12379 r ,
POST THIS CARD NEAR FRONT OF BUILDING
PFRMIT NUMBER
CITY OF CUPERTINO 123?9
INSPECTION DIVISION
• JOB INSPECTION RECORD
PERMIT EXPIRATIOA)
JOB ADORE LINIT# LOT#
PERMIT EXPIRES IF WORK
OWNER NT ACTOR IS NOT STARTED WITHIN
INSPOCTIQIN I DATE INS PE 0 INSPECT N ECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION y -k lc _2 l-�_y,���-' p IOC ANCE OR 180 DAYS FROM
UFER Y LAST CALLED INSPECTION.S'
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - ISSUANCE DATE
MECHANICAL - R D EE C PLG. CH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUIL ING PERMI
IN ORMATIO
WOOD FLOOR VALUATION SIFT.
PLUMBING -
MECHANICAL
PERM TO
ELECTRICAL
FRAMING
INSULATION sro res rvP.c>NsrR.
- OCC.GROUP HE .UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - SO,FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING ON USE
" NLS IND CON PB OIM1B,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 0 ❑ ❑ ❑
ASSESSORS PARCEL NO. -
ROUGH
PLUMBING TRACT No, PARCEL No,
GAS TEST
MECHANICAL '
ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN # '
ZONING ENG.SITE NO.
INSULATION D PLUMBING
GAS
MECHANICAL FIRE SPRINK ENERGY TQE
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` "� ` NEI
,
LATH—INTERIOR - ELECTRICAL M
f7 FLOOD20NE AL.U.C.
LATH—EXTERIOR I FIRE DEPT. Y❑ N❑ ❑ No
SHEETROCK IGRADE FEE SUMMARY
SHEAR INTERIOR BUILDING ..'?,
SHEAR EXTERIOR TEMPORARY APPROVALSBUILDwG
FIREWALLS - ELECTRIC _I PLAN CHECK
. FEE I
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE "I
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY.BUI,LDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
0� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
• Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
BUILDING PROJECT I DENT]FICATI ON PERMIT NUMBER
7 a ILPING APPLICATION & PERMIT
N OLI 455
Z Z> BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 12379
OWNER'S PLAN CHECK VALIDATION
Q7. ELECTRIC PERMIT dEE
RSPHONE (p 3 7
NAME cions ( OUTLETS-SWITCHES-RECEP 10.00/1.00 (
NAME ` qq
LIGHTING FIXTURES 10.00/1.00ADDRESS -Rs H k%KJ< APPLIANCES-RESIDENTIAL 4.00s�
CONTRA /yLf .F
S- - PHONE 20115PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.NO. ISIGNS TRANS. 3.00
ARCH OR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLP 20.00
APPLICANT'S
ADDRESS
� . A O MOTORS SCH.E
l
S T L Q$OS SERVICE CHANGE 20,00 (�
Roo LICENSED CONTRACTORS DECLARATION p �51^(yy�8T
rt ewa u I hereby affirm that I am licensed under provisions of Chapter 9 1 MIRAI DAZE
f G (commencing with Section 7000)of Division 3 of the Business and B DG. ELECT. PLG. MECH.
'A o Z Professions Code nd m license is in full force and effe� 0
Vi-
.Z o y, License Class Lie.Number Jl(-7 q/ -�F Irawd clo
ru
Q m R Date �- j $7 Comracyy��;
¢ l2 e BUILDING PERMIT
¢ li w u OWNER-BUILDER DECLARATION INFORMATION
0o MISC.- REFER TO ORD
X 0 u N I hereby affirm that I am exempt from the Contractor's License VALUATION S/FT.
ae u o a, Law for the following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE 10.00
r - Code:Any city orcountywhich mEluiresapermit toconstruct,alter,
W
22
¢ ¢ ¢ 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 1l
_ L f/I U
Ix - G LL requires the applicant for such permit to file a signed statement that TOTAL Q pE MIT TO
whe is licensed pursuant to the provisions of the Contractor's License
r z � Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
¢ Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢= the basis for the alleged exemption.Any violation of Section 7031.5
S DRIEST PE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S500).):
❑ 1,as owner of 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 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 docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve
eats are not intended or offered for sale.l f,however,the building GAS
or
8.00
m
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 that he did not build or int.
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ I,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 dues 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 contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,BAP.C.for this WATER HEATER WIVENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.-DATE ACC.FILE NO.
WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG,SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy there f(Sec.3800,LalyC -
Policy No. fi'
Q ❑ Cc[i fled copy is creby furni5lied. FIRE SPRINK ENERGY T 24
Z Z ❑ Ce " d mp Mted with the cit {`pectiml division. MISC.- REFER TO ORD.
O APPliCant f"� Y E] N❑ Y ❑ No
~ SatPERMIT ISSUANCE 10.00 PLOoo zOrvE AL.u.c.
Lu CfiRTIFICATF,OFSATI FROM WORKERS'W COMPENSATION INSURANCE: PLG.CONTR. LIC.NO. PLG,
1 O (This section need not he Completed if the permit is for one TOTAL V❑ N❑ V ❑ N❑
=) Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per. QTY. MECH AL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California. -
Date Applicant ( ALTER OR A D TO 5.00 BUILDING �
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex.
Z emption,you should become subject to the Workers'Compensation gPPL
IANC 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply wit h FEE
U such provisions or this permit shall be deemed revoked. AIR HAND UNIT(TO F.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLIN I 10,000QF.M.16.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST H (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 6.00 MICROFILM
3097,Civ.CJ.
Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 3Q
Lender's Address
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 601LER•COMP13 H,P.O(100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construcliom and
hereby authorize representatives of this city to enter upon lbe `
above mentioned property for inspection purposesBOILER-COMP IOver,100,000 BTU)SEE FEE SCH. MECHANICAL
. �V
(We) agree to save, indemnify and keep Imrmless the City of MISC.- REFER TO ORD.
Cup lino against liabilities,judgments, costs and expenses which Is ISSUANCE 10.00 - CONST.TAX
m in any way ac egagainst Said City in consequence of the
r' tin 0 61.1 MECH.CONT. LIC.NO, MECH.
TOTAL lS TOTAL CtS
stare m Ap IicanllC Calif
��CO AY All 644-7- OFFICE COPY