10009 TH IS
ARD
�STCITc1*OFECUPERTINING . ,
E I PERM1llT NUMBER
INSPECTION DIVISION
JOB INSPECTION.RECORD /)
PERMIT EXPIRATION
JOB ADDRESS /�/�/T '//✓ " UNIT# T# I
.. .. - PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR I NSPf CTI ON ECO D 180 DAYS OF PERMIT ISSU.
FOUNDATION •1_11 ANCE OR 180 DAYS FROM
UFER.
LASTCALLED INSPECTION.
� � �
PERMIT VALIDATION
PREGUNITE
S
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB / I(
PLUMBING
ELECTRICAL ISSUANCE on TE
MECHANICAL BLOC. ELECT, PLG.. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT`,
INFORMATION
WOOD FLOOR VALUATION S/Er.
PLUMBING
MECHANICAL ` 15-1Y 6I T l
ELECTRICAL PERMIT TO
FRAMING !'
INSULATION _ ,b / STORIES TYPE CONSTR..
OCG GROU? RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
RES IND CON PB UM..'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED \ wa I] •- I] El El
ROUGH ABSESSORB PARCEL NO.,
(. ...
PLUMBING IGAS TEST - TRACT NO. PARCEE NO.
MECHANICAL _ 7_ 7I S
ACC.DATE ACC.FILE NO.
ELECTRICAL 3_ya� FINALS DATE INSP. . ,
FRAMING _Z - SAN # ZONING ENGr SITE NO.
INSULATION PLUMBING 6
- GAS
' FIRE SPRINK ENERGYT-}<
MECHANI AL
COVER NO WORK UNTIL ABOVE HAS BEEN SI NED HEATIN "� '
LOOD ,
LATH-INTERIOR -Zp � ELECTR CAL _ FZONE A.L.0C.
LATH-EXTERIOR Z�. FIRE DET. v " r I] NE]
SHEETROCK - -�-5:9 GRADE n, FEE SUMMARY
SHEAR INTERIOR -( 2, BUILDING y '
SHEAR EXTERIOR 2 TEMPO RAR APPROVAL$ BUILDING
FIREWALLS - ELECTRIC PLAN•CHECK Z{
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE.FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION.- PLUMBiN.G
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - SEE PERMIT FOR EXPIRATION.DATE - MECHANICAL
CONST.TAX
IMPORTANTI
PLEASE READ REVERSES.IDE BEFORE TOTAL rr
CALLING FOR FINAL INSPECTION. 1
OFFICE COPY
3
14
FINAL C
File No.
Date
Location
Subject
Notes I `` - `` t•
Approve6 Y ,
Dat /� Ins ector
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LD1 NG PROJEMENTIFICAAft PERMIT NUMBER
aD,LD. c APPLIC N & PE T 10009
ao s
UI LDING-ELECTRICAL-PLUMBING-MECHANICAL
ry R'a PLAN CHECK VALIDATION
NAME DTV. ELECTRIC PERMIT FEE
6tkU2J1I -4 C0 PHONE
CONTRACTORS UTLETS-SW'TC
HES-RECEP 10.00/1.00
LD-t. NIMr/F..� I% uc.ND. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR s /` APPLIANCES-RESIDENTIAL 4.00
�l �.IQ Jv PHOrvE fJ(V�O�I� PANELS 10.00 DATE OF APPLICATION
onCRiTECi PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
r
ADDRESS
AR R SIGNS TRANS. 3.00
(�E,N,G. .SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
R
Z2NTo lJ - NNS v EMP.METER OR POLE INS. 20.00
AORESS MOTORS SEE FEE SCH.
arpR Ess 'D
Z,5 �e s'. SERVICE CHANGE 20.00
w
0 5
H D o LICENSED CO TEMP.POLE 30.00 TRACTORS DECLARATION �(10
< u 1 hereby affirm that I am licensed under provisions of Chapter'9 LJ JO
v, a„ (commencing with Section 7000)of Division 3 of the Business anJ ISSUANCE DATE
BLpG. ELECT. PLG. MECH.
F 0 z Professions Code,andysy license is in full force' D33 1119-, O
o i G License Class Lia Number D r'ty (�P. t,1 L EJ
0 License
_-�Contrnaor- V Y--I
a u f BUILDING PERMIT
0 w a OWNIi R-BII LUER DIiC1.A RATION INFORMATION
w ;
A ,
I hereby affirm that I am exempt trout the Contractor's License MISC.- REFER TO ORD
F a.o st Law for the following reason.(Sec.7031.5.Buzinessand 1'rofessiona PERMIT ISSUANCE 10.00 VALUATION f/FT.
m � Code:Any'city or county which requires a permit to construcLalteq
w 4 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG NO. ,LEC. /D�
L DLL requires the applicant for such permit t0 file'a signed statement that TOTAL
n he is licensed pursuant to the provisions of the Contractors License PERMIT TO
w m
Hes Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the S 1xV(l
i x ao Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
LL F $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
A , by any more
hnt for anfive pudreddollar,subjects O,c.pplicum toacivilpcnalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(3500).)'.
❑ u as owner of me property,a or ,and the
with wages as BACK FLOW PROTECT. DEVICE 4.00 DCC.GROUP REB.UNITS
their sole compensation,will(S the work,and the structure is not
intended or offenJ for sale(Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 R-3
Code:The hContractor's buldsor License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 s0.FT.FLOOR AREA TOTAL ACREAGE
himself re through his ow"employees.provide)that such improve.
mentsarenot
entisn old or within
ronefor year
If.howetion the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 3220
or improvement is soli within one year of lie did
the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builJer will have the.burden of proving that he JiA not build or ins- BUILDING USE
RES IND CON PB 011ier
prove 1,aso owner
of talo.). INDUSTRIAL WASTE INTER. 30.00 4 ❑ ❑ ❑ ❑
❑ 1,as owner of the property,um 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 (p _p-5-0contracts for such projects with a contractorls)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. B.&P.C.I'or this WATER HEATER W/VENT 6.00 7✓8 Z
reason
c)wncr, Dam WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
1 hereby alfurn that 1 have a certificate of consent to sell-insure.
or a certificate of Workers'Compensation Insurance,or a certifiedy ZONING ENG,SITE NO.
copy thereof(Sec 3800,Lab.C.). �` �l4
1'alicY No. Company O r+
CerGNcd nmy -here y mss FIRE SPRINK ENERGY T-24
Z Z ❑ Certified o yx�--fi •d w'th 1hLity inz�ection division.
FO Applicant c (� MISC.- REFER TO ORD. Y ❑ N❑ I v ❑ N❑
'CC W CFR'1'IFICA 1017 oXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.D.
L COMPENSATION INSURANCE PLG.CONTR. LIC.N0. PLG.
CL O ('Phis sectio" need not be completed if the permit is for ane TOTAL V F] N❑ Y [:] N❑
UZO hundred doll...IS 100)or Iess.)
I certify that in the performance of the work Ism which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H 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.
y Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT': IL after making this Certificate of six- _
F ? cmption,you should become subject m the Workers Conlpcnsa0oo APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must Ionlivlth comply with FEE
U such provisions or this permit shall be deem00ed revoked. AIR HANDLING UNIT(TO 10C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
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.L HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name
Lenders AddreHEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I Imvc read this aPpli cation andslate that the above VENTILATION FAN (SINGLE) 4.00
information is correct, 1 agree to comply with.I1 city and county PLUMBING
oNinxnces and state laws relating to building construction, and BOILER-COMP(3 H.P.Or100,000B.T.U.) 6.00
hereby enthorien representatives of this city to enter upon the BOILER-COMP 10w,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property formsp of this
purposes.
(we) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities, st Saidjudgments, costs and expenses which CONST.TAX
may n any way accrue ag ' sE City in consequence of the PERMIT ISSUANCE 10.00 r
granting f this c mit, � MECH.CONT. LIC.NO. MECH.
t,1 CF TOTAL TOTAL ,�
Signal o A plicani Contactor Date
OFFICE COPY
------------
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
Yoa are hereby awhonxed to Connect electrical service for
'Owner or Te
nonl tpOLst ca�
Ar -7,S-36
No.of Wires- `Size of Wires
t Size of SwlReconnect.
Motor Lood Voltoge Phase
Healing Lood K.W. Vohoge
No.of Meters ( LightIIO NewServiceHeol I20—_Three WireNo.of Add.Meters Power Three PhoeeELECTRICAL INSPECTOR
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO Bldg,Dept.
Office Copy
El Backflow Device
Sanitary Permit No. //_ O.7
'\ Sewer Connection
Plumbing Permit No. 166=
NQ lumbing Final
Lor No. —
I Owner or Tenant
tit
Ar-
' Tract (/
Date Connected . _/ — / 19 /
_Date Final19
L —l/
PLUMBING INS�OR
i
CERTIFICATE OF COMPLETION 4o7-7
�—
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO q
DATE_ 19 BLDG. PERMIT NO. OO /
THE BLDG. LOCATED AT jt� (2
OWNED BY /
�! HAS BEEN COMPLETEDI OR USE AS
IA TEREDI
I
I
it 7
�n p
BUILDING INS ECTOR
t
CITY OF CUPERTINO COPY
COPY
OFFICE
GAS SERVICE NOTICE
To
You are hereby authorized to connect the GAS service for
Owner or Tenant O"+' / i�-P,
At 74`31) Jo, Q Q ,
ONew Service r>
No. of Meters Reconnect
No. of Add. Meters Move Service - {
Move
//Meter ✓1
PLUMBING INSPECTOR