10118 ,.POST THIS CARD NEAR FRONT OF BUILDJNG ,
PERF1IT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION
In ' . JOB INSPECTION RECORD
' - - PERMIT EXPIRATION
JOB ADDRESS Lqql( a hmit UNIT#
PERMIT EXPIRES IF WORK
OWNER' CONTRACTOR IS NOT STARTED WITHIN
INSPITTION DATE INSPECTOR SPECTION R CORD 11.80 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180,DAVS FROM
UFER 7')-1-T / dF- LA STCALLEDINSPECTION.
PERMIT VALIDATION
PREGUNITE -
POUR NO CONCRETE UNTIL ABOVE HAS BEE SIGNED
UNDERGROUND /.SLAB '!JAN 2,2i' f�'{[.;I`
PLUMBING - - ` I "Y
ELECTRICAL CifiluSA
MECHANICAL RLUG.' :E MECH.
I
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
- INFORMATION
WOOD FLOOR VALUATION SIFT. '
PLUMBING 4--3-46
MECHANICAL S-S-
ELECTRICAL - PERMITTO -L
FRAMING W `"
INSULATION srORIEs TYPE CONSTR.
A..-
y.-
` - OCL GHUP RES.UNITS
PLACE NO SUBPLOOA UNTIL A OVE HAS B EN SIGNED
• ROOF SQ FT,FLOOR AREA TOTAL ACREAGE
l
DIAPHRAGM -ZS^ B LDING USE -
RES I CON PB Omni
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED Y IDI o cl 11 0
ROUGH 7^/�n �F/ ASSESSORS PARCEL NO,
PLUMBING
GAS TEST - - '
TRACT NO. PARCEL N. C.
i/y'
MECHANICAL
ACC.DATE ACG FILE NO,
ELECTRICAL FINALS. DATE INSP.
FRAMING SAN #eD IM
ZONING ENG.SITE NO.
INSULATIONSBEENSI
PLUMB NG
GAS / —Q
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVEHEATING Y,� IV❑ YoNESFLOOD20NE A.L.U.C.
LATH-INTERIOR . b_ ELECTRICAL
LATH-EXTERIOR _� FIRE DEPT. Y❑ NE] Y ❑ NE)
SHEETROCK - ' GRADE FEE SUMMARY
SHEAR INTERIOR 40 BUILDING .- '7
SHEAR EXTERIOR 6p_ TEMPORARY APPROVAL BUILDING .
FIREWALLS : ELECTRIC PLAN CHECK
GASB
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE.FOR INSPECTION BY PHONING 252.4505, ELECTRIC
oONE 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 '
`CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY - -
APPLIgANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
EIN ILDI NG PROJECT I DENTI FICATION B PERMIT NUMBER
UILD APPLICATION & PERMIT 10118
ADORLes x
L044BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
W ER's PLAN CHECK VALIDATION
.NAME ^, CITY. ELECTRIC PERMIT FEE N14 I (A1C,IK PNONE lJi6 7
CONTRACTORS // Af
UTLETS-SWITCHES-RECEP 10.00/1.00 �vQ/Y n�
CC LIC.Na. LIGHTING FIXTURES 10.00/1.00 4 790 '
CONTRACTOR'S PPLIANCES-RESIDENTIAL .4.00 0,ty O
ADDRESS .�w,Ee� ��—y f ��w
gJRPHouEZsfc' D5cl PANELS 10.00 DAT�dW TION
ARCHITEC PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE , P.C.NO.
OR '
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
AR CH.OR ENG. 5.00 PERMIT VALIDATION
ADDRESS ISPECIAL CIRCUIT -
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH. �E
ADORE as
SERVICE CHANGE 20.00
Doo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
¢ u I hereby affnm that I am licensed under provisions of Chapter I S NCE DATE
to <a (commencing with Section 7000)of Division 3 of the Business and BLDG. T. PLG. MECH.
r O i Professions Code,&my license is in full force and effect ❑ ❑ ❑
z O H License Class Luz Lic.Natalia,
9 m r w Date Contractor
a se s BUILDING PERMIT
¢ ¢ wa OWNER-BUILDER DECLARATION INFORMATION
woMISC.— REFER TO ORD
5 u t I hereby affirm that I am exempt from the Contractor's License
F u_O`� Lawlor the following reason.(Sec.7031.5,Business and Professions --- VALUATION
PERMIT ISSUANCE 10.00
Code:Any City orcounty which requires a permit to construct alter,
¢ ¢ ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
n —y mi
m u requires the applicant(Or such pert to file a signed statement that TOTAL PERMIT TO
w he is licensed pursuant to the provisions of the Contractor's License r
H 2 r
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe v
a Business and Professions Code)Or that lie is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢= the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CgNSTR.
A. by any applicant for a permit subjects the applicant tog civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of riot more than five hundred dollars($500),: -
❑ I,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 OC GROUP RES.gNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00 C'/)(`J /
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 SD,FT.FL OR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
maids are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 200 WILDING USE
builder will have the burden of proving that he did not build or im- . . .
RES ND CON PB Osner
Prove for purpose of sale,. INDUSTRIALWASTE INTER. 30.00
O 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(See.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6,00 ASSESSORS PA CEL NO.
and Professions Code:The Contractors License Law does not apply sr Q 0
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 (IA
contracts I'or such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 77&r
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby alfir Ila 1 1 a cerlil'ic out consent l"self-insure, ZONING ENG.SITE NO.
o a c RID er mpenr n or cc or a c rUfi•d
cu In 'c a lr
Pc
O ❑ Cert led co y i here rolshc I FIRE SPRINK ENERGY T-24
Z Z y( Certi ied cop ' fit ith city inspection division.
CO) Applicant MISC.- REFER TO ORD. v N v NE]
Hy PERMIT ISSUANCE 10.00 FLOODZONE A.L.O.C.
CC CIiRTIFICA E F: EMOTION FROM WORKERS'W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Z( This section need not be completed if the permit is for One TOTAL v❑ N� V N❑
Itundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of Califomio. / 3-a
y
Date Applicant BUILDING
ALTER OR ADD TO MECH. 5.00
} to NOTICE TO APPLICANT: If,after making this Certificate Of Hx-
? emption,you should became 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 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.RM.) 6.00 SEISMIC FEE 5
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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.C,.
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I 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 PLUMBING
Ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city lO enter upon the BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL
ahuve-mentioned property for inspection pugroses.
(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 gains[ said City in consequence of the PERMIT ISSUANCE 10.00
grant in of this cnniL MECH.CONT. LIC.NO. MECH.
ll Z9 TorAL TOTAL
Signa reo pphcant CDntncmr ate
OFFICE COPY