14223 POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PFw "MIT NUMBER 14223
INSPECTION DIVISION
I JOB INSPECTION RECORD
F� g PERMIT EXPIRATION
JOBADDRESS �XO�D a;O //Uh�`rr�'/}-L7' 1J - UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER ./fes C7 CONTRACTOR .<-.!� /.(/O oil A/p,� � IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
1 FOUNDATION fj .L7 �I vA R� d{Le't $'•e ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
LIFER $!
PREGUNITE
PERMIT VALIDATION
POUR NO CONCRETE
UNTIL
ABOVE
UNDERGROUND /SLAB BEEN SIGNED - y,w„Q Ce 1, d Y6A�p '�
lam/ p / 1,690, u
ELECTRIICAL 7'Lr�a /t.e,111� d� ; � M
'ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLG. MECR.,
❑� ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �,2 �, - BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING lY /BALL VALUATION SIFT.
MECHANICAL ,gkgr eF - �I'
ELECTRICAL E - c/ PERMITTC
FRAMING j KJ C O 0 l��Q �' /7-
INSULATION 1 STORIES TYPE CONSTR.
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED �f
ROOF o SG.FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM / : !`
BUILDING USE
'L /y RES IND CON PB oihe,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED N / • ❑ ❑ ❑ ❑ ❑
., r
ASSESSORS PARCEL No.
ROUGH ;
PLUMBING l -
GAS TEST _ �� RACT No. vARCEL No.
MECHANICAL
ELECTRICAL FINALS DATE �I AC .DATE ACC.FILE-NO.
FRAMING -� - SAN # '
INSULATIONPLUMBING ZONING ENG.SITE NO.
GAS
MECHANICAL FIRE SPRINK ENERGY T2<
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED 1HEATING ❑ "❑ ❑ "❑
LATH-INTERIOR ELECTRICAL FL000 zoNE
LATH-EXTERIOR FIRE DEPT. ❑ "❑ '' ❑ "❑
SHEETROCK GRADE
FEE SUMMARY
SHEAR INTERIOR BUILDING
F SHEAR EXTERIOR TEMPORARY APPR VALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY B DI NSPE TOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL �•<!
CALLING FOR FINAL INSPECTION.
OFFICE COPY
1:
PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• BUILDING PROJECT I DENT[FICATION PERMIT NUMBER
UG,LDING APPLICATION & PERMIT
P
OF
ESS
1'DM£STE�D 0.D.. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 14223
OWrvEH'S PLAN CHECK VTION
%®f NAE j ELECTRIC PERMIT FEE '3 3 VVVVVV
�j IY 33�:;
c NTRACTOR'S UTLETS-SWITCHES-RECEP 10.00/1.00
E
�lI/l No. LIGHTING FIXTURES 10.00/1.00
,,ONTRA roR's [APPLIANCES-RESIDENTIAL 4.00
ADDRESS
Y PA�� H 0 N PANELS 10.00 DATE OF APPLICATION
V ARCH CT C,1 PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
W xSs .yo.(,�"Wz. SIGNS TRANS. 3.00
X ARCH.
E6s ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
Sr, EMP. METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH. k
AOOREss
SERVICE CHANGE 20.00
,00 LICENSED CONTRACTORS DECLARATION Y
a u U I hereby affirm that I am'licensed under provisions of Chapter 9 ISSUANCE DATE
H Q H (commencing with Section]000)of Division 3 of the Business and - owl
BLDG • ECT. PLG. MECH.
F m z Professions Co d my license is in full fo ❑ ❑
z O,.,_/, Lice la Lic.Numbe
4 Y wJr` Date Contractor 1
¢ ¢ w a OWNER-BUILDER DECLARATION BUILDING PERMIT
o a " MISC.- REFER TO ORD INFORMATION
X g; LL N I hereby affirm that I am exempt from the Contractor's License VALUATION SIFT.
u o j Law for the following reason.(Sec.703 L5,Busuiessand Professions
- PERMIT ISSUANCE 10.00
Code:Any city or county which requirese permit to construct,alter,
al ¢ ¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
o a, requires the applicant for such permit to file a signed statement that TOTAL
u w m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
r z a
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ H o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i 3 m by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars($500).)
ALTER-DRAIN VENT-WATER IEA.) 5.00
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCD.GROUP RES.UNITS
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 docs not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 so.Fr.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedformic.l f,however,the building GAS-EA.SYSTEM-I INO.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of soled. RES IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ El ❑ ❑ ❑
licensed contractors to construct till 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 for such projects with a mntractons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
O tum exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.06 ACG DATE ACC.FILE NO.
WORKERS'COMPENSAT1ON DECLARA'f1ON WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab. eT
Policy No. Company
0 ❑ Certified copy is hereby furnished FIRE SPRINK ENERGYT24
Z Z C,, y file w'th t' n iivi'on.
F p npplirmtl G `eL MISC.- REFER TO ORD. Y [:] N Y E] N[]
fir W CER1'IFICATBOFH:XEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE kLU.C.
L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLO
n"O (This section need not be completed if the permit is for one TOTAL Y E] N Y C] N❑
::) Z hundred dollars IS 100)or less
U O 1 certify that in the performance of the work for which this per-
QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as to
a U become subject to the Workers'Compensation Laws of California.
y Datc Applicant
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 BUILDING _76 L
F. Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK )U
proFEE of the Labor Code, you must forthwith comply with J 7 37
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 UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE // 06
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(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 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 BOILER-COMP PLUMBING
ordinances and state laws relating to building construction, and (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 BTU)SEE FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL
(We) a indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cuperti st liabl 's,judgments, costs and expenses which CONST.TAX
may i any w y accrue, ainst sail City in consequence of the PERMIT ISSUANCE 10.00
erm iL MECH.CONT. LIC.NO. MECH.
7tgTOTAL TOTAL �F, 6 �j
Signature ontractor Date
OFFICE COPY