT
INFORMATION
MISC.- C1 E TO ORD
PERMIT ISSUANCE 10.00
VALUATION
S/FT.
ELEC. DONTR, LIC. NO.
EOTA p W
TOTAL V J
PERMIT TO
r
CLE G7
DTV. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant (or a permit subjects the applicant tea civil penalty
of not more than five hundred dollars ($500).):
ALTER -DRAIN -WATER IEA.) 5.00
❑ 1, as owner of the properly, or my employees with wages as
the it sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE . 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
in or offered for sale (Scc. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
ments are not intended or offered for sale. It however, tire buildingGAS
FIXTURES - PER TRAP 5.00
SO. FT. FLOOR AREA
TOTAL ACREAGE
GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or int -
prove for purpose of sale.).
❑ 1, as owner of the property, am exclusively contracting will
GAS EASYSTEM -OVER 4 IEA.) 2.00
- .
BUILDING USE
RES IND CON PB Omer
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
licensed contractors m construct the project (Sri, 7044, Business
and Professions Code: The Contractor '.% License Law does not apply
to an owner of property who builds or improves thereon, and who
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
contracts for such projects with a contractors) licensed pursuant to
the Contractor's License Law.
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
❑ I um cxcmpl under Sec ,B.hl'.C. iia this
reason
'
WATER HEATER W/VENT 6.00
sone, Date _
WATER SYSTEM 5.00
ACQDATE
ACC. FILE NO.
WORKERS'COMPENSATION DECLARATION
I hereby affir a certificate of consent m scl Ginsure,
ora¢¢¢is��9 t rke om pellsxHon surance, or a cer' icJ
WATER TREATING EQUIP. 5.00
ZONING
ENG. SITE NO.
Pol o.- Company 7�
1'.] f , c Oo Company
'
FIRE SPRINK
Y ❑ N❑
ENERGY T-24
Y ❑ N❑
❑ CCrtifiC Iereby flVn(Shed.
O Certif copy w' I lh •inspec" division.
Applicant- _
MISC. - REFER TO ORD.
CER'I'IFICA'[I:OF IiXEMP1'I ON 1' , WORKERS'
PERMIT ISSUANCE 10.00
FLOOD ZONE -
A.L.u.C.
COMPENSATION' NSU NCE
('Phis section need nol be completed if me permit is for one
PLG. CONTR. LIC. NO.
PLG.
TOTAL
Y ❑ N ❑
Y ❑ No
Hundred dollar.(5100) or less.)
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in any manner so as m
DTV. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
become suhjecl to the Workers' Compalsalion Lows of Culifornu.
Date -Applicant
NOTICE TO APPLICANT: It after making this Certificate of Ex-
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
PLAN CHECK
emption, you should hecomesubjecl to the Workers'Compensat ion
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT ITO 10=11F.NL) 4.00
FEE
AIR HANDLING UNIT(OVER 10MCF.M.) 6.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
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 (Scc.
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lenders Name
Lender's Address
HEATING UN IT ER 100,000 B.T.U.)9.50
CTR C
ELECTRIC
a
I certify that l have read this application and slate that the above
VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county
ordinances and state laws relating IO building construction, and
PLUMBING
BOILER- COMP (3 H.P. of 100,000 B.T.U.) 6.00
gQILER-COMP (Over 1011.000 BTUI SEE FEE SCH.
I MECHANICAL
hereby authorize representatives of this city to enter on the
above-mentioned properly for inspection purposes.
IWrl Bur to save, indemnify and k p hannl-., e City of
MISC. - REFER TO ORD.
Cupertino gains( liabilities, judgments 'osis an uses which'
y way accrue, against ai 'ity in uence of the
his unit.
CONST. TAX
PERMIT ISSUANCE 10.00
MECH. CONT. LIQ N0. MECH.
TOTAL
TOTAL
naNrc o' t/Com or ac
OFFICE COPY