12374 POST THIS CARD NEAR FRONT OF BUILDING R61IINUMBER
CITY OF CUPERTINO2374
INSPECTION DIVISION
JOB INSPECTIO RECORD
i PERMIT EXPIRATION
JOB ADDRESS ✓/ U T# LOT# PERMIT EXPIRES IF WORK
OWNER 1 `"l CONTRPCTOR IS NOT STARTED WITHIN
INSPECTION D -INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR.JELO DAYS FROM
LIFER LAST CAECTION.
PREGUNITE MAR
VALIDATION
MAR 2 - 1987
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - (' .Ofcamjno
UNDERGROUND /SLAB
PLUMBING "
ELECTRICAL ISSUANCE DATE
MECHANICAL - - BL E t �.. PLG. MfICFL
❑ ❑..
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUI DING PERMIT
INFORMATION
WOOD FLOOR �� vnwnnON s/Fr.
PLUMBING
MECHANICAL • -
PERMIT TO
_ ELECTRICAL • - . � ,I r
FRAMING L
- ST IES TYPECONSTR.
INSULATION
OCC.GROUP RES.UNI TS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILD USE
' - flE9 IND CON
' PB Ober
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED �� ❑ ❑ ❑ ❑
- ASSESSORS PARCEL NO.
ROUGH
PLUMBING
- - TRACT NO. PARCEL No.
GAS TEST
MECHANICAL - '
ELECTRICAL Acc.DATE ACC.FILE NO.
3 9 FINALS DATE INSP.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
MECHANICAL FIRE SPRINK ENERGY T-74
O
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "o Y "E]
LATH—INTERIOR ELECTRICAL FLOOD ZONE A._.0 C,
LATH—EXTERIOR FIRE DEPT. v❑ NE) yo "�
SHEETROCK, GRADE FEE SUMMARY
SHEAR INTERIOR ' BUILDING
SHEAR EXTERIOR - TEMPORARY APPROVALS BUILDING
ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
h
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
1 O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
l z
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. .
OFFICE COPY "
.APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LD1 NG PROJECT 1 DENTI FICATION- - PERMIT NUMBER
fBUILOIN APPLICATION & PERMIT ^ ^ n a
Ao0gds40 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL I G r 4
ER'S
MIL
l A` Y� .` PLAN CHECK VALIDATION
""ME m OTY. ELECTRIC PERMIT FEE
PHONE
CONTRACTORS
A].4 . UTLETS-SWITCHES-RECEP 10.00/1.00
NAM
LIC.No. LIGHTING'FIXTURES 10.00/1.00 ILILIfit
f.CINTRAcrOR's Aj�jPPLIANCES-RESIDENTIAL 4.00
ADDR 5
PHONEUlm PANELS .10.00 DATE OF APPLICATION
pqC lrEr
PANELS (OVER 200 AMP) 20.00 'PLAN CHECK FEE P.C.No.
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH.E69 E "G' SPECIALCIRCUIT 5.00 PERM IgeON
ZIP EMP.METER OR POLE INS. 20.00 '� MAR 2 11$7
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 Of W�no
ad 00 LICENSED CONTRACTORS DECLARATION
c i W I hereby affirm that Iain licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and
rA a D, BLDG. ELEC PLG. MECH.
H � 2 Professions=ode,ftd my license is in full fort f
Z: o 2 - License LE.Number ❑ ❑
0 Z .0 Date Contractor
¢ - BU DING PERMIT
¢ a i a OWNER-BUILDER DECLARATION
u INFORMATION
wI hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u00 Law for the following reason.(Sec.7031.5.Businessand Profcssions
PERMIT ISSUANCE 10.00 VALUATION S/FT.
E w Code:Any city or county which requiresa permit to construct,aher, O
¢ ¢< 0 improve,demolish.or repair any atructurc,prior 10 its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O u
requires the applicant for such Permit to file a armed statement that TOTAL PERMIT TO
w $ he is licensed pursuant to the provisions of the Comrxclor's License ,I
a z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the
E a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
t v
¢ H� the basis for the alleged exemption.Any violation of Section 703 1.5 STORIES TVP CONSTR.
ar ; - by any applicant for a permit subjects the applicant to civil penalty
of not more than five hundred itollars(S500)J: ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 oce.GR LIP ES. NITS
their sole compensation,will do the work,and the structure u not
intended or offered for sale(See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 Sp,FT.FLOORAREA TOTALACRENGE
hinnelf or Ihrough his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 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
prove for purpose of sated. INDUSTRIAL WASTE INTER. 30.00 INO CON PB Omer
0 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors Construct Coiruct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's Licensc Law does not apply l
to.an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5IEA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
the Contractor a License Law. SEWER-SANITARY-STORM EA.2DOk/10.00 TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec.-,B.&P.C.for this WATER HEATER WNENT 6.00
reason
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofe.menl In self-inwre, ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copyth Lab.any
Policy
O 0 Certified 0 t heref�byp�t,uprr�et�hpd. FIRE SPRINK ENERGY T34
❑ Certifc, (} /ice L:{R�'� city inspection division. MISC.- REFER TO ORD.
z p //,. APPlicant �f�a5 �:{RiQaTTTT,_ Y ❑ N❑ Y ❑ N❑
it CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00FLooD ZONE A.L.U.c.
LU > COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG.
0- Z (This section need not be completed if the permit is for one TOTAL Y E] N C] Y ❑ N❑
hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this ver- OTY MECHANICAL PERMIT FEE .FEE SUMMARY
UL F mit is issued,1 shall not employ any person in any manner w as in
O w become wbjecl to the Worken'Compensation Laws of California.
a Dat` APPIIceni ALTER OR ADD TO MECH. 5.00 •BILDINGUO S
} to NOTICE.TO APPLICANT: If,after making this Certificate of Ex- -
F ? sorption,you should become subject to the WorkersCompcnsition APPLIANCE 5.00 PLAN CHECK ',Sp
provisions of the Labor Code, you must forthwith comply with FEE �,(J
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000OF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE O
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 ISca MICROFILM
3197,Civ.C.). a HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UNIT 100,000 B.T.U.)9.50 D
Lender's Address " ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information a correct. I agree to comply with all City and county PLUMBING
ooinmec, 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(Oxer 100,000BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for Inspection purposes.
(We) agree to save, indemnify and keeponnIx the City of MISC.- REFER TO ORD.
ino against IiabiGiies,judgments, costs it expenses which ST�
PERMIT ISSUANCE 10.00 CONTAX
any way accrue eyairu Id Bit asequence of the
and gof lhi5 perm MECH.CONT. LIC.NO. MECH. 1113,
r,/Vy\�
TOTAL TOTAL
•/ S atum of App an ontraaor Da
OFFICE COPY