12388 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO `'` 12388
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT'EXPIRATION
JOB ADDRESS ��-�'� �\'g'P�A01.1✓ UNIT#- LOT# X -
_ SYS PERMIT EXPIRES IF WORK
OWNER ��,�,fq G,. i CONTRACTOR �p (f IS NOT STARTED WITHIN
IN�E"G1'Iald. D',T9 INSPECTOR INSPEC ON RECOREY 180 DAYS OF PERMIT ISSU-
FOUNDATION NS - .ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER yS J '
PREGUNITEG'-D - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED r
UNDERGROUND /SLAB PAXD �. 7_
PLUMBING
ELECTRICAL bN I dSSUJANCE DATE
MECHANICAL - BL[G. ELECT, PLG. MECH.
Lip U1 0❑ '
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WINFORMATION
WOOD FLOOR
VALUATION $IFT.
PLUMBING - - -
MECHANICAL `� " •�
ELECTRICAL L •LPERMIT To `+
FRAMING
INSULATION - STORIES TYPqCOHS'R.
OCC.GROUP RES/NITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SUFT.FL00RAREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
RESIND CON PBN
. Oei
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑. ❑ ❑ ❑
--ROUGH ASSESSORS PARCEL N0:
_ n O /t�OT� s� '9=2s-�7 0 uc Sit4aGt -
PLUMBINGI -jP ,V Ati 7 eluw WJT// A,4740 VO rRAcr No. PARCEL No
GAS TEST-�..J Y(1'2, SbG/�r�'packc O - e J
MECHANICAL 1 X12 � 4?'�-cv�W�, -2(
ACC.DATE ACC FILE NO.
ELECTRICAL FINALS DATE. INSP:
FRAMING -1, - SAN'0 4 7
ZONING ENG.SITE NO.
INSULATION � 2 -�. PLUMBING ia9ff UP--
AS FIRE SPRINK ENERGY TpE
el • MECHANICAL ♦ -i Y ❑ N❑ v ❑ N❑
COVER•N0,WORK'UNTIL ABOVE HAS BEEN SIGNED 'I HEATING
.U.
LATH-INTERIOR - 3- ELECTRICAL FLOOD ZONE A.LC.
LATH-EXTERIOR FIRE DEPT. . Y❑ N❑ _Y ❑ NE]
SHEETROCK - �, s 7 GRADE FEESUMMARY . ,,,
SHEAR INTERIOR - F:P7 ' BUILDIN - L
SHEAR EXTERIOR -f-lif-P7 II/FS TEMPORA APPROVALS BUILDING
FIREWALLS - ELECTRIC PLAN CHECK
0- GAS FEE
-
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I SEISMIC FE6 71'
OCCUPANCY OF BUILDING IS NOT PERMITTED LNIT�1_" :LDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
' 1
ARRANGE FOR INSPECTION BY PHONING 252-4505,' ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
• — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
CONST.TAX '+' 'l 1 a
IMPORTANT!
PLEASE READ REVERSE SIDE BEFOREr
CALLING FOR FINAL INSPECTION: TOTAL
OFFICECOPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
8131 LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
TU-ILDING ^ APPLICATION & PERMIT
DRESS ^ n
d� 'MT�N 4(.[/ ^7 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
NpuE^R'S _ 388
J /��5 PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
GREJEURY GROUP PHDN 7 A&10 S-S'
CVNTRACTO '� J - 1
NAME CjILLQ rL� OUTLETS-SWITCHES-RECEP 10.00/1.00 �
tri" rte.// uc.Na. 009 LIGHTING FIXTURES 10.00/1.00 /(p CJ
CONTRACTORS � � PPLIANCES-RESIDENTIAL 4.00
AOOR ss
CPHONE D" PANELS 10.00 DATE OF APPLICATION
ON
ARCHITECT ^_ , - �_ ' PLAN CHECK FEE P.C.N0.
v�-�J��s�"`-� PANELS (OVER 200 AMP) 20.00
EiGINE ✓n 0(1 No. / SIGNS TRANS. - 3.00
AR.SS ENG.��7 v PERMIT VALIDATION
ADDRESS OR SPECIAL CIflCUIT 5.00
1Q�!l eL ZIP fzzlla TEMP.METER OR POLE INS. 20.00
ADDRESS �x�Q MOTORS SEE FEE SEH. AIDS
APPLICA
Cti `W Ci41O IOVSERVICE CHANGE 20.00
2
0
Foo LICENSED CONTRACTORS DECLARATION Mt
a U I hereby affirm that 1 am licensed under provisions of Chapter 9 IS A CE DATE
as z"' (commencing with Section 7000)of Division 3 of the Business and
Q y PLG. MECH.
H N z Professions Code,a y license is in full force arW effort„ ❑ ❑ ❑
o i m C License Class Lia Nnnbe, lA7.P-U7
Date Contractor
Qyf
rc a a OWNER-BUILDER DECLARATION BUILDING PERMIT
u - INFORMATION
o a
X ; u. 1 hereby affirm tint 1 am exempt from the Contractor's License MISC.- REFER TO ORD
a_ Law Law forthe followm reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
L• - Code:Anycity orcounty which mquiresa permit toconstrum,alter,
m
a Fo improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
i E o u requires the applicant for such permit to file a signed statement that TOTAL
X $ he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
F i i Luw(Chapter 9(commeneing with Section 7000)of Division 3 of the LS/
i i c Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
M r m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TY"E CONSTR.
by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN IEA.) 5.00 /-
of not more than five hundred dollars(55001.): ALTER- rsL J
❑ I,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 doessuch work FIXTURES-PER TRAP 5.0D SQ FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
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 MD 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 ASSE5SOR5PARCEL NO.
and Professions Code:'fhe Contractors License Law does not apply
to / �p
an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 ' -J -313--
y J
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
rea❑son I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
7
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have u cerlificale ofcunsent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insuran ora certified
copy thereof(See.3800,Lab.C.)1& Cl� z�/� 7
Policy No. Company /T-
O Ctrtt F. dcypy is here by fufnishc♦,d,�.�/ FIRE SPRINK ENERGY T-24
CelrtiOie�d . is riled wi u t os ectiml Ivision. ❑ ❑ ❑ ❑
Zp ucmut�G c WsI tt, yt`LII�/.t�p MISC.- REFER TO ORD. Y N Y N
CC to --- T PERMIT ISSUANCE 10.00
CC - CERTIFICATE OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.O.G.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
Z (This section need not be completed if the permit is for one TOTAL Y F] N❑ Y❑ No
hundred dollars(S 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 F mit is issued,I shall not employ any person in any Horner so as In
O become subject to the Workers'Compensation Laws of California.
IS. Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING G�S4D
} as NOTICE TO APPLICANT: If,after making this Certificate of Ex-
♦- 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 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(QVER 10=C.EM.) 6.00 SEISMIC FEE
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
3097,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 l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county BOILER-COMPI3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
1 ordinances and state laws relating to building construction, and
hereby autlnrize representatives of this city to enter upon the BOILER-COMP (Over l00,0008TU15EE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, Indemnify and keep harmless the City of MISC.- REFER TO ORD. 91L'Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX 7x3 7 L j
may way accrue agams aid City in consequence of the
flandfiling oft sperm it
y MECH.CONT. LIC.NO. MECH.TOTAL TOTAL 3�-35
Signa re of Applicant/Con raclor Date '
OFFICE COPY