C 9304 POSTTHIS CARD NEAR,FRONT OF BUILDING PF.RMIT NUMB ER
CITIOF CUPERTINO 939
INSPECTION DIVISION
14,
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS /0l?/ . rl,c� rr. UNIT# LOT# -
`u PERMIT EXPIRES IF WORK
OWNERInk CONTRACTOR L./i4' St _ IS NOT STARTED WITHIN
INSPECTION DATE INSPE TOR I INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
LASTCALLEDI NSPECTION.
PREGUNITE .PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB C
PLUMBING ..;•�,,I All
ELECTRICAL ISSUANCE DATE
MECHANICAL B IG. - -ELECT. PLG. MECR,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Ip) BUILDING PERMIT
II�r INFORMATION
WOOD FLOO VALUATION $/FT.
PLUMBING
MECHANICAL •,•.� �'
ELECTRICAL - - PERMIT TO
FRAMING ( ._r4lzN " N'i
INSULATION - ST RIES TYPE CONSTR.
OCC.GROUP, RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - SO FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
RES IND CON PB 00-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 4 - a K Fs o ❑ ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING -
GAS TEST TRACT NO, PARCEL NO.
MECHANICAL
ELECTRICAL U- - � FINALS DATE INSP. ACO DATE ACC.FILE NO.
FRAMING SAN #
EN
INSULATION D��6 PLUMBING ZONING G.SITE NO. i
GAS
MECHANICAL FIRE SPRINK , ENERGY TZ<
COVER NO WORK UNTIL ABOVE HAS-BEEN SIGNED HEATING Y ❑ N❑ YE]. N❑
LATH-INTERIOR Jp-Z ELECTRICAL - FLOOD ZONE AL.U.C.
LATH—EXTERIOR 10— b FIRE DEPT. Y❑ N❑ Y NO
SHEETROCK • GRADE FEESUMMARY
SHEARINTE RIOR BUILDING - BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY. SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING A
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
- SEE PERMIT FOR EXPIRATION DATE*-
MECHANICAL•,
'
IMPORTANT! CONST.TAX
` � `4^•
PLEASE READ REVERSE SIDE BEFORE TOTAL 5
CALLING FOR FINAL INSPECTION.
OFFICE COPY 1
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BAL _ POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATI , PERMIT NUMBER
y RDILOING APPLICATION & PERM9304
�•� ADDRESS
/60
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNERS '- P N CHECK VALIDATION
NAME
DTV. ELECTRIC PERMIT FEE
L PHONE
1 NOAMERACTDfls UTLETS-SWITCHES-RECEP 10.00/1.00
AY E m UiL- LIC.NO q Z01 Q.r/ LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
`ADDRESS � -SI29-a
APPLIANCES-RESIDENTIAL 4.00
(I
PHONE 279 a210 PANELS 10.00 DATE OF APPLICATION
ARCHITECT OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEEP.C.NO.
ENGINEER
' LIC.NO. ISIGNS TRANS. 3.00
ADDRESS ENc' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 n
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00Ir
0 o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
a i I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
¢ a (commencing with Section 7000)of Division 3 of the Business and RLD ELECT. PLG. MECH.
r y- Professions Cot and my license is in full force nil eff rot ❑ ❑ ❑
o0 m a License Class Lic.NumM1e
�_ Uale - Can onto,
Q, F4 JUL L 4191 BUILDING PERMIT
¢¢O OWNER-BUILUF:R DIiCLARATI INFORMATION
E
4 u y I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
u D ¢ Law for she following reason.(Sec,7031.5,Business and Professions
VALUATION /FT.
_ PERMIT ISSUANCE I BO I
Code:Any dryer coo myir any structure permit townsuance,also
�' ��
¢ rt ¢ improve,demolish,or repair any structure,prior so its issuance,also ELEO CONTR. LIC.ND. ELEC.
D , requires the applicant for such permit to file a signed statement that TOTAL
n w $a- he is licensed pursuant to the provisions of the Contractor's License IT _1ui;
F Z Q Law(Chapter 9(commencing with Section 7000)of Division 3of(he
i 4 D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
ler 0 the basis for the alleged exemption.Any violation of Section 7W 1.5 STORIESL;11Y 0tT o.
n3 § by any applicant for a permit subjects the applicant too civil penalty .l ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($5001):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sotr
le compensation,will do the work,and the sucture is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00
Code:The Contractor's License Law does not apply to an owner of
property who buiMs or improves thereon,and who does such work 2 FIXTURES-PER TRAPments S,DD 56 FT.FLOOR AREA TOTAL ACREAGE
himself re of intended
his own employees provided that such improve-
orimprovemennronded or offend within
onefor
year
however,thebuildingowneg GAS-EA.$YSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,she owner- GAS-EA.SYSTEM.OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not buil)or im- S IND CON PB Other
prove for purpose of sale.). INDUSTRIAL IAL WASTE INTER. 30.00
❑ 1.d as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors od to construct doe project(Sec. 7044,Business LAWN SPR INKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor'sbuild1-kunst Law does not apply
to tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 6(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM PAIMo ACO.DATE ACC.FILE NO,
WORK I7RS'COMPF.NSA'1'ION DECLARATION WATER TREATING EQUIP. 5.00 w
I hereby affirm shat I have a certificate of consent to self-insure, (s ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereoriSce.3800,Lab C.).�
Policy No. Company STATE
O ❑ Certified copy is hereby furnished. CI 0 lip FIRE$PRINK ENERGY i.Z4
Z gZ ElCertifie< copy filed w' the city inspection division.
N� Applicant_ Is MISC.- REFER TO ORD. Y❑ N❑ Y 11 N�
CL - CERTIPI r OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC:NO. PLG.
Z (This uctidn need not be completed if the permit is for one TE% Y N Y[:] N
hundred dollars I S I O0)or less.)
U O 1 certify that in the-performunce of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ any person in any manner 50 as to
U W become subject to the Workers'Compensation Laws of California. Q
I Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING - S
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
t- Z emplion,you should become subject to the 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 10,000GF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that Iherc is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit Is Issued(Sac. MICROFILM
3097.Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UNIT 100,000 B.T.U.)9.50 /I
Lender's Address ELECTRIC
I certify that I have read this application and slme duo she above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
Ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100r0008.T.U.) 6.00
hereby authoriro representatives cc this city es enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
II. above-mentioned properly representatives
ofth i purposes.ts.
(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 CONST.TAX /
may in any way accrue against said City in consequence of[he
\ granting of this permit MECH.CONT. LIC.NO. MECH. .�
TOTAL TOTAL �S
Signa are fAp Iicanl/ContracLt )or Date
OFFICE COPY