13931 POST THIS CARD NEAR FRONT OF BUILDING
- , PERMIT Nl10.1RER
CITY OF CUPERTINO 13931
INSPECTION DIVISION
JOB INSPECTION RECORD
I
PERMIT EXPIRATION
JOB A.DDRESS I 0640' Cl anv #
vi aT.T Aa UNITLOT#' PERMIT EXPIRES IF WORK
OWNER .
CONTE ACTOR Antique Termite Inc. IS NOT STARTED WITHIN
I SPECTI ON DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT.ISSU
FOUNDATION ANCE OR 180 DAYS FROM,
LASTCALLED INSPECTION.
UFER
PREGUNITE PIIE�R wllrrv--aqqu. oarlory
' - Y'�i11:y
� I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED J1
UNDERGROUND-/SLAB - �,
PLUMBING - , kltq •SI�iV�GTf11A1�`'rn Yl
ELECTRICAL ISSUANCE DATE
BLDG_ LECT. PLG. MECH.
MECHANICAL
. 1 ❑ ❑ ❑ '
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR i VALUATION SBFT.`
.PLUMBING
MECHANICAL r ��
PERMIT TO
ELECTRICAL ,
FRAMING. TOHIES TYPE GNSTR.
INSULATION - -
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF SO.IT FLWRAHEA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
HES IND CON PR Olne•
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED -L] ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL _
. ACC.DATE ACG FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN # ZONING ENG.SITE NO.
INSULATION PLUMBING -
GAS
MECHANICAL
FIRE SPRINK ENERGY T 24
- r Nv
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.L.U.C[:] � [:] N[:].
- LATH—INTERIOR - ELECTRICAL � '
LATH—EXTERIOR FIRE DEPT. r NEI. v I] N❑
SHEETROCK GRADE A&E SUMMARY
SHEAR INTERIOR - BUILDING
B LDING
• SHEAR EXTERIOR TEMPORARY APPRO ALS
FIREWALLS ELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BU I LDING F INAL IS SIGNED BY BUI LDI NG I NSPECTOR. MICROFILM -
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION FICATION PERMIT NUMBER
BOILING APPLICATION & PERMIT
AD°RES= 3931
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
Ow ER'B PLAN CHECK VALIDATION
NAME oZJ`' J
NA - OTY. ELECTRIC PERMIT FEE
PHONE
RAcroRs UTLETS.SWITCHES-RECEP 10.00/1.00
NA
/
C.No. 7 LIGHTING FIXTURES 10.00/1.00
CONTRACT 's
ADDRESS PPLIANCES-RESIDENTIAL 4.00
�� 94s'
PHOUE PANELS 10.00 PATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .c.No.
OR
ENGINEER
sec.No. SIGNS TRANS. 3.00 7,11"-Is .
ADDRESS ENG _ SPECIAL CIRCUIT '5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 �• f'� J `
APPLICANTS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 n,L� Q# P I lydfi o
o o LICENSED CONTRACTORS DECLARATION �J.L(}C{,yl
G Z W I hereby affirm 'bar I am licensed under provisions of Chapter 9 ISSUANCE DATE 1
(Commencing with Section 7000)of Division 3 of the Business and BLDG. E ECT. PLG. MECH.
0 i Professions Code,and my license is in full for d ff ct ❑ ❑ ❑
0 O�, - Date Lic.Number
g r o Dem
Con tr cloy
a y 5 BUILDING PERMIT
r< x w 6 OWNER-BUILDER DECLARATION INFORMATION
ao> MISC.- REFER TO ORD
w S u � 1 hereby affirm that I am exempt from the Contractor's License VALUATION 5/FT.
H LL o gLaw for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
ww Code Any city orcounty which requiresa permit to construct,alterre ,
(, OG
<Oimprove,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC.NO. ELEC. 6
ic O , retinues the applicant for such permit to file a si,m'd statement that TOTAL PERMIT TO
'` w $m he is licensed pursuant to the provisions of the Contractor's License
F x Luw(Chapler9(commencing with Section 7000)of Division 3 of the
- < Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Tcls,I"
o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE C NSTR.
n ;$ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
.four more than Ilse hundred dollars(5500).1:
❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the 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'.%License Law dos not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.rT.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-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Omer'
prove for purpose ofsale.). I INDUSTRIALWASTE INTER. 30.00
Cl 1,as owner of the propcny;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:'fhe Contractor's License Law does 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 mn(nctotls)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.20011/10.00 TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec. ,B.&P.C.for theWATER HEATER W/V ENT 6.00
reason
Owner - Date WATER SYSTEM 5.00
ACC.GATE ACC FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certifeate of consent to sa10.1morc' ZONINGor a certificate of Workers'Compensation Insurance,or a certified ZONING SITE N0,
copy thereof(See.3800,Wb.C.L
Policy No. Company
O ❑ Certified copy,,h ,eby furnished. FIRESPRINK ENERGY T-24
Z Z ❑ Certified copy, fled with Lie c' y inspection inion. MISC.- REFER TO ORD.
Q Applicant Y❑ N❑ Y ❑ NE]
CC CERTIII CA'f Ii OF . EMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.
L COMPENSATION INSURANCE - - PLG.CONTR. LIC.NO. PLG.
1 YE] IN E] Y❑ rv❑
CI (This section need not he completed if the permit is for one TOTAL
D Z hundred dollars IS I OO)or less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner m as to
Ow become subject to the Workers'Compensation Laws of California. BUILDING
a D.E. Applicant ALTER OR ADD TO MECH. 5.00 U
>_ N NOTICE TO APPLICANI': If,after making this Certificate of Ex-
? emption,you should become subject to the Workers'Compensation 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 10MC-FAU 4.00
CONSTRUCTION LENDING AGENCY. AIR HANDLING UNIT(OVER 10=12-F.M.) 6.00 SEISMIC FEE
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 permit is issued(Sec. MICROFILM
3097,Civ C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender's Address ELECTRIC
• 1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4,00
information is correct. I agrce to comply with all city and county PLUMBING
ordinances and slate laws relating to building construction, and BOILER'CD P(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEESCH. MECHANICAL
above-mentioned properly for inspection purposes.
(we) agree to save, indemnify and keep iurndess the City of MISC.- REFER TO ORD.
- Cupertino against liabilities,jud mems, costs and expenses which CONST.TAX
ma ' un we, accrue, PERMIT ISSUANCE 10.00
Y y y eget id Cit 'n eonuquc of e
gr t' g of this permit MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL 36,00
Slgnatur 'Applicw t/Contractor U
OFFICE COPY