8334 w' POS--T.THISCARD NEAR FRONT-OF BUILDING ' ."•'•
� - PERMIT NUMBEN
CITY OF. CUPERTINO.' .
Q
:]'� INSPECTION D,I,VON 6334
" '
– J B I SPECTIONISI
RECORD
�_ JW
•� �. - PERMIT EXPIRATION ?
JOB ADDR ESSF^ U I r L'OT# ,PERMIT EXPIRES SIF WORK
' •OWNER d - CONTRACTOR - IS NOT STARTED,WITHIN`-
INSPECTION DATE INSPECTOR INSPECTION RECORD 1186 DAYS OF, PERMITISSU _
FOUNDATION- ANCE OR;180.DAYS FROM
•
LIFER. e. ,LAST CAL LEDI NSPECTI ON,
• .,. . ,,.
PR EGUNITE PERMITTVALIDATION, ..,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND'/SLAB.
PLUMBING .'1' / V �.7 i • �,
ELECTRICAL, - .F ' L' ,t. '�ISSUANCE DATE'S". y
MECHANICAL „', G 'ELECT. PLG. nECR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR,,, INFORMATION
VALUATION .-�$/FT.;
PLUMBING
MECHANICAL_
ELECTRICAL - - - r PERMIT
FRAMING - -
STORIES
INSULATION � '. _ - T P ONSTR:..L• ,
OCC.•GROUP . RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
I' -
• ROOF SO,FT.,FLOORAREA TOTAL ACREAGE
DIAPHRAGM • ^ . +_ + .' r
- BUILDING USE.
RES• IND ..CON PB Omxn
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑` ❑"
ASSESSORS PARCEL NO.
ROUGH C
PLUMBINGTRACT NO,- PARCEL NO.
GAS TEST -
MECHANICAL,
FINALS ACC.DATE' ACC.FILE NO.� '
ELECTRICAL, - - DATE INSP.
FRAMING', —2 SAN* -},
INSULATION - - PLUMBING I - ZONING ENc'slrE NO.
GAS - '
MECHANICAL - FIRESPRINK, ENERGY T@<'-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� "�
LATH-INTERIOR _ ELECTRICAL -
FLOODZONE ALU.C,
LATH-EXTERIOR FIRE DEPT. Y❑ 0 E] -yo , N❑
SHEETROCK GRADE FEE SUMMARY +-
- , SHEAR INTERIOR w BUILDING
• - SHEAR EXTERIOR - TEMPORARY APPROVALS BUILDING , _ •.' e ..-
• FIREWALLS.: ELECTRIC' ' PLAN CHECK '
GAS ' , - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED 19CCUPANCY SEISMIC FEE 1
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGN D BY BUILDING INSPECTOR. MICROFILMLLJ Fw
ARRANGE FOR INSPECTION BY PHONING 25505, + ELECTRIC
2-4
-ONE WORKING DAY BEFORE REQUIRED.INSPECTION: PLunnelvc `
1� z PLEASE GIVE JOB ADDRESS.WHEN PHONING.
— SEE PERMIT'FOR EXPIRATION 'DATE -"`' MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEF-ORE•, .TOTAL '
..CALLING FOR FINAL INSPECTION.
OFFICE COPY e,.
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
• 'BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
aUnLDING ' .APPLICATION-
ADDRESS b, /� e
F 3 LON&1QOW BUILDING-ELECTRICAL-PLUMBING-MECHANICAL il4
NAMER'S PLA ECK VALIDATION
UWKNo '
NI CITY, ELECTRIC PERMIT FE .{
kLtn! ' PRONE KNomN
• NDNTRACTOR'S "
NAME UTLETS-SWITCHES-RECEP 10.00/1.00 ^
Egg S fF31 co S LIONO. ' LIGHTING FIXTURES - 100 7 . 0/1.00
CONTRACTORs
' -
sV aooREss "' APPLIANCES-RESIDENTIAL 4.00
ulTti QQ, S4eJ PHONE3PANELS 10.00 DATE OF APPLICATION
agcwTecT 1
PANELS (OVER 200 AMP) 20.00 'PLAN CHECK FEE P.C.NO:
ENGINEER
ARCH.ORENG, -
Lic.NO. SIGNS TRANS. 3.00 -
_ _
" ADDRESS � SPECIAL CIRCUIT' 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 .
' - APPLICANT'S -
ADDRESS ,. MOTORS SEE FEE SCH
- SERVICE CHANGE
Foo LICENSED CONTRACTORS DECLARATION - TEMP.POLE 30.00 -
¢ wr
O v I men affirm that 1 am licensed u -
Y oder rovis'o
a z w p a ns of Chapter 9 h,
w ¢ (commencing with Section 7000)of Division 3 of the Business and I ISSUANCE DATE
H w i Profession de and mylicense isin full force'n ¢ffecL BLDG. ELECT. PLG. MECH.
z o License Cl a B�Lic.Numbe O �� , r❑ r "❑• ❑
4 w _H"]• Dete T Contractor - -
y i J 7'L-o?m 11F Ct T"L.
' S ¢w a OWNER-BUILDER DECLARATION BUILDING PERMIT
a o A
U MISC. - REFER TO ORD x RMATION
X 3 N. .1 hereby affirm that 1 am'exempf from the Contractor's License
F w o e( Law for the following reason.(Sec.703 1.5,Business and Professions LUA ION $/FT:
ac m Code:Any city or county which structure permitconstruct,alter, PERMIT ISSUANCE 10.00
¢ ¢¢ improve,demolish,or repair any structure,prior too'its issuance,also ELEL.LONTR. LIC.N0.
o u requires the applicant for such permit to file a signed statement that - ELEC.TOTAL
A aa m he is licensed pursuant to the provisions of the Contractor's License '
tzQPERMIT TO
Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe _W96 --r
f 4 0 Business and Professions Code)or that he is exempt therefrom and CITU. PLUMBING PERMIT FEE U''� t' �
a I- o the basis for the alleged exemption.Any violation of Section 7031.5
i - m STORIES TYPE CONSTR.
; _ by any applicant fora permit subjects $500).applicant[oacivil penalty ALTER-DRAIN VENT-WATER (EA.) 5.00
of not more than flue hundred dollars(my em:
❑ I,as owner at the property,or my employees with wages as BACK FLOW PROTECT:DEVICE 4.00 DCC.GROUP RES.UNITS -
their sole compensation,will do the work,end 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
property who builds or improves thereon,and who does such'work FIXTURES-'PER TRAP 5.00 -.' SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve. -ments are not intended or Offered for sale.If,however,the building' GAS-EA.SYSTEM,l INC.40UTLETS- 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 IEA.) 2.00
builder will-have the burden of proving that he did not build'or im- - . -
. BUILDING USE
prove for purpose of sale.). + INDUSTRIAL WASTE INTER. 30.00 RE5 'IND CON PB .Other
❑ I,as owner of the property,am exclusively contracting with -
licensed contractors to construct the 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 contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO.' PARCEL NO.
❑ 1 am exempt under Sec. ,BAP.C.for this '
reason WATER HEATER W/VENT 6.00 '
Owner 'Date WATER SYSTEM 5.00 ACO-DATE ACC FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. . 5.00 -
I hereby,affirm that I have a certificate of consent to self-insure. -
or a certificate of Workers'Compen�ssa�tion 1nsurapp�pG,o a certified - •ZONING ENG.517E NO.
copy thereof(Sec.3800,Lab.C.).MAt 'FIENLy IN�(FRFAo -
PolicyNolPr Company LLW 25 Q-I IOo�I le
O O CertifiIed copy is hereby furnished. FIRE SPRINK ENERGY T-Z4
Z Z>( Ig�od G�gqppy,rs R1yd itI It ity inspection division.
Fp
Applicant 3s�+ e,.rr5 MISC. .'REFER TO ORD. - - 0 O
V N V . N
cc y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMITJSSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU 0 .COMPENSATION INSURANCE PLG,CONTR.• LIC.NO, - PLGJIL . '� N(]
(This section need not be com leted if the y N y
Z p permit is for one TOTAL
U O hundred dollars IS 100)or less) ,
I certify that in the performance of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
-IL 1- mit is issued:7 shall not employ any person in any manner so as to Sys
OWW
become subject'to the-Workers'Compensation Laws of California.
Date Applicant ' - 'BUILDING �d
i-
} m 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
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.)- 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=11F.M.) 6.00 SEISMIC FEE Sa-
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 - HEATI NG UN IT(OV ER 100,000 B.T,U.)9.50 , ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
• information a correctl1 agree to comply with all city and county 2B ER-000 H.P,or,100,000B.T.U.) .6.00 ^'PLUMBING
ordinances and state laws relating to building construe lion, and -
hereby authorize representatives of this'city to enter upon the BOILER-COMP (Over 100,000 OT61 SEE FEE SCH: MECHANICAL
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 CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
granting of this permit MECH.CONT. LIC.N0. MECH.Dat
.: licanty a TOTAL
l . . TOTAL
Sgnatureof App /Contraclor / e
OFFICE COPY - -