12784 II "POST THISCARD'NEAR FRONTOFIBUILDING
PFRMIT NUMBER
" ,CITY, OF CUPERTINO
INSPECTIOKDLVISIO-N
. I r JOB,INSPECTION RECORD v
' PERMIT EXPIRATION
JOB ADORE �02 � ����- �� UNIT# LOT# "
y PERMIT., EXPIRES IFWORK
t. .. �.
OWNER ' �N'.( 'T!'C- ',2Tni�RrS/ 'CONTRAGiORC' IS-NOT,�(STARTED'WITHIN*
INSPECTION DATE' INSPECTOR INS CTION RECORD 180 DAYS OF PERMIT ISSU-
, - I ANCE 014,1801DAYS FROM:t
- FOUNDATION _ "W WQ `pdY•TY�M;l rld( �Z�FG -
UFER- LASTCALLEDrINSPECTION"
.e
v .PREGUNITE t' �.]-,-iR . ,SPCI r. (�r..e 1✓� vERMlr,vnuonnoN -
POUR NO CONCRETE UNTIL ABOVE HAS BEE SIGNED '; 1 Y
" UNDERGROUND /,SLAB.'
PLUMBING
N .
gerilR
ELECTRICAL ' I .. a '•' ... - ' ISSUANCE DATE.'
^'MECHANICA .4 •1. 'y=. BLDG: ELECT. �'PIGi, MECM.
Oldw j
• ;`1,. DO NOT POUR FLOOR UNTIL ABOVE AS BEEN SIGNED T• BUILDING PERMIT,
t t -MOOD FL R I - INFORMATION
"VAWATION- ,.$/FT. .
PLUMBING I '
MECHANICAL'
PERMIT TO
ELECTRICAL
FRAMING ., r t `',,• `-`. "" ... -
" INSULATION I. - e -,+ STORIES-, TYPEco NSTR,�,'
0CC.GR0 UP RESIiUNITS
PLACE NO SUBPLOOR UNTIL ABOVE HAS BEEN SIGNED ,
1 y ROOF. F, ) SO.FT FLOOR AREA TOTAVALREAGE
J
DIAPHRMAG �
�• ' RES,..,. BUILD USE
., INO CON' PB } Other '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED„, ` ' ' ❑ .❑ ' '❑ ❑ ❑
I ROUGH— - SES RS PARCEL NO .,
I AS 50
PLUMBING , �., � pN'T. I' .v;li •.., 1/'.• .moi� .
r ,
GAS TEST 'C 1RAcryo PARCELING
' MECHANICAL --t • r / 7i'. . - ' ..� - q �'' I,
ACC GATE , ACC FILE NO
FINALS N ELECTRICAL '." %� .�. LS DATE INSP., d
'FRAMING,' ., SAN'# 'l„�.,/�;�• "„r.
PLUMBINGzoNING ENG.slrE No. -
INSULATION "i ''�`- //-oZ1_44 -
.r' GAS' ”
' MECHANICAL •'t p EIRE SPRINK" ENERGY T24 '
COVER NO WORK UNTIL ABOVE.HAS.BEEN SIGNED „i HEATWG-' ❑ •'N❑ r ❑. N❑
i,
ELECTRICAL ,' - Fi000 zorrE A.u:u,c.
LATH-INTERIOR-'
- x,• W FIREDEPTe
= LATH-
EXTERIOR - ^. r ' /-" 'I � - v_�❑ ^"-❑ Y ❑ N❑ '
,. GRADE p - ` FEE SUMMARY
SHEAR EXTERIOR E y �;
SHEAR�INTERIOR i BUILDING,
t
T MPORARYLAPPROVALS - `
FIREWALLS'
�� ELECTRIC;, PLAN CHECK
`
-, i1 - GAS .. ; .. ' FEE,. '.
NO TAPE OR PLASTER UNTIL ABOVE'HAS BEEN SIGNED U NC;Y I. "; ,I ` ISMIC FEE
-' OCCUPANCY OF,BUILDING,ISNOT PERMITTE D UNTIL BUILDING FINAL'ISSIGNED BY BUILDINGINSPECTOR. �
rid, ,,,,� .'.,r. MICROFILM _
,ARRANGE FOR".INSPECTION BY.PHONING:252-4505L
ELECTRIC ,l
ONE WORKING•DAY_BEFORE REQUIRED INSPECTION., PLuNSIvc
,.� 0� PLEASE GIVE JOB ADDRESSWHEN PHONING. Z�
^ '= SEEIPERMI'TFOR'EXPIRATION'DATE — MECNAnICA� . /
IMPORTANT! coN_sT:TAX
PLEASE''READ REVERSE SIDE BEFORE
CALLING FOR,FINAL INSPECTION. TOTAL1
;v OFFICE COPY ;
P
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
BUI LDI NG•PROJECT I DENTI FICATION - 2784
PERMIT NUMBER
BWLDING eT - APPLICATION & PERMIT' ,�
ADDRESS '
.Z2 S 2 �-�/E.� Chi BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S Y PLAN CHECK VALIDATION
NAME - QTY. ELECTRIC PERMIT FEE
• PHONE
CONTRACTORS
,
NAME S OUTLETS'-SWITCHES-RECEP 10.00I1.00 c$- „
'/ Sn"Ij CC / LIC.ND ,Z GV2. 7 1LIGHTING'FIXTURES _ 10.00/1.00 -
ADDRESS Rs .217Z) 2 PPLIANCES-RESIDENTIAL 4.00
PHOrvfPANELS • 10.00DATE OF APPLICATION
ARLMfTECT PANELS (OVER 200 AMP( - 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINE�Fy9� • -
7eTfR uo. SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT V M OATID
ADDRESS ,533 SPECIAL.CIRCUIT' - 5.00 yy�yf
SSS 1 z, EMP.METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH.
( ADDRESS
SERVICE CHANGE 20.00
woo _ LIC17NSED CONTRACTORS DECLARATION y ' `✓1'1 tq/Gj'tIOU
.
Is
z w1 hereby affirm that I am licensed under provisions of Chapter 9 ,•w,.. - ISSUANCE DATE
w a H (commencing with Section 7000)of Division 3 of the Business and J un i „ hIL i BLDG. ELECT. 1 PLG. I MECH.
H 0 Z Professions Code, d my license is in full force a d eiffct.�-
,Zoow License Class 1 Lie.Number.3gazV-
,Zs w S'Date 5--
a x f J+ City Of CupertinoBUILDING PERMIT
IS M w a OWNER-BUILDER DECLARATION - INFORMATION
o A ° • ' MISC.- REFER TO ORD
F
e, I hereby affirm first 1 am exempt from the Contractor's License VALUATION g/FT.
H ao J' Law for the followingreason.(See.7031.5,BusinesIand Professions PERMIT ISSUANCE10.00 C3 �
Code:Any city orcountywbichrequiresupermit toconstruct,alter, /Q t/ �.eA.,s "
rtor ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
C rc requires the applicant for such permit to file a signed statement that TOTAL/, PERMIT40
E:
m he is licensed pursuant to the provisions of the Contractor's License t�a t
Fii Law(Chapter 9(commencing with Section 7000)ofDivision 3 oflhe KJ
a Business and Professions Code)or that Ire is exempt Iherefrotn and QTY. . PLUMBING PERMIT FEE
ac the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant o a civil penalty gLTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(8500)):
❑ 1,as owner of the property,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 is not
intended or offered for Sale (Sec, 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 - 3 `
Code:The Contractor's License Law does not apply to an owner of
. properly who builds or improves thereon,and who does such work FIXTURES=PER TRAP 5.00 s '- SD.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided(hut such inmrove-
menu are not intended or offered for sale.if:however,the buildingGAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 a
or improvement is Sold within one year of completion,the owner-M1GAS•EA.SYSTEM-OVER 4(EA,1' 2.00 U BUILDING u5E'
builder will have the burden of proving that did not build or im- .RES IND CON PB OtM1ar
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 � 11 El ❑ F-1❑ I,as owner of the property,am exclusively contracting with -
licensed conlracturs to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 6 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code•.The Contractors License Law does no(apply `
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-fV ER 8'(EA.) 1.00 2 g/a /6 -Q 7�
contracts for such projects with n contrudur(sl licensed pursvum to SEWER-SANITARV•ST RM EA.200ft/10.1 7 iJ T
In
he Contractors License Law. TRACTN0. PARCEL NO.
❑ I am exempt under Sec. ,BAP.C.for this I �r��O
reason - WATER HEATER W/VENT] 't,.� 6.00 / ,
Owner Date ' WATER SYSTEM v - "- - 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSA'f[ON DECLARATION WATER TREATING,EQLJj?,.VII%rfJn0 5.00
I hereby affirm that I have a certificate ofconsent to wIf-insure,
or a certificate of Workers'Compo99salion Insppm��e,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.)./i Al y
Policy No. Company o p /•vs
0 ❑ Certified copy is hereby furnish. - -- FIRE gPRINK ENERGY T-24 •-
Z Z ❑ 'Certified copy is filed with the city inspection division. - --
p' Applicant MISC.- REFER TO ORD. Y❑ N❑ I Y❑ N❑
cc m PERMIT ISSUANCE
� CERTIFICATE OI°EXEMPTIONXEhEXEMPTIONFROM WORKERS' 10.00 0 FLOOD ZONE A.L.U.C.
Lu ? - COMPENSATION INSURANCE, PLG.CONTR. LIC.N0. PLG.. •� 'I
CL O (This section need not be completed if the permit Is for one I TOTAL /(T^ Y❑ IN Y C] NE]
N❑
0 Z hundred dollars IS 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
UMMARY,-
LL F mi[is ovuedll shall not employ any person in any manner so as to
0 W become subject to the Workers'Compensation Laws of California.
a Date 'Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE TO APPLICANT: If,-after making this Cer ificate of Ex
? eruption,you should become subject to the Workers'Compensation APPLIANCE y re 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply will, FEE
V - such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10:?( FCF,M.) 4.00 _
CONSTRUCTION LENDING AGENCY AIR HANDLING ONIT,(OVER 1101=C. M.) 6.00 SEISMIC FEE LUC,
1 hereby affirm that there is a aonstruction.lending agency for EXHAUST HOOD (WITH,DUCT)41\11 5.00 eJ/z`^
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C). HEATING UNIT IT0 100;000 B.T.U.1' •8.00 'r
Lenders Address Name
Lender's HEATING UNIT(OVER 100,000 B.T.U.)9.50
- ELECTRIC
I certify that l have read this application and state that the above VENTILATIONS FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING 7a
ordinances and state laws relating to building construction, and BOILER•COMP(3H.P.Or100,000B.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. 3.1
1 -'
(We) agree to save, indemnity and keep harmless the City of MISC.- REFER TO ORD. ??
Cupertino against liabilities,judgments,costs and expenses which PERMIT ISSUANCE 10.00 /O CONST,TAX p�7d_gf7
may in any way accrue against said City in consequence of the
gr ting is n L� / / MECH.CONT. LIC.NO. MECH. -
. / //- �; _ TOTAL.3/J_ TOTAL r', � /�
I.Signature o SS]pJppiiCcambecoonlrg(ctor U�/, at
OFFICE COPY - - .