12739 POST THIS CARD NEAR FRONT OF BUILID IN
CITY OF CUPERTINO PrRhRr NUMBER
INSPECTION DIVISION
12739
JOB INSPECTION RECORD
� -7 r� �y' t PERMIT EXPIRATION
•AYY, JOB ADDRESS '� 'j / F'gZl<W0Il�S• CT UNIT# LOT#
/q1 PERMIT EXPIRES IF WORK
WN
OER ((� TIL //-S SO �, - CONTRACTOR UICZII CONS 7 ISI NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION e.X�-C('T �`R��'� I�Lett LAST CALLED INSPECTION..
UFER
PERMIT VALIDATION-
PREGUNITE - - r
V 1
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - _ 1987 -.
. UNDERGROUND /SLAB
- .J11'•`y
PLUMBING cur" RD �l
ELECTRICAL - F arA� ISSUANCE DATE .
BLUQ ELECT. PIG. MECH.
MECHANICAL
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - VALUATION SIFT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL �/` 1�),
FRAMING —(�- I - �`44�
STORIES TYPE CONSTR.
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SU BFLOOR UNTIL ABOVE HAS BEEN SIGNIED -
b ROOF $O.FT.FLOOR PRFA i0i1L ACREAGE
DIAPHRAGM 1
L ` 7 ONIpIUSE
RES IND CON PB Omo
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING f- _
TRACT NO, PARCEL NO.,
GAS TEST -•� ;/ o
MECHANICAL 6
ACC.OATE ACC.FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING — SAN # O
ZONING ENG.SITE NO.
INSULATION' � � PLUMBING _ Qr7 wo
-
GAS -/O- f7
FIRE SPRINK ENERGY LZ<
MECHANICAL ,/Q Y EI NE) Y El NEI
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING j,
LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.0 c.
LATH-EXTERIOR - 10-13-P7 FIRE DEPT. Y N� v N❑
SHEETROCK 0_/ 7 GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR - TEMPORARY APP OVALS BUILDING
FIREWALLS - ELECTRIC y- PLAN CHECK
(� -Z GAS FEE
NO TAPE 0 PLASTER UNTIL ABOVE HAS BE SIGNED OCCUPANCY SEISMIC FEE �•,f - ,t
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
)) O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL %; 7
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
So ILIANc APPLICATION & PERMIT
ADDRESS
O �� C �. 2•J3� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 12739
OW R'S PLANCHECK VALIDATION
. NAME / I' OTY, ELECTRIC PERMIT FEE
"Aw+ O'v PHONE
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
nA
.uC.No. LIGHTING FIXTURES 10.00/1.00
coNTR cio 's - PPLIANCES-RESIDENTIAL 4.00
AOORE
S PRONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C,N .
ENGINES /n�lC 64 A4 No.
0 1442 SIGNS TRANS. 3.DO
YrKl t.1/
ARCH,OR
ADDRESS ENG.//O ! �� ;auz SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
L J/ C.L'�l/ PAID
L ( �ZIP � EMP. METER OR POLE INS. 20.00
ADDRESS ADDRES Nn � MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
0O o LICENSED CONTRACTORS DECLARATIONp;el•�,`!¢ 0
<u u I hereby affirm that 1 am licensed under provisions of Chapter 9 1i11SSUA000NI�'CE O TE
"' (commencing with Section 7000)of Division 3 of the Business anJ SLOG. ELECT. PLG. MECH.
FD i Professions Code, d my license is in full to n f
a o`n.- License�.I ss.J Li C.Number ❑ ❑ ❑
oH r w DatcContmctor
BUILDING PERMIT
¢ ¢ w < OWNER-BUILDER UECLA RA'1'10
O d u MISC.- REFER TO ORD
X. S: INFORMATION
LL H 1 hereby affirm that 1 am exempt from the Contractor's Licens
uoa VALUATION Law for the following reason, 7031.5,Business and Professions PERMIT ISSUANCE 10.00 $/FT.
t W Code:Any city or county which tequiresa 2 permil toconstrucLaller,improve,demolish,cur repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO' ELEC. 0(p
- o¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
whe is licensed pursuant tD the provisions of the Contractor i License
Hai Laos(Chapter 9(Commencing with Section 7000)ofDivulon 3 ofthe
ZZ a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢F$ the Basis for the alleged exemption.Any violation Of Section 7031.5 STORIES TYPE CONSTR.
i ; - by any more
fora permit subjects S5000.licant too civil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00 ]i xs-'N//�
of not more than or hundred dollars the applicant
Cl 1,as owner of the property,or my employees with we as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RESUNITS
their sole compensation,will do the work,and the structure IS not }
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 x" .3 /
Code The Contractor's License Law doe not apply to an owner of
S property who builds or improves thereon,and who docs such work F IXTURES-PER TRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendcdorofferedforsalell;however,the building GAS-EA.SYSTEM-1 INC.4OUTLETS 6.00 cZ9 r
or Inipro tare t is sold within cine year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that lie did not huild or am- BUILDING USE-
provel'orpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON RB Om.,
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ El El
licensed contractors to construct the project (See. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Ww docs not apply
to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Comractoi s License Law. TRACT NO. PARCEL NO.
0 1 am exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00 . 7 9'7
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPF--NSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insam' ZONING ENG.SITE NO.
_ or a certificate of Worked Co np cation Insanity certified
copy thereol(See.3800,Lab.C.
Policy No, Company
O ❑ Cert i a OPy is hercb shed. FIRE SPRINK ENERGY T-24
Z Z ❑ Cert' u• sop is fin ith t e cin inspection division.
O Applicant •'� MISC.- REFER TO ORD. Y ❑ N E] Y ❑ N❑
c y C5 'ICAT.OP E IPI'[ON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
W COMPENS ION INSURANCE PLG.CONTR. LIC.NO. PLG. Y N❑ Y ❑ N❑
Z
CI his section need not be completed if the pennil is lot one TOTAL
-hundred dollars(S I W)or Icse.)
U O I certify that in the performance of the work for which this Per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
W U mit is issued.I shall not employ any person in any manner so as m
become subject to the workers'Compensation Laws of California.
O i Date Applicant BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 -
f.. ? emplion,you should become subject to the Workers'CorNmetion APPLIANCE 5.00 PLAN CHECK
provisions of the labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=1Z.F.M.) 4.00
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE / Oa,2
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the p�rl'ormance of the work for which this permit is issued Ise, MICROFILM
3097,Cis CA HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATING UN IT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that l haveread this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
s ordinances and state laws relating to building construction, and BOILER-COW(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 RTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We Agra to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. p
Cu ti against liabilities,judgments, costs and expenses which CONST.TAX !
ma in y way accrue 'rest said City in consequ ce f the PERMIT ISSUANCE 10.00
ting fth15 rat it, /_ MECH.CONT. LIC.NO. MECH.
(� TOTAL TOTAL
Sign se of App' and/Co ac or Date
OFFICE COPY