C 9237 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
. . CIN .OF, CUPERTINO 237
INSPECTION DIVISION
JOB INSPECTION.RECORD
/ /� n�i1 I� .�j� PERMIT EXPIRATION
�` JOB ADDRESS Z23�� IIDnNI� „ff9i-OL UNIT,# LOT# -
,PERMIT EXPIRES IF WORK
OWNER .S, CONTRACTOR ' ISNOT STARTED'WITHIN
-
INSPECTWN DATE INSPECTOR �,VSPECTION RECORD 780 DAYS OF PERMIT ISSU-
FOUNDATION — • .. ;ANCE OR 180 DAYS FROM
LIFER
LASTCALLED INSPECTION. •
PREGUNITE P / AnoN
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED F• - AUG. - 21985
UNDERGROUND /SLAB CIiY 0f CU
PLUMBING . pertino,
ELECTRICAL - - ISSUANCE DATE
MECHANICAL LUG. ELECT. PLG. MECH.
o o 11
- DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING _ VALUATION
MECHANICAL ,
iELECTRICAL - '•LII vERMrt TO
FRAMING O1 E
- STO IEI
INSULATION S `TYPE CONSTR,
- - -
OCC.GROUP RES,UNITS-
' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF • • SO.FT,FLOOR AREA TOTAL ACREAGE -
DIAPHRAGM
BUILDING'USE
RES. IND CON PB OJ.er
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ -
ROUGH ASSESSORS PARCEL NO. -
PLUMBING
-
GAS TEST TRACT NO. PARCEL NO.
� � � -
MECHANICAL
' ELECTRICALS FINALS DATE INSP. ACC
. . .DATE ACC.FILE NO,
FRAMING SAN #
INSULATION - PLUMBING ZONING • ENG,SITE No.
GAS
MECHANICAL FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING y ❑ N Y ❑• No
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C.
LATH—EXTERIOR FIRE DEPT. - - • Y❑ N❑ YI�7 N❑
SHEETROCK GRADE , . FEE SUMMARY
SHEAR INTERIOR - BUILDING —
SHEAR,EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK_' Fir
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE.
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR': MICROFILM
ARRANGE FOR INSPECTION BY.PHONING 252-4505, ELECTRIC
0O
ONE WORKING DAY BEFORE REQUIRED•INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING..
— SEE PERMIT FOR EXPIRATION DATE — MECHANiCAL
I
IMPORTANT! coNsr.rnx -
PLEASE READ REVERSE SIDE BEFORE TOTAL:"
CALLING FOR FINAL INSPECTION. ."
' .. .OFFICE COPY.
, f
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
.�, BU I LDING PROJECT I DENTI Fir'ION APPLICATION & P AIT g237
AOOREss -
Z 23 SL(o N BUILDING-ELECTRICAL-PLUMBING-MECHANICAL Cl
OWNER'S - O •.-I , .H.. [,.T: PLAN CHECK VALIDATION
IT'>'">'
NAME (j (�OTY. ' ELECTRIC PERM ^ ��FEE"+
I C PHONE _..
CONTRACTOR'S
NAmE UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.NO. LIGHTING FIXTURES 10.00/1.00
ADDRESS TGR's PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10,00 DATE OF APPLICATION
OARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE D.C.N0.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
AnooAess ENG. SPECIAL CIRCUIT 5,00 PE ATION
ZIP EMP.METER OR POLE INS. 20.00
APPucANrs MOTORS SEE FEE SCH. ' 1y85
ADDRESS U
SERVICE CHANGE 20.00
W
02 LICENSED CONTRACTORS DECLARATION TEMP,POLE 30.00 OFC yQf iil;O
a u �u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
h z w (commencing with Section 7000)of Division 3 of the Business and
¢ c B D ELECT. PLG. MECH.
H z i Professions Code,and my license is in full force and effect. ❑ ❑ ❑
0= W License Class Lic.Number
w H Date Contractor
am4 BUILDING PERMIT•I
OWNER-BUILDER
x x w R-BUILDER DECLARATION INFORMATION' �>
X a. e H 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD --
u o a Law for the following reason.(Sec.]031.5,Business and Professions VALUATION] S/FT.
- PERMIT ISSUANCE 10.00
F va� Code:proe,y city Or eouney it any str requires une permit rioto consuance, ter,
x i ¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.
i u o u requires the applicant for such permit to file a signed statement that TOTAL
w$ he is licensed pursuant to the provisions of the Contractor'sPERMIT TO
License - 1 1 `
H z r
Law(Chapter 9lcommencing with Section 70001 of Division ision3of the •" ' 1,.'
f 4 4 Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBINGPERMIT-7 -'FEE"
x H$ the basis for the alleged exemption.Any violation of Section 7031.5 " - STORIES TYPE CONSTR.
s ; 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(55000:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP REB.urvlTs
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,ARE&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 Sp.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve.
ments are or intended or offered for sale.I L however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EASYSTEM-OVER 4 IEA.) 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 S IND CON Pe Other
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ 1:1 0
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cade:The Contractor's License Law does not apply
to an-owner of property who builds or improves thereon.4nd who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractortsl licensed pursuant to
she Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10,00 TRACT NO. PARCEL NO.
❑ lam axe under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Ow
Date7-717�3 WATER SYSTEM 5.00 ACC.GATE ACC.FILE NO,
WO ERS'CO TION DECLARATION WATER TREATING EQUIP. 5.00
I hereby !firm that I hap certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800.Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T is
Z Z C1 Certified copy is fled with the city inspection division.
1- O Applicant MISC.- REFER TO ORD. y No v N[3
CCy CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U.C.
L COMPENSATION INSURANCE PLG.CONTR. LIC NO. PLG,
CLZ( This section need not be completed if the permit is for one TOTAL Y NC] v NC]
U O hundred dollars(S10o)or less.)
I certify that in the performance of the work for which this per- OTV r' ' FEE.BUMMARN'
MECHANICAL PERMIT PEE
LL H mit is issued, I shall not employ any person in any manner so as to 1'•d
U become subject to the Workeri Compensation Laws of California.
O i Date Applicant BUILDING
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
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 10p00C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE JC
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 ITO 100,000 B.T.U.) 6.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that 1 have read(his 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-COIv1P13 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives ofthis city eu enter upon the
above-mentioned property for inspection
BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
hipurposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against IiebiliY gmenls, costs and expenses which CONST.TAX
may in any way ace again said City in consequence of the PERMIT ISSUANCE 10,00
grantin is perm' 7 MECH.CONT. LIC.NO. TOTAL
ignature o vlil: m tractor 7
Date :TOTAL
/ VOFFICE COPY