13478 POST THI RD NEAR FRONT OF BUILDINPF G RA HONKER
CII OF CUPERTINO r 13478
INSPECTION DIVISION
JOB INSPECTION RECORD
p �/ _ rPERMIT EXPIRATION
JOB•ADDRESS 1012 - IV, �,TR7A-L �V� UNIT# LOT#
/� PERMIT EXPIRES IF WORK
OWNER RVI �' !y CONTRACTOR IS NOT STARTED•WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER LASTCALLED INSPECTION.
PREGUNITE PERMIT VAL DATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL IssuANCE DATE
MEGH AN ICAL J��^.BLDG. ELECT. PLG. MECH.
❑IC;C�av' ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED gyp' BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING /1�07'-G°: Oi✓ti� Fcy111D aGo .
MECHANICAL /. �.5 .43-Mr AVAS `
PERMIT TO ,
ELECTRICAL - /�1/LOO . ✓/� /A/ 1973 ,
FRAMING S✓ j
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
NPLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
\ ROOF SO.FT.FLOOR AREA TOTAL ACREAGE
6 DIAPHRAGM BUILDING USE
RES IND CON PS OIGer
""APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.OATE ACC.FILE NO.
FRAMING SAN #-
INSULATION PLUMBING ZONInO ENG.SITE NO.
GAS
MECHANICAL FIRE SPRINT( ENERGY T2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y [:1N❑ Y ❑ No K
. .
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.LUC
LATH—EXTERIOR FIRE DEPT, Y❑ N❑ Y 0 N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z� PLEASE GIVE JOB ADDRESS WHEN PHONING.
1 — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE ;
CALLING FOR FINAL INSPECTION. TOTAL �(
OFFICE COPY
I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFIC N PERMIT NUMBER
aUILDING 40 APPLICATION & P T
A°,o/ay Al 0,-7rCf tee- 13478
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME DTV. ELECTRIC PERMIT FEE
��
iU - 'Ho E s
CONTRACTOR S
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00
CONTE ACTOR'S APPLIANCES-RESIDENTIAL 4.00
ADDRESS
'HONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ADDRESS ^�
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS rS
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
,02
0o LICENSED CONTRACTORS DECLARATION /%`�a//
¢ u w I hereby affirm that I am licensed under provisions of Chapter 9 (�j}0 , f (.fnPftI/WzNOE DAT
Z a' (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PL MECH.
H o i Professions Code,and my license is in full force and effect. ❑ ❑ ❑
2v,i W License Class Lic.Number
Date Contractor
¢ E BUILDING PERMIT
¢ z w¢ OWNER-BUILDER DECLARATION INFORMATION
AO MISC- REFER TO ORD
w ; H 1 hereby affirm that I am exempt from the Contractor's License
Huoy VALUATION $/FT.
J Law for tire following reason.(See. uires a,ermit to Professions PERMIT ISSUANCE 10.00
Code:Any city or coon pair any structur e permit to cons issuance,
also
¢ ¢ ¢Q
improve,demolish,or repair an structure, riot to its issuance,also ELEC.CONTE, LIQ N0.
P p Y P ELEC. L'
- O u requires tire applicant for such revisit to fele a Mgnnt statementisLithat TOTAL PERMIT TO
E:
m he is licensed pursuant en the provisions of the )ofDivision License Adz)/
d
v i i Law(Chapterand
Professions
nCodecing ).,th Section is exempt thenen 3 andthe /-�(f
¢ Business and Professions Code)ar that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ = the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a3 � by any applicant for a permit subjects the applicant to a civil penalty gLTER-DflAIN& VENT-WATER IEA.) 5.00
of not more than five hundred dollars(S500)J:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their'ole compensation,will do the work,and 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 5677 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-11NC.40UTLETS 6,00
or Improvement is sold within one year of completion,the owner. GAS EASYSTEM-OVER 4 (EA) 200
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 RES IND CON PB other
❑ 1,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 SEWER-SANITARY-STORM EA.200ft/10.00
lire Contractors License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec..,B&T.C,for this WATER HEATER W/VENT 6.00
reason
+ Owner:Z2/. 4a., Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATI DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to selr-dwre' ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE N0.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
Z Z O Certified copy is filed with the city inspection division.
p: MISC.- REFER TO ORD.
O Applicant Y[:] N❑ Y ❑ NO
rnPERMIT ISSUANCE 10.00
Lu - CERTIFICATE OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.u.c.
W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL 0 (This section need not he completed if the permit is for one TOTAL Y❑ N❑ Y❑ N
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- 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. 6
a
Dam Applicant BUILDING 6o z
>_ N NOTICE TO APPLICANT: IL arms making this Certificate of six- ALTER OR ADD TO MECH. 5.00 '--�-
F 2 emption,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 10AWC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1000C.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the 1097 Civ.0 jnce of the work far which this permit is issued(See, HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
NH EAT[NG U N IT(OV ER 100,000 B.T.U.)9.50
Lender's NameAddress ELECTRIC
I certify that I have read this application andstale that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county BOILER•COMPI3 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(Over 100,0008TU)SEE FEESCH. 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 whkh CONST.TAX
may in any way acerae against said City in consequence of the PERMIT ISSUANCE 10.00
Ill grantor of pe it. MECH.CONT. LIC.NO. MECH.
'%r/d- TOTAL TOTAL
Sighoushre of App want/Contractor out.
OFFICE COPY ''