14048 POST THIS CARD NEAR FRONT OF.BUILDING
PERMIT NUMBER
.CITY OF CUPERTINO 14048
.
INSPECTION'DIVISION
( Et JOB INSPECTION RECORD
Jf E � PERMIT EXPIRATION, '
JOB ADDRESS L,40-,— UNIT#' _-LOT# .W. ��•
- - - PERMIT-EXPIRES IF WORK '
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE-OR-180 DAYS FROM
UFER
- C gTTCALLEDINSPECTION. . '
PERMIT VALIDATION'
PREGUNITE - -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB,
y i�x , .
PLUMBING 7T UL
ELECTRICAL., f O0 L. ,F>•.� Iss ' DATE
'MECHANICAL - - el BLD PLG. MECR�
a ❑' ❑ q
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR
PLUMBING VALUATION $/FT. '
- -' -•
MECHANICAL
MITTO
' ELECTRICAL � - .".l .JPER�;. ,_. �• ',
FRAMING
INSULATION _ - _ STORIES TYPFCONSTR.
- CCC.GROUP RES.UNITS
t -� PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
\ ROOF' SO FT,FLOOR AREA TOTALACREAGE
j DIAPHRAGM ED ING
' -
`"w!,.,.r-^-! •y, . . RES IND ILUCON USEEPB
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ Q ❑ E:l
' ASSESSORS PARCEL NO.
ROUGHy—
PLUMBING 'Zff'o-�
GAS TEST . TRACT NO. PARCEL NO. -
MECHANICAL
.ACC11.DATE . ACC.FILE NO.
ELECTRICALAG
FINALS ,DATEINSP. .
FRAMING /j, SAN
INSULATION PLUMBING zoNlrvc ENG.SITE No. .
GAS
_ . . MECHANICAL FIRE SPRINK ENERGY T 20
Y Yo
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑' "❑ NE)
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L:UC.
LATH—EXTERIOR 7• 'L_$8 - FIRE DEPT. _Y❑ "❑ Y ❑ N'[:]
SHEETROCK' GRADE FEE SUMMARY
SHEAR INTERIOR' BUILDING *MLS
-
SHEAR.EXTERIOR •-TEMPORARY , PPROVALS BUILDING
FIREWALLS ,. - ELECTRIC - PLAN CHECK , O
GAS FEE
NO TAP OR PLA TER UNTIL ABOVE HA BE I GN EO'l OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR; ,
MICRO FILM -
ARRANGE,FOR INSPECTION BY PHONING 252-4505; " ELECTRIC
P .
o� ONEWQRKING DAY BEFORE REQUIRED INSPECTION: • wc
J'
PLEASE GIVE JOB ADDRESS WHEN PHONING.' LuMey
SEE PERMIT FOR EXPIRATION DATE— MECHANICAL
CONST.TAX (�
- ' '.IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL '
CALLING FOR FINAL INSPECTION. /
-�� -OFFICE COPY J ,
ArPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
^ rI' BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
"...DING APPLICATION & PERMIT 14048
ADOREss H 4H /—/ / nn � ` BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S / / G. /7 lam' PLAN CHECK VALIDATION
NAME r OTY. ELECTRIC PERMIT FEE
J C — C PHONE j�/
CONTRACTOR'S �-• 2� r, 3
NAME. - UTLETS-SWITCHES-RECEP 10.00/1.00 cJ
LICE No. LIGHTING FIXTURES 10.00/1
ADDRESS DRESS ,00 .� S�
'CONTRACTORS
PPLIANCES-RESIDENTIAL 4.00
A
PHONE IPANELS 10.00 DA PPLIOATION
ARCHITECT PANELS (OVER 200 AMP) - 20.00 PLA P.C.No.
OR
ENGIN EL AY-
LIc.No. SIGNS TRANS. 3.00
ADDRESS Ervc'ADDRESS SPECIAL CIRCUIT 5.00 v�nME IN ON
o[ /,�wO 5/ vuV Ck zIP SD/ EMP.METER OR POLE INS. �uro�yl e®
APPLICANTSMOTORS CH
SEE
ADDRESS ^'7J
SERVICE 20.0 \
`/!�
� 7 v-
wo o LICENSED CONTRACTORS DECLARATION
a v u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISBu
z w (commencing with Section 7000)of Division 3 of the Business and
BLDG. ELEC .
vOi i Professions Code,and my license is in full force and effect. (� (�
'2 o w- License Class Lie Number LX 181
Date - Contractor r-,
a Y `r u . I UILDING PERMIT
¢ ¢¢ a OWNER-BUILDER DECLARATION INFORMATION
'Sou ° MISC.— REFER TO ORD
X ; I- I hereby affirm that I am exempt from the Contractor's License .VALUATION S/FT.
ar o0 Law for the following mason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 0— q 611
i Code:Any city or county which requires a permit to Construct,alter, p'✓
¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. . ELEC. �/�^,pVG
u O LL requires the applicant for such permit to file a signed statement that TOTAL / - PERMIT TO
wm he is licensed pursuant to the provisions of the Contractor's License
F Z
a Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe
i er Business and Professions Code)ar that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR.
u ;m by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN&VENT-WATER (EA:) 5.00
of not more than five hundred dollars(5500).): Z- O
❑ 1,as owner of the property,or my employees with wages asBACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP REB.UNITS
(heir sole compensation,will do the work,and the structure is not
intended of offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
T•-- 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 0 BD,FT.FLOOR AREA TOTAL ACREAGE
\, himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 ,
j J .cuts are not intended or offered for sale.If,however,the building
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 Other
•• prove far purpose fsale.). INDUSTRIAL WASTE INTER. 0.00
yN I,as owner of the property,am exclusively contracting with ❑ Cl El ❑ ❑
IiCetl'ad contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 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.)
contracts for such projects with a contractor(s)licensed pursuant to ,w
the Contractor's License Law. SEWER-SANITARY-STOR 26mR/1 00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec..,BAP.C.for this WATER HEATER_WVEN40 6.
reason
Owner Date WATER SYST ACC.DATE ACC.FILE NO,
RKERS'COMPENSATION DECLARATION WATER TREAANt EQUI 5.00
I hereby affirm than I have a certificate of consent to self-insure, r ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,oro certified
copy Ihereof(See.3800,Lab C-)
Policy No. Company
0 O Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. y❑ N❑ y ❑ N❑
O Applicant
F" H PERMIT ISSUANCE 10.00 p FLOOD ZONE A.L.u.C.
>
Lu CERTIFICATE OF EXEMPTION FROM WORKERS',
CL _ COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. TOTAL Q ❑ N E] Y
1 O (This section need not be completed il' the permit is for one y [:] NE]
:3 Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California. BUILDING
Date Applicant ALTER O O ME H. 5.00 S
>_ N NOTICE TO APPLICANT: If,after making this Certificate of fix-
Z emption,you should became subject to the Workeri Compensation APPLIAN 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith Comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLI rr(TO 1Q C.F.M.1 4.00
CONSTRUCTION LENDING AGENCY AIR HAN NIT .) 6.00 SEISMIC FEE dJ
I hereby affirm that there is a construction lending agency for EXHAU HO D5.0°.
the performance of the work for which this permit is issued(Sec. y MICROFILM
3097,CN.C.). 't HEATING U (TO 100,000 B.T U.I Avmb I .
Lender's Name H EATING UNIT(OVER1 B.T,U.)9. ELECTRIC Bi
Lender's Address
1 certify that I have read this application and state that the above VENTILATION FAN (SI LE)
PLUMBING
information statl correct. I agree tcomply with all oily and county Q
�} ordinances and slate laws relating to building construction, and
BOILER-COMPI3 H.P.or 100, . .U.1 6.00 O
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over,100,000 BTUI SEE FEE SDH. MECHANICAL /l
above-mentioned property for inspection purposes.
(We) agree to save, indemnify 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
may in any way accrue against said City in consequence of the
grankng of this pc D - MECH.CONT. LIC.NO. METH.
G// / ,`� TOTAL
/9-4TOTAL 9
`
l alure of Applemnt/holm m PI-Ji
C
OFFICE COPY