12745 POST THIS CARD NEAR FRONT'OF BUILDING
1 CITY OF CUPERTINO PERNIT NUMBER
INSPECTION DIVISION 12745
JOB INSPECTION RECORD
PERMIT EXPIRATION -
JOB ADDRESS a6l 79 C 7 UNIT# LOT# 6
- I PERMIT EXPIRES IF WORK
OWNER v" OC CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PREGUNITE i ALIDATION
POU NO CONCRETE UNTIL ABOVE HAS BE SIGNED 1 JU�� 3.
)
UNDERGROUND /SLAB {C)•��
PLUMBING Of CiDpi?R.
ELECTRICAL _ ISSUANCE DATE
MECHANICAL aLDc. ELEcr. vLc. mecR.
S 3 ❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE RAS BEEN SIGNED BUILDING PERMIT.
INFORMATION
WOOD FLOOR �vn LUAT ION a/PT.
PLUMBING —
MECHANICAL
ELECTRICAL PERMIT To
=LW
FRAMING T L
INSULATION 'sroRlEs rrvE CONSTR.
OCC.GROUP RES.UNITS
PLACE NQSU"FLUOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF SO,FT-FLOOH AREA TOTAL ACREAGE
DIAPHRAGM • 'F
O D LLD ON USE
' RES IND CON PB OiwI
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 11 ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST _ TRACT NO. PARCEL NO.
MECHANICAL _
7 t
ACC.DATE ACC.FILE NO.
' ELECTRICAL - FINALS DATE INSP.
FRAMING 6 SAN # - ZONING ENG.SITE NO.
INSULATION I 8"� PLUMBING •-
GAS
MECHANICAL FIRE SPRINK ENERGY TPa
COVER NO WORK NTIL ABOVE HAS BEEN SIGNED HEATING - r "E ° "�
FLOOD ZONE A.L.Ut.
LATH—INTERIOR ELECTRICAL
LATH—EXTERIOR II -z3_ FIRE DEPT. ' ':❑ NEI Y ❑' N❑
SHEETROCK - GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING '
SHEAR EXTERIOR p,y TEMPORARY APPROVALS BUILDING '
FIREWALLS - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
I- - ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
CONST.TAX K 7u ,✓
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL 15 J
CALLING FOR FINAL INSPECTION.
OFFICE COPY
_ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
B 1L APPLICATION & PERMIT
A T 9 ~00,,05 1,KW BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
12745
.EA S PLAN CHECK VALIDATION
• NAME QTY. ELECTRIC PERMIT FEE
PHONE
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
NA
uc.No. LIGHTING FIXTURES 10.00/1.00
CONTRACT Rs PPLIANCES-RESIDENTIAL 4.00
A? PHONE / I PANELS 10,00 DATE OF APPLICATION
ARCHITECT C.NO.
ORPANELS (OVER 200 AMP) 20.00
ENGINEER1414VIe/L•E Cl"~ �{4
LIC,Na. G�Q/4o SIGNS TRANS: 3.00
AARCH.OR DDRESS ENO na �- SAIvM eR 7- SPECIAL CIRCUIT 5,(p PERMIT VALIDATION
LOS 5 W✓I zIP EMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS, SEE FEE SCH.
ADDRESS PSL —
SERVICE CHANGE 20.00 `
wo o LICENSED CONTRACTORS DECLARATION 1 (� t] e, '�0 7
c u u I hereby affirm that I am licensed under provisions of Chapter 9 J ISSUANCE DATE
N z w (commencing with Section 7000)of Division 3 of the Business nd
BLDG L. ELEECT. PLO. MECH.
r o i Professions Co ad my license is in full for d a[ C ❑ ❑
>; O'v1 — Liccnu Lic.Number
0 m r w Uate Contractor
a M BUILDING PERMIT
m ao OWNER-BUILDER DECLARATION INFORMATION
iT
w y I hereby affirm that 1 am exempt from the Contractor's Liceruc MISC.— REFER TO ORD
3
VALUATION S/FT.
Hu OOj law for the following reason.(Sec.7031.5,Businusand Professions PERMIT ISSUANCE 10.00 JG)
Code:Any city or county which requires a permit to construct,alter,
aaa Q p Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO, ELEC.
O re requires the applicant for such emid to file a signed statement that TOTAL PERMIT TO
whe is licensed pursuant to the provisions of the Contractors License spa w L
Fri Lew(Chaum
pter9(cmencingwith Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
ar$ thebasisfor the alleged exemption.Anyviulation ofSection7031.5 STORIES TYPE CONSTR.
A , by any applicant for a permit subjects the applicant to a civil penalty
of nALTER-DRAIN&VENT-WATER (EA.) 5.00 'f2— r /�.�
net more than five hundred dollars(S500)J: +- v4
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE ,4.00 oce.GROUP RES.UNITS
their sole compensation,will Jo tire work,and the structure u not
intended or offered for sale (Sec. 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 does such work FIXTURES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
ments are not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 3o Cl
or improvement is sold within one year of completion,the owner- GAS EASYSTEM.OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- - . BUILDING USE
prove for purpose ofsale). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PS Otne,
❑ 1,as owner of the property,am 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
contracts Law. SEWER-SANITARY-STORM EA.for such pprojects with a comrlractos)licensed prsuam uto
the Contruemr's h roje.• 200ft/10.00 TRACT NO. PARCEL NO.
p
❑ 1 am exempt under Sec.—,B.&P.C.for this WATER HEATER W/VENT 6.00 "7
reason
Owner - Date WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO.
WORK Ii RS'COMPENSAT ION DECLARATION WATER TREATING EOUIP. 5.00
1 hereby affiml that I have a OtHil-K.1,of consent to.11`4...P, ZONING
or a certificate of Workers'Co nsalion Insure •,m a certific� ENO.SITE NO.
copy thereof(Sec 3800,lab.0
Policy No. Com ny
O ❑ Cern copy is liefeby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Cert' a• m ole it t e
is ity inspection division. MISC.- REFER TO ORD.
F APPlicant V,❑ No Y ❑ N❑
Lu m— PERMIT ISSUANCE 10.00 CER FICAT ' (EION ION PROM WORKERS' ZONE A.L.UL.
2- COMPEPE NSATION INSURANCE PLG.CONTR. LIC.No. PLG. V❑ N❑ Y ❑ NE]
Z (Phis section need nmit.,at be complete) it the perIs for one TOTAL
hundreA dollars IS 100)or IcssJ
U O 1 certify that in the performance of the work for which the per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
DE 1— mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation laws of Califomia. //
0 n Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING bs3 00
} H NOTICE TO APPLICANT: if.after making this Certificate of Ex-
F ? emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must lorth a th comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)"C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNET(OVER 10MCF.M.) 6.00 SEISMIC FEE l31/17
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 Nmut is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50
Lenders Address ELECTRIC
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information n correet. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-CONP(3 H.P.or 100,0008.T.U.) 6.00
hereby authorize representatives of the city to enter upon the BOILER-COMP (Oxer 1W000 RTU)SEE FEE SCH. MECHANICAL
above mentioned property for inspection purposs-s.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
CENn against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 1000 CONST.TAX �7� (�
may y way ace 'rat said City in c/onscquyyyyynnn""a/of the
granli go thisp rmil. Y/l MECH.CONT. LIC.NO. MECH.
/ TOTAL TOTAL 9
Signal of AppE ant/C ractor A 'Date / S O
OFFICE COPY