C 09593 ..J. _ .
POST THIS CARD NEAR•FRONT OF BUILDINIG �` 1
IL ` •' PERMIT NUMBER
J i
..CIT*F rCUPERTfNO` '
�1 INSPECTION DIVISION
r JOB INtSPECTION RECORD
PERMIT EXPI RATION
\ JOB ADDRESS '[LI� -tel IT' UNIT#
PERMIT EXPIRES IF WORK r
OWNER• CONTRACTOR ,IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU;
FOUNDATION toT-27- Arwp. A f igo( 'ANCE OR 180 DAYS FROM
LIFER\ 1 •r LASTCALLED INSPECTION!
i _ - r�yQ.u,I.d�•�� �c..t•�' .r
PREGUNITE e, : ,� PERMIT VA41OanoN
-bl
aM
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �A1AR -i ,'L 'SI
R
UNDERGROUND /SLAB S
PLUMBING ) •-
ELECTRICAL -'C(ly 01 Cn,q�:
.ISSUANCE DAT
MECHANICAL - e ELE PLC. CK
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILOING PERMIT
INFORMATION -
PLUMBING WOOD FLOOR 4 VALUATION SIFT.
L1
" '.MECHANICAL - ° .y� PERMSPERM
IT TO
ELECTRICAL •
FRAMING
INSULATION - STORIES TYPE CONSTR.
\ i - OCC.GROUP RES.UNITS
\' CE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 1� !
+ROOF , SO.FT.FLOORAFEa 'TOTALACREAGE
HRAGM •�t''• is l
BUILDINGUSE
UU' rL - -7-97 f( — `9/ S ♦ hh/qAj RGs� IND CON PB omen
/APPLY NO ROOFING UN IL AB VE HAS BE IGNED f9eF 1 D AsEl 11ARc El ❑
ROUGH
PLUMBING J.1-
GAS TEST }d - TRACT NO, PARCEL NO.
MECHANICAL - rs
ACD.DATE. • ACC.FILE N0.
ELECTRICAL S-r.�L FINALS DATE- INSP. _
FRAMING' SAN #
ZONING ENG.SITE NO.
INSULATION, _ PLUMBING -(b-
GAS
MECHANICAL FIRE SPRINK ENERGY T 24'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
Y❑ . N❑ Y.❑ N
LATH—INTERIOR ELECTRICAL' FLOOD ZONE A.L.U.C.
LATH-EXTERIOR FIRE DEPT.. Y 0 N v ❑ N❑,
SHEETROCK GRADE ' - FEE SUMMARY
SHEAR INTERIOR BUILDING
TEMPORARY APPROVALS BUILDING I
SHEAR-EXTERIOR , w .. .. ,
FIREWALLS ELECTRIC PLAN CHECK
GAS v
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT-PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ; 1'; ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. s PLUMBING I ,
z ,PLEASE GIVE JOB ADDRESS WHEN PHONING.- :' V
MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
- - r - •�� ."= CONST.TAX '
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
' OFFICE COPY
-;,!ePLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
-b r°(3UI LDI IiiG PROJECT IDENTI FIC APPLICATION &PE T PERMIT NUMBER
AO, Ea5
[BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 09593
OWNER'S
AN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
PHONE
NAMECONTRACTOR's OUTLETS-SWITCHES-RECEP 10.00/1.00
L) ON, LIC.,NO,l/ - jLIGHTING FIXTURES 10.00/1,00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
i
y 0 p PHONE / PANELS 10.00 DATE OF APPLICATION
ARCHITECT
On PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER r �V N�
uc.No. SIGNS TRANS. 3.00
ADRESS ENG^LL
ADDRESS _
��Avg SPECIAL CIRCUIT 6.OQ PERMIT VALIDATION
�
ej ) zI EMP.METER OR POLE INS. 20.00 PAID
ADDRESS Ts MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 �pAAR 311QRF
002 0o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
Q i u I hereby affirm that I am licensed under provisionsof Chapter 9 I E
vHi<"'
(commencing with Section 7000)of Division 3 of the Business and
H m i Professions Code nd my license is in full fort a d fife L E PLG. MECH.
Q i=o License Clas Li C.Number El 1:1
❑
F ,Asp
Date--A_
ale O- Contractor
x a ' OWNER-BUILDER DECLA ATIO BUILDING PERMIT
w U INFORMATION
wg LL H I hereby affirm that I am exempt froni Contractor's License MISC,- REFER TO ORD d._7
u O j Law for the following reason.(Sec.7031.5,Business and Professions Q ^ VALUATION $/FT.
H - PERMIT ISSUANCE 10.00 „^M
La Code: e.dem y Gr county whiny structure,
requires une, riot t o is issuance,
lter,also !%J/AI / 90
E Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIF NO. ELEC. (/!/
y O u requires the applicant far such permit to file a signed statement that TOTAL 0� PERMIT TO I
is m m be is licensed pursuant to the provisions of the Contractor's License
z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢Hcy the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR.
d ; by any applicant fora permit subjects $500).applicant toacivil penalty ALTER-DRAIN
of not more than five hundred dollars(my em): !!�
❑ o az owner at the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC OR UP ES.UNITS
5 1
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
Code:The Contractor's License Law does not apply to an owner of
•
himself
who builds his improves empa thereog and whoadoes t such improve.
work FIXTURES-PER TRAP 5.00 SD.FT.F OOR AREA TOTAL ACREAGE
himself rmixts m through his own employees,provided that such im ilding
or improvement
net mens is Sold w thinoffered
onefor
year
(however,thebuildingo ding GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
Gr improvement is sold within one year of completion,the owner-
pry builder will have the burden of proving that he did not build or ins- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 8 ILDION USE
prove 1.as owner
of the
INDUSTRIAL WASTE INTER. 30,00 IND CON PB Omer
❑ L as owner of the properly,he exclusively contracting with ❑ 0 C1
licensed contractors m construct the project(Sec:7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 1 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law Joos not apply I
to an owner of property who builds tr improves thereon and who LAWN SPRINKLERS•OVER 5(EA.) 1,00
the Co is for such License
projects with a contractorts)licensed pursuant to
the Contractor's License law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec...BAP.C.for this WATER HEATER W/VENT 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 certificate of consent to scI insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(See.3800,Lab.C.).
Policy No. Company s-SAT• Fu N:D
Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T.24
Z Z ❑ Certified c p is filed with se city sispection division, MISC.- REFER TO ORD.
O Applicant - Y No Y ❑ NE]
~y pp �- PERMIT ISSUANCE 10.00
- CERT( ATE EXIiMPT10hr FROM F.RS' FLOOD ZONE A.LU.C.
W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. ❑ ❑ [:] ❑
Z (This section need not he completed if the permit is for one TOTAL Y N YN
hundred dollars 1$100)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 mil is issued,1 shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California. q
o. Date Applicant BUILDING 67o sD
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
ALTER OR ADD TO MECH. 5.00
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
proOO
visions of the Labor Code, you must forthwith comply with FEE s
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10) DC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MCEM.) 6.00 SEISMIC FEE 70 G
I hereby affirm that there is a Construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
ilia performance of the work for which this permit is issued(Sec. MICROFILM
3097,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 p
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 JQ &0
Lender's Address ELECTRIC
I certify that I have read 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
ordinances and state laws relating to building construction,end BOILER-COMP(3 H.P.or t00,0008.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(xi agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD. p
Cupertino against liabilities,judgments, costs and expen which PERMIT ISSUANCE 10.00 CONST.TAX � 4/ e�
may in any way accrue against said 'ty in consequence of the
granting of This permit. sl y MECH.CONT. LIC.NO. TOTAL �--1
PERMIT
O TOTAL
Si o of Ap �an/ on[ra tar Date
OFFICE COPY