13203 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 13203
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS �O / `ER'Q��yfA� - `=' UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER TAY NG CONTRACTOR IS NOT STARTED WITHIN
INSPECTI N DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION CVS- h G { C CE OR 180 DAYS FROM
L ST CALLED INSPECTION.
LIFER
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING 1 I 1, /DArTE
ELECTRICAL .ISSUANC
MECHANICAL �IL7 y CT. PLG. MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUI DING PERMIT
INFORMATION
WOOD FLOOR
VALUATION SIFT.
PLUMBING - _-_
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING
SIORI[5 TYPE CONSTR.
INSULATION
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$O FL FLOOR ANEA TOTALACREAGE
ROOF
DIAPHRAGM
BUILDING USE
HES IND CON P6El El El El
OmP1
APPLY NO ROOFING UNTIL ABOVE HAS BE SIGNED El
ASSESSORS PARCEL NO,
ROUGH
PLUMBING
TRACT NO, PARCEL NO
GAS TEST
MECHANICAL
ACC.GATE ACC.FILE NO.
ELECTRICAL o- - FINALS DATE INSP.
FRAMING D -]$ SAN #
ZONING ENG SITE NO.
INSULATION �_( .�'7 PLUMBING
GAS
FIRE SPRINK ENERGY T 2
MECHANICAL YC] N❑ v ❑ N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
fLOODZONE A.L.U.C.
LATH-INTERIOR ELECTRICAL
LATH-EXTERIOR II -��_�7 '� FIRE DEPT. v[-] N[3 Y N[]
SHEETROCK ('i, / GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING BUILDING
SHEAR EXTERIOR TEMPORARY APPROVAL
FIREWALLS ELECTRIC PLAN CHECK
FEE
scra-FeAN GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY =DATE —
ELECTRIC
uJ ONE WORKING DAY BEFORE REPLUMBING
0 PLEASE GIVE JOB ADDRESS WHE
Z MECHANICAL
— SEE PERMIT FOR EXPIRCONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL _
CALLING FOR FINAL INSPECTION. 14
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BO,EO,Nq APPLICATION & PERMIT /�/� /�
ADDRESS • 13203 f 2 0 J
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I JG J
OWNER'S PLAN CHECK VALIDATI
NAME 2
F 7- ZZ�S QTY. ELECTRIC PERMIT FEE r1
•. ToNL( Lkv PHONE `D
CO TRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 e.3
NAME
LIC.NO. LIGHTING FIXTURES 10.00/1.00 V
CCONTRACTOR OR's APPLIANCES-RESIDENTIAL 4.00
ONTRA
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
O
E
LLe5IQ,No, SIGNS TRANS. 3.00
ARCH.OR ENG' SPECIAL CIRCUIT $,O0. PERMIT VALIDATION
ADDRESS }��rT., 1 `n
rTVl�1T �. 5.�, z,P \l(� EMP.METE R LE INS. 20.00 p
APPLICANTS MOTORS SEE FEE SCH. �.ffl y
ADDRESS /\
104813 SERVICE CHANGE " 20.00 / U
OO2 MU F F•�
0 o LICCNSIiU CONTRACTORS DECLARATION
<o u I hereby affirm that I am licensed under provisions of Chapter 9 SSUANCE DATE
rA a w i4.(commencing with Section 7000)of Division 3 of the Business and v B E yyy��_LG. MECH.
H o z Professions Code,and my license is in full force and effect x� r-r I ❑
z o n - License ClassLic.Number I� JLy� u
9 w Uxtc Contractor IIR}
P: Y BUILDING PERMIT
2 w¢ OWNER-BUILDER DECLARATION INFORMATION
REFER TO ORE
w 3 LL w 1 hereby affirm that I am exempt from the Contractor's License MISC.- VALUATION 5/FT.
Fu04 Law for the following reason.(See.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 O 33 .L..L�
Code:Any city or county whichrequiresa permit reconstruct alter, f/V U
F¢ u,Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO.
ELEC.
ce a: O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
d w m he is licensed pursuant to the provisions of the Contractor's License
FzaLaw(ChimWi-9(commencing with Section 7000)of Division 30fthe
4 D Business and Professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE
¢ H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a- by any applicant for a permit subjects the applicant-loacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(S500).1:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
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-
t mems arc not intended or offered for sale.If.however.the huddling GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,rhe 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-
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omar
❑ 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 Ilemon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for suck projects with a contmetods)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ I am exempt under Sec...BAPC.for this WATER HEATER W/VENT 6.00
ease"_
Owner _ Uatn 2 WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKER ' n ATIO iCLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm I have a certificate of consent to sell-i nsorc, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished I FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is fled with the city inspection division. MISC.- REFER TO ORD. v ❑ N❑ Y ❑ N❑
O Applicant
CC CP-RTIFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
Lu > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y -] N❑
d 0 1'This section need not he completed if the permit is for one TOTAL
::) Z hundred dollars IS 100)or less.)
U O 1 certify that in rhe performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any manner so as to
U become subject to the Workeri Compensation Laws of California. BUILDING Q � S�
n Daze Applicant ALTER OR ADD TO MECH. 5.00
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z anthem,you Should become subject to the Workers'Congxneazlon APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith Comply with FEE
C.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 q
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE d •3�.
1 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(See. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Cfv.C.).
Lender's Address Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
IOU
Lender's Address
1 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 13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP 10ver 100,000 BTU)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.
C lino against Iia Hires,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
'fl,
y n any we. ac a against said City in consequence of the
tin of this can MECH.CONT. LIC.N0. MECH.
Z-5/��] TOTAL TOTAL
�(/ L
S_
m re of 'cant/Contmcto Doe
OFFICE COPY