12938 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
4 CITY OF CUPERTINO
INSPECTION DIVISION ' 12938
JOB INSPECTION RECORD
- PERMIT EXPIRATION
/0 3 / 7 AIMy,-xr.4- 9?d
JOB ADDRESS UNIT# LOT# '
PERMIT EXPIRES IF WORK
- OWNER U' CONTRACTOR 199'tl-n' IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
LIFER _ LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
•UNDERGROUND /SLAB PAR,
PLUMBING -
ELECTRICAL lS 1��" 'ISSUANCE DATE
y
MECHANICAL BLDG. ELECT. PLG. MECH.
p{CUPert►�► ❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
.WOOD FLOOR INFORMATION
PLUMBINGVALUATION $LFT.
. � - �' -
MECHANICAL
ELECTRICAL -" PERMIT TO
FRAMING
INSULATION STORIES TYPE CONSTR,
OCC GROUP RES.UNITS
_ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF ` SQ FL FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
HES INO CON PB Other-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH ASSE SSORSPARCEL NO.
PLUMBING
GAS TEST
TRACT NO. PARCEL NO.
- � '
MECHANICAL
.
ELECTRICAL � FINALS DATE INSP. ACCDATE ACC,FILE NO
FRAMING SAN #
ZONING ENO,SITE NO.
INSULATION . PLUMBING'
GAS
` MECHANICAL FIRE SPRINK ENERGY T2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ No
LATH-INTERIOR - ELECTRICAL FLOOD ZONE A.L.UL.
� .- �a-
LATH-EXTERIOR . . FIRE DEPT. - Y❑ N❑ Y ❑ .N❑
SHEETROCK GRADE FEESUMMARY
SHEAR INTERIOR BUILDING I -
SHEAR EXTERIOR". TEMPORARY APPROVALS BUILDING -
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY L SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
F� ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
. ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING,
z PLEASE GIVE JOB ADDRESSWHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
8U1 LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
auILOING - APPLICATION & PERMIT
ADDRESS10-317
�� ILDING—ELECTRICAL—PLUMBING—MECHANICAL 12938
eY
OWNER'S / PLAN CHECK VALIDATION
NAME I C' tJa� OTY, ELECTRIC PERMIT FEE
PNNONE (/
NAME Acr Rs OUTLETS-SWITCHES-RECEP 10.0011.00
NAME440
LIC.NO. LIGHTING FIXTURES 10.0011.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
ADo s
PHONE �/ PANELS 10.06 DATE OF APPLICATION
ARCHISECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR -
ENGINEER
LIC,NO SIGNS TRANS. -3.00
ARC" OR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
—SS
ZIP EMP. METER OR POLE INS. 20.00
APPLICANT'S MOTORS .SCH.
ADDRESS ��
SERVICE CHANGE 20.00,
w o o LICENSED CONTRACTORS DECLARATION
< o U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
vHi< w (commencing wins Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H D i I'mf5#0WKN1R-BnU1LDER
is in full foAcp' � Q
z 0 2 Licec.Number 7 ❑ ❑ ❑ ❑
O Dula ntracmr
x f BUILDING PERMIT
Ic w u DECLARATION INFORMATION
oA MISC.— REFER TO ORD
X 3 u y I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
F au Da Law for the following reason.(Sec.7031.5,RusinessanJ Pmle;cions PERMIT ISSUANCE 10.00
us Code:Any city or county which requires a permit to constn ct,alter,IS _
rt 3 improve,demolish,or repair any structure,prior to its issuance,also E C.C T LIC.NO. ELEC.
D u requires the applicant for such permit to file a signed statement that /Y TOTALPERMIT TO
u w $m he is licensed pursuant to the provisions of nm Contractor's Licansol
Hit Law(Chmptef9(commencing with Section 7000)ofDivision 3 ofthe
a Business and Professions Code)or that he isexempt therefrom and CITY. PLUMBING PERMIT FEE
¢=$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR,
n , by any applicant for a permit subjects the applicant to a civil Penally ALTER-DRAIN -WATER (EA.) 5.00
Of not more than five hundred dollars($500).):
O 1,as owner or 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 ProfessionsDRAINS-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 5,011 SO,FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-1 6.00
meats are not intended or offered for sale.If,however,the budding
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 than he did not build or int. RES IND CON PB DrM1Bf
prove 1,as owner
of the
INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ L as owner of the property,um exclusively, 70 4,Bu with
and Pro contractors : construct the project La does l Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 A55Es5oR5 PARCEL No.
and n owner of Code:The Contractor's License Law Boas non apply
to owner of property who builds tr improves rrood a and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts Contractor's
Licenects Lwilhaconlrudy{s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ 1 am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Data WATER SYSTEM 5,00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-Insnf0. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.). -
Polley No. Company
0 ❑ Certified copy is hereby lu FIRE SPRINK ENERGY T-24
Cert ifieyyo �,�p�1W{ the ras cation division.
Z p ApplicaV -e-pi -`— p MISC.- REFER TO ORD. y N� v ❑ N�
Fy
CERTIFICATISPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
Lu —
W �_ COMPE EXEMPTION FROM WORKERS'NSATION INSURANCE PLG.CONTR. LIC.N0. PLG.
Q. O (I Ilia Section need not be completed if ilia permit Is for one TOTAL Y❑ N❑ Y❑ N
::) Z hundred dollars IS 100)or less'.)
U O 1 certify that in the performance of the work for which"his per- OTY. 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.
y Data Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT': It ufner making this Certificate of Ex-
�-.. ? empfion,you should become subject to Ila 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(TO 10,0000.F.M.) 4,00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER I0=CF.M.) 6.00 SEISMIC FEE
1 hereby affirm that "here is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
file 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 HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify that I have read this application and state"hut the above VENTILATION FAN (SINGLE) 4,00
information is correct. I agree to comply with sill city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000WT.U.) 6.00
hereby authorize representatives of this city to enter Inion the BOILER-COMP (Over 100,000 BTU)SEE FEE SCM. MECHANICAL
above-mentioned property for inspection purpose.
(We) agree to save, indemnify and ke unless file City of MISC.- REFER TO ORD.
Cupertino against liabilities judgme sand expenses which CONST.TAX
may in any way ac gai ty in conseque of the PERMIT ISSUANCE 10.00
granting of t L CH.CONT. LIC.NO. MECH.
r TOTAL
Signature of Applicant/Contractor kyric
OFFICE COPY