10117 POST THIS CARD NEA RFRONT,OF:BUILDING
PERMIT NUMBER
CITY OF CUPERTINO ��
INSPECTION DIVISION
/ JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER CONTRACTOR - IS NOTSTARTEDWITHIN
INSPECTIO DATE INSPECTOR NSPEC 10 RECORD 180 DAYS OF PERMIT ISSU- '
FOUNDATION _?-' - U ANCE OR 180 DAYS FROM
,7 g� � b ASTCALL'ED INSPECTION.
LIFER vb
• PREGUNITE ;: PERMIT vnuonnory
lea Sl - 3 P-:AID` • .
POUR NO CONCRETE UNTIL ABOVE HAS BE GNED / rJA'N'2 2
UNDERGROUND-/SLAB 1986'. .
PLUMBING - y,� .I
ELECTRICAL City DfISSUANRaIn
MECHANICAL BLDG. ELY PLG. MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
• WOOD FLOOR VALUATION $/FT.
- PLUMBING
MECHANICAL .G. '
ELECTRICAL PERMIT To
FRAMING
INSULATION _�•( .• sroRlEs TYPE corvsna.
1 OCC.GROUP RES.UNITS
T
PLACE NO SU FLOOR UNTIL ABOVEASB N SIGNED /
ROOF SO.FT.FLOORAREA -TOTAL ACREAGE
1 DIAPHRAGM 1 4-1 uDwc USE
1 RES O CON PB Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED A
v y � SP
ROUGH /_ S. _ �y�/
ASSESSORS PARCEL NO.
PLUMBING p _
s
GAS TEST C 7-11-9'6-TyE U,�-• TRACT NO, PARCEL N0.
MECHANICAL C I _ V'
` ACC OATS ACC.FILE NO,
ELECTRICAL - INALS DATE INSP.
FRAMING -.SC 6 SAN # zowNG ENCI sere No:
INSULATION - PLUMBNG 86
GAB Ia ae
fIRE SPRINK ENERGY T 24
MECHANICAL -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y "0 "�
LATH—'INTERIOR O O ELECTRICAL FLOOD ZONE - .A.L.U.C.
LATH—EXTERIOR FIRE DEPT. vEl P,El Yo NQ '
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC ,J• - PLAN CHECK _
GAS - - - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PE RMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDINGINSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lw ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
°z�. PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE,— MECHANICAL
-
``�� CONST.TAX
IMPORTANTI
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
,'BL ILDING PROJECT I DENTI
PD„o t w
FT[ICATION C-
PERMIT NUMBER
APPLICATION PERMIT
BUILDING-ELECTRICAL-PLUMBING-MECHANICL 11
T7
OWNERS PLA
NAME QTYELECTRIC PERMIT FEECo PHONE ZUb ION
A�
CONTRACTORS JAN 2 2 1986
rvnME � ,��� 1 /�� OUTLETS-SWITCHES-RECEP 10.00/1.00
Nli,ll �^'a ce uc.NO, LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 City of Cupertino
OGRESS
Q PHONE PANELS 10,00 DATE APPLICATION
OR
RCRITECT PANELS (OVER 200 AMP) 20.00
PLAN-CHECK
FEE P.C.NO.
ENGINEER
Llc.rvo. SIGNS TRANS. 3.00
non'Ess ENO' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 ;",070
ADDRESS
APPucnrvrs ��(vMOTORS A SEE FEE SCH. p,/7LN '/
SERVICE CHANGE 20,00
woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
< u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
H z "' (commencing with Section 1000)of Division 3 of the Business and
¢ n BLDG. ELELT. PLG. MECH.
7 Professions Code, m license is in full force and effect.
O 0 u°l W License Class_.Y Lic.Number ❑ ❑ ❑
Date - Contractor
a x f�f BUILDING PERMIT
¢ o a D OWNER-BUILDER DECLARATION - INFORMATION
wI hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
a.u Y' P VALUATION $/FT.
r _ D¢ Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 /
Code:Any city orcounty whichrequiresapermit m construct,alter,
/76 GI-�f-p
ac , ¢ improve,demolish',or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
e auat requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
m lie is licensed pursuant to the provisions of the Contr:mlor's License
F z i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe Tyf/w
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE vs i
¢ m the basis lox the alleged exemption.Any violation of Section7031.5 STORES TYPE CO
A. by any applicant for a permit subjects the applicant too civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00 /`�/- � 11412
of not more than five hundred dollars(5500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT,DEVICE 4.00 OCC.GROUP REB./JNITS
their sole compensation,will do the work,and the structure is not I
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.FVIOR AREA TOTAL ACREAGE
• mems are not hrough
or offerdforS, le.If,ed however,
the
improve GAS-EA.SYSTEM-1 6.00
mems are not intended or offered for sale.If,however,the building s'21-1 7
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
Timebuilderwill have the burden of proving That he did not build or im- RES IN CON Pe Other
prove 1,asofor nee of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ L as owner of the properly,he exclusively. 7044,Bij with ❑ ❑ ❑
licensed contractors to construct the project La 7044,Business LAWN SPRINKLERS-1 INC 6 V.B. 6.00 ASSESSORS PA EL NO.
and Professions Code:The Contractor's License Law does not apply '
to anowner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 9(EQ.) 1.00
contracts for such projects with a conlror(
ctos)licensed pursuant in - _j,C/-0
the Contmctar's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
17 1 am exempt under See. ,B.&P.C.fur this WATER HEATER W/VENT 6.00 (�
reason 7 Q
Owner Date WATER SYSTEM 5.00 ACC.DATE_ ACC.FILE NO,
WO KERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I h r•by of inn al I have a ce ft ifcate o f consent to set f-Insuru,
ora ificat i o crs oro enwtiop Insurance,or a mrtifieJ ZONING ENG.SITE NO.
copy I • C
Polic P i
O ❑ CeHI(I c0 yis het yfur ' •d. FIRE SPRINK ENERGY TQ4
Z Z �Ix' Certific is •d IDs the city inspection division. MISC.• REFER TO ORD.
Q APP,c.nl Y❑ N❑ Y ❑ N❑
~ va PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
'UJ CIiRTIFI OMO SATIOTINS FROM WORKER$'
W � COMPENSATION INSURANCE PLG.CONTR. LIC.No. PLG.
Z (This section need not be completed if the permit is for one TOTAL Y E) N❑ Y[:] N[3N
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shot]not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California. / �,V.
O y Dam Applicant ALTER OR ADO TO MECH. 5.00 BUILDING to a3
} N NOTICE TO APPLICANT: 11',after making this Certificate of Ex.
Z 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
C..1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER 1OPMC.EM.) 6.00 SEISMIC FEE •3
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. MICROFILM
3007,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 that the above VENTILATION FAN (SINGLE) 4,00
y. Information n correct. I agree to comply with all city ucti county BOILER;COMP 13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
I ordinances and slate laws relating to comply
with
construction, and BOILER
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEEFEESCH. 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 which PERMIT ISSUANCE 10.00 CONST.TAX ASL �B
may in any way accrue goinst said City in consequence of the
grand of eh's ermit MECH.CONT. LIC.NO. MECH.
I I b`7 � TOTAL TOTAL
Sig ure of pplicant/Contractor )ate
OFFICE COPY