9338Afr
POST THIS CARD NEAR FRONT OF BUILDING
CIT)W CUPERTiNO
INSPECTION DIVISION
JOB INSPECTION RECORD
//�1 �S+
JOB ADORESS _ ZZ Ewe LaneUNIT# LOT# ~
OWNER CONTRACTORy ,
1
;\IFRMI T NumBEH
PERMIT EXPIRATION
'PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
INSPECTION DATE INSPECTOR
INSPECTION RECORD
..FOUNDATION _
��_ �S-/Q oK
UFER_ 0 -
PREGUNITE
y--'
PERMIT VALIDATION
,ISSUANCE: DATE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICAL
BLD�G.
ELECT.
PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
4 1 FORMATION
WOOD FLOOR
PLUMBING � � _
� �
VALORTION
�
§/FT.
MECHANICAL - �_ _
ELECTRICAL
PEHHMIl To
FRAMING
INSULATION
STORIES
TYPE CONSTR. '
P.LACE•NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED.
OCC. GROUP
RES. UNITS-
4 ROOF
SO. FT. FLOOR AREA
TOTALACREAGE
D,IA_P.,HRAGM
y
■
-
HULLOING USE
H IND CON . RD 00...
❑ ❑ ❑ ❑
'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ROUGH
-
LI,
ASSESSORS PARCEL NO.
,, _
PLUMBING •r
GAS TEST
� g -
.Fl/.T2d /I iS•
/r
"TRACT NoO .
PARCEL No.
MECHANICAL
ELECTRICAL d_
FINALS DATE INSP.
ACC.DATE
ACC. FILE No.
FRAMING -'� f -
SANdt � F'
INSULATION.
PLUMBING 3__2
ZONING
ENG. SITENO.
-
GAS t3y.7-
MECHANICAL-"
FIHESPRINK
Y ❑ NO
.E.N2FGYT24
Y ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED.
HEATING - -
LATH-INTERIOR .
ELECTRIC L -UW- i
FLOOD ZONE
" r ❑ .'N'❑
0.LU.C. ,
v ❑_ N❑
LATH-EXTERIOR
FIRE DEP
SHEETROCK
GRADE - -
FEE SUMMARY
SHEAR INTERIOR
BUILDING -2'
"
sulLOwc
'
SHEAR EXTERIOR
TEMPORARY APPROVALS
FIREWALLS
ELECTRIC -
PLAN CHECK
'FEE
'
GAS
PE
NO TAOR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL•BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
J
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
Z �J ;f ONE WORKING DAY BEFORE REQUIRED INSPECTION.
E PLEASE GIVE JOB ADDRESS WHEN PHONING.
F —SEE PERMIT FOR EXPIRATION DATE —
ELECTRIC
.4
PLUMBING
MECHANICAL
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL. INSPECTION.
TOTAL
OFFICE COPY .
I •
. I i Lf r -ILL, uN uvrUKll0AIIUN WITHIN RED LINES —USE BALL POINT PEN ONLY
BUI LOI NO PROJECT I OEMTI FN'ATIf
APPLICATION & PERK PERMITNUMBER
BUILDING — ELECTRICAL— PLUMBING — MECHANICAL 9338
x k FtgssasasEsa�
SWITCHES -RECEP 1@BO/1,00'�
FIXTURES qz/1.00
10 Ye.
SASQ]NEEaPANELS
(OVER 200 AMP) 20.00
PLAN CH CK E ,
LIC. 40.
AacR. oa ENO.
SIGNS TRANS. 300
ADDREEa
SPECIAL CIRCUIT 5,00
PERMIT VALIDATION
AnLICANTa ZIP
EMP, METER OR POLE INS. 20,00
Accuses
MOTORS
y, H.
o or i
SERVICE CHANGE 20.00
V
Foo LICENSED CONTRACTORS DECLARATION
TEMP. POLE
a u u i hereby affirm that 1 am licensed underrovisions of Chapter 9
N a (commencing with Section 7000) Of Division
O'
3 of the Business and
i Professions Cod d license is in full (ore
Z, o 0 - icenae CIm
I58UAN E DATE
p N - o Lin. ra,to
- S j Date Contnctor
4
LD
B� EL QI'
1 u Q
is
5 c i U OWNER -BUILDER DECLARATION
,1 3 w y 1 hereby affirm that 1 am exempt from the Contractor's License
F u o 4 Law for the following reason. (Sec. 7031
MISC. — REFER TO ORD
PPM
.5, Businessand Professions
sW>� Code: Any city or county which requires permit to construct, alter,
o: Q.< O improve, demolish, or
PERMIT ISSUANCE 1Q770
VALUATION
f/FT.
repair any Structure, prior to its issuance, also
O I requires the applicant for such permit to file a signed statement that
n w M he n licensed punuant m the
ELIC. CONTR. LIC. NO.
ELEC.
w.w.
�Q (✓-v y
provisions of the Contractor's License
ZLaw(Chapt<r9fcomm
< encing with Section 70001 ofDivision 3 of th'""•
4 o no and Pro IS Om Code)
••��•'• -..r)r
TOTAL
�-
P RMrt To
or that he is exempt therefrom and
the basis for the alleged exem Ption. Any violation of Section 7031.5
-
r,,:cx, •v::,..:.•„�,.�,.:-
8ik�sIr•SF 142
by anY applicant fora permit subi.cts theapplicanl [oa Civil penalty
of not monMehundred dollen (fS00). I
.li
ALTER -DRAIN Be VENT•WATER
fT RI
TYP ONSTR.
as wn
intertheir sole campneenMl n. will do my.as.)
he work nE the Structure ieel with s or
intended Or, ffend for sale (Sec. 7044, Business
(EAes 5,00
BACK FLOW PROTECT. DEVICE 4.00
°�
a and Proof ons
Code: The Contractor's License Law does not apply to an owner of
property who builds improves
DRAINS -FLOOR, ROOF, AREA, GOND. 5.00
U
�— 3
RET. uNli9
or thereon, and who does such work
himself or through hu own amployeas, provided that such improve-
FIXTURES •PER TRAP 3.E0
manta art not in tended or offend for Mle. If, however, the building
or improvement is mss within one year of completion, the owner-
builder have
GAS•EA.SVSTEM-11NC.40UTLET$•B:BB
FT. FLOOR AREA
i8
TDULACaeAGB
w01 tha burden of proving that he did not build or im•
prove for Itorpose or rale,).
•
GA$ • EA. SYSTEM •OVER 4 IEA.) 2.00
So
❑ 1, AS owner of the property, am exclusively contracting with
licensed contractors to construct the
INDUSTRIAL WASTE INTER. 30,00
BUILDING USE
RES IND CDN pB Otnn
project (Sec. 7044, Business
and Professions Code: The Contractor', License Law does not apply
to
LAWN SPRINKLERS - 1 INC 5 V.B. 8,00
an owner or property who build, or improves thereon, and who
contracts for such projects with a contracrogG licensed pursuant to
LAWN SPRINKLERS •OVER 8 (EA.) 1.00
f ARCEL NO.
9�
the Contractor's License Law,
❑ 1 am exempt under Sen.
SEWER -SANITARY -STORM EA. 200h/
•J — O 7
reason , B.S.P.C. for this
Owner
WATER HEATER WNENT
TRACT NO.
PAR EL NO.
Date
WATER SYSTEM
WORKERS'COMPENSATION DECLARATION
from that I
i55
WATER TREATING EQUIP- 5.00
ACC. DATE
ACC. RILE No.
or a certificate
of WorkersComve a pensation Insurancortircat, of e or a to lcertinM
OPY !hereof (Sec. 3800, Lab.C.I C
Policy No. Company I: 1r�
'3
20441446
ENG. SITE NO.
ifled c embY fumlahM.
z Z ertifit p is filed it city tion
I Of u ertlno
O Applicant division
MISD REFER TO ORD.
FIRESPAINK
ENERGY T-24
.0 CE FICATE OF E%EMPTION OM WORKERS'
1J
PERMIT ISSUANCE
Y N�
Y ❑ NQ
_
COMPENSATION INSURANCE
1 O ILO. CONTR. LIC. NO.
(Tres section need not be completed J 104 PLO.
L0
FLOOD ZONE
A.L.U.C.
z pemmit h for one
hundred dollars if 1001 or ictal
J O 1
TOTAL
Y� N�
Y� N❑
certify that in the performnn of UM TION for which this
'1 U mit is gassed, 1 shall not emplo ray OOs00 M ray manner n a, to
w become wbjecl to the Workers' Compn�liNl Van
of California.
Applicant
)-
ZDate
NOTICE TO APPLICANT: it, net mE1t1EE qy Cart10uM of E.-
emotion, you should become
ALTER OR ADD TO MECH. 5,00.
BUILDING
subject to the mem' Companestbn
Provisions of the Labor Cade, You mm forthwith comply with
APPLIANCE '1 (1
� 5.00
such provision, or this permit thSit be peelped Iasoktl
AIR HANDLING UNIT (TO 1 O/YDC.F.M)
PLAN CHECK
FEE
CONSTRUCTION LENDING AGENCY
4.00
AIR HANDLING IIINIT(
1 hereby affirm that there is a construction NndN
the performance of the work for which this i agency for
8'00
EXHAUST HOOD (WITH DUCT)
SEISMIC FEE wj Fay
3097• Civ.C.). pemfil u istuM ISec.
5.00
Lenders Name
HEATINGUNIT1TO100.0008.T.U.1 8.00
MICROFILM
Lender's Addraa
_
HEATING UNIT (OVER 100,000 B.T.U.19.60
1 certify that 1 have read this application rad Nate that the above
information is correct. I gree to comply with all city and
VENTILATION FAN (SINGLE) 4.00
ELECTRIC _
county
ardinancn and Rate Mws mating to building construction, and
hereby authorize representatives
BOILER• COMP 13 H.P. a 100,000 B.T.U.) 8.00
PLUMBING 7j4
of this city to enter upon the
above-mentioned property for inspection purposes,
B01 LER-COMP IOvv 100,000 BTU) SEE FEE BCH.
IWe) agree to save, indemnify and keep harmlees the City of
Cupertino
MISC.
MECHANICAL
WDWtiea, judgments, costs and expenses which
may
•
REFER TO ORD.
y accrue egauut said Ci in con consequence of the
tint perms,.
PERMIT ISSUANCE 10,0D
CONST. TAX 0b . .
LIC. NO.
DNJ MECH. CONT...
MECH.
• IgnatnR of AppOcant/Contractor
TOTAL
OFFICE COPY