12776 POST,THIS CARD NEAR FRONT OF BUILDING
PERMIT NUM62R
CITY�� OF CUPERTINO ' a
INSPECTION DIVISION ' 2776
--JOB INSPECTION RECORD
-,(� -PERMIT EXPIRATION
JOB ADDRESS "�-�a-•TO -L1���`r� C'�' UNIT#" LOT,# / PERMIT EXPIRES IF WORK
OWNER, G/. ,rl/ CONTRACTOR .0 lj ' IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR IN ECTION RECORD 180 DAYS OF PERMIT ISSU-
"a
FOUNDATION Yr r df`7 ANCE OR 180 DAYS FROM
LIFER �L,
;II�LASTCALLED INSPECTION.
- .7 .. . . ; •
PREGUNITE . I ' PERMIT,VAI.IDATION
dIIA III, _
POUR NO CONCRETE UNTIL ABOVE HAS BEE SIGNED PA�p
A UNDERGROUND /SLAB "' '
PLUMBING ,3 -11 l� Q.,• '1�U-�t' ( .
• ELECTRICAL - J J ISSUANCE DATE
BLDG. E�E�pD.PLG. MECH
L' .
MECHANICA _I ' f
JJJLq
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
• WOOD FLOOR: - - VALUATION $/FT.
PLUMBING y..
MECHANICAL, PERMIT To
ELECTRICAL '
"FRAMING -c 17 STORIES • TYPE CONSTR.
INSULATION -
I, -- OCC.GROUP ARES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
!•I 50,FT.FLOOR AREA TOTAL ACREAGE
ROO
F
' DIAPHRAGM -
BUIL use
CON
. c NES IND CON PB• OIM1UI
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED IT ❑ 1:1 F-1'
ASSESSORS PARCEL NO.
.,ROUGH
PLUMBING' d. � ^�A -
GASTEST, ' TRACT NO. PARCEL NO.
. MECHANICAL' ^� ACC.DATE AGE.FILE No.
ELECTRICAL - FINALS DATE INSP.
FRAMING, . , .� . SANk h - .
_ PLUMBING ZONING ENG.SITE NO.
INSULATION
.. GAS
.. MECHANICAL r FIRE SPRINK ENERGY T 24
-`COVER NO WORK UNTIL ABOVE"HAS BEEN SIGNEDd'TM$ HEATING Y ❑ N❑ Y ❑ . No
LATH—INTERIOR II p $'1
L ELECTRICAL ; FLOOD ZONE A,L.U.C. '
LATH—EXTERIOR' ' c ,5"` FIRE DEPT. y❑ No Y ❑, N❑
SHEETROCK - 01 GRADE - FEE SUMMARY
BUILDING _
SHEAR INTERIOR TEMPORARY APPROVALS - ,BUILDING
SHEAR EXTEFIOR - ^2'S(. '
FIREWALLS ELECTRIC - :� PLAN CHECK '
GAS FEE,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY a SEISMIC FEE }
OCCUPANCY OF,BUI LDING IS NOT PERM ITTED LINT)L BUI LDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING,252.4505, ELECTRIC . ,
F ONE'WORKING DAY BEFORE. REQUIRED INSPECTION. PLUMBING
10 PLEASE GIVE JOB ADDRESS WHEN PHONING. 7c
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL ' ',a`� -7
.I,MPORTANT! } coNST.TAx
PLEASE READ REVERSE SIDE BEIFORE
TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
' APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL,POINT PEN ONLY
1 - BU LDING PROJECT I DENT]FICATI ON - PERM T NUNIRER
aIIILDINGAPPLICATION &PERMIT ���� .
• ,AOORESY I A •.
-25 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S r,�p rys,' PLAN CHECK VALIDATION
k NAME -_I `ga{fit' OTY• ELECTRIC PERMIT FEE
'PHONE ,
CNTRACTOR'S
NOME '� I fa' OUTLETS-SWITCHES-RECEP 10.00/1.00 S
Enowr) LUi LIC.NoB _1 19 LIGHTING FIXTURES r 10.00/1-.00 !
CONTRAc R's I,r al _� APPLIANCES-RESIDENTIAL 4.00 a% '
ADDRESS
eyp 9 C PHONE"4' 1 PANELS I 10.00 a �- DATE OF APPLICATION
ARCHITPCT. - PANELS (OVER 200 AMP) 20.00 PLAN CHEZKF -P.C.NO.
OR
ENGI
k+M,;L
Cita 5114 LIC.No.; SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT
- SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ADORESs
MT*.- AJF. zlr 10JO ( TEMP.METER OR POLE INS. 20.00 - -
ADDRESS ` MOTORS SEE FEE SCH. -
ADDRESS
SERVICE CHANGE 20.00 / �/ 7
w o o LICENSED CONTRACTORS D17CLARATION nn f�(0
Iyf n �[1
a u I hereby affum that I am licensed under provisions of Chapter 9 / J U,SLEC NT I DPA .
a, w (commencing with Section 7000)of Division 3 of the Business and 'BLDG. ELECT. PLG. MECH.
_ w i Professions Code,aggqppppf{{{�{{{my license is in full for��eggnnyy((ejj�e��t��'' }r'
z 0 w D License Class Lic.Numbc,oX61t_xfi_ - city 0 .� `yl@ Bpwln
o r w Date�7 Contractor
x E - BUILDING PERMIT
LC ¢¢a OWNER-BUILDER DECLARATION INFORMATION
Aoa" MISC- REFER TO ORD
X g N I hereby affirm that I am exempt from the Contractor's License VALUATION
H'u of Law for the following reason. 703 1.5,Business and Professions PERMIT ISSUANCE 10.00 O
� In0 Code:Anycity orcounty which requires a permit to construct,alter,
��� -
P: a O improve,demolish,or repair any structure,prior ID its issuance,also ELEC.DGNTR. LIC.NO.. ELEC.
0, requires the applicant for such permit to file a signed statement that TOTAL �Q PERMIT TO
w$ he is licensed pursuant to the provisions'of the Contractor's License I S�a w L
r,zi Law.(Chapter 9(commencing with Section 7000)ofDivision 3oftIm
a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE f
t M _'$ the basis for the alleged exemption.Any violation of Section 7031.5'. STORIES TYPE CONSTR.
YPECONSTR.
a3 by any applicant fora permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER IEA.) 500 V /I• /y!e
of not more than five hundred dollars($500).): -
❑ I,as owner of the,property,or my employees with wages as .ggCK FLOW PROTECT. DEVICE 4.00 OCC,GROUP RES.UNITS
their sole compensation,will do the work,and,the structure is not
• intended or offered for sale (Sec. 7044, Business and Professions - DRAINS-FLOOR,ROOF,AR EA,COND: 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work T1 FIXTURES•PER TRAP 5.00 SO.FT.FE06FTREA TOTAL ACREAGE
himself or through his own employees,provided that such improve
meets are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion; the owner- GAS-EA.SYSTEM-OVER 4(EA,) 2.00 . ( BUILDING USE
builder will have The burden of proving that he did not build or im-
RES IND CON Pe Gone,
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively Contracting with .❑ 1:1 11
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLE_ DJ:.av3rIsP 5 V.B. 6.00 ASSESSORS PARCEL NO,
and Professions Code:The Contractors License Law does not apply - -to an owner of properly who builds or improves Ihereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3 �,Q -16- 74
contracts for such projects with a contraetoAs)licensed purslmnt to �• -
theContractor'sLicenseLaw. I SEWER- AN �j -S;f,OA '9 200ft/10.00 Q TRACT NO, � PARCEL NO...
D .l am exempt under sec. ,B.&P.C.for this 1 WATERHEA ERW/VENT 6.00
reason
Owner 1, Date WATER SVST - U B({In0 5.00 •�
ACC.DATE ACC,FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I I hereby affirm that I have a certificate,�It Consent Io sdl�iasiru, ZONING ENG.SITE N0.
or a certificate of Workers Compens'lion Insurance,or n cerlitieJ
Copy thereof(Sec.3800,.Lib,C.) 71V
Policy No.EJ Certified
�- '
O Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 -
Z Z ❑ Certified copy is filed with OIe'city Inspection division. MI$C.- - REFER TO ORD.
0 Applicant .. .. '• 'Y❑ .N❑ -Y ❑ N❑
D' N CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE " 10,00 /0 �� FLOOD ZONE' A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTE].- ❑C.NO. PLG. 7 Y❑ ' N❑ Y❑ , N❑
D. O (This section need'not be completed it the permit is fur one TOTAL oe
Z hundred dollars(8100)or less.)'
U 0 1 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 so as to
U become subject to the Workers'Compensation Laws of California. dt1
U CL Date Applicant ALTER OR ADD TOM 5.00 ' BUILDING
} to NOTICE TO'APPLICANT: If,after making this Certificate of Ex�
2 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 O C, :M:) 4,00 r
CONSTRUCTION LENDING AGENCY AIR HANDLINGUNIT 0,06.0 .0 6.00 SEISMIC FEE
1 hereby affirn that there is a construction Iendinb•xgency for { EXHAUST HOOD(WITH DU T) s. 5.00 S^
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). I HEATING UNIT TO8.00Of
Lender's Name
Lender's AddressHEATI NO UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
'
I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 � _
information is correct.1 agree to comply with all city and county PLUMBING ,
Ordinances and state laws relating to building construction,and BOILER-COMP 13 H.P.or 100,000 B.T.U.1 6.00 76Z
hereby authorize representatives of this city to enter upon the BOILER•COMP (0.,100,000 BTU)SEE FEE SCR. MECHANICAL '
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. qq
' Cupertino against liabilities,judge encs, costs and expenses which' CONST.TAX
may in an*way a inst Cit in consequence of the. PERMIT ISSUANCE 10.00 /0
'
grmnYrq;of this I _ MECH.CONT, LIC.NO. MECH, ? fr•..--vi -�
-
TOTAL. J/ TOTAL 7y� '
Signature of Applicant/Contractor Dale ! -'• �iI
OFFICE COPY _ _