13379 POST THIS CARD NEAR FRONT OF.BUILDING '
•PfRNIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION'
JOB INSPECTION RECORD
VCG'r1/l c.. L - PERMIT EXPIRATION
RR JOB ADDRESS VD UNIT# LOT#
p • PERMIT EXPIRES IF WORK
OWNER ��'IZ,.Q, W CONTRACTOR T- ,� ON IS NOT STARTED WITHIN
r`. INSPECTYON DATE INSPECTOR IPISPECTION RECORD 18.0 DAYS OF PERMIT ISSU-
FOUNDATION. (gyp f�S f=Z�i�'` -t-. �7-- ANCE OR 180 DAYS FROM
I"1 4
LIFER LAST CALLED INSPECTION.
$ �],
PREGUNITE ( PERMIT VALIDATION
"POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED / l�d ` T �� / ✓
UNDERGROUND /SLAB rD au\ v.1 C'
PLUMBING' .{--f 3 7 .U-
`t-7&L a,MJuL Ih 190/ �':'
ELECTRICALISSUANCE DATE
MECHANICAL —tom - a L @µLgo ECT. PLG. MECH.
oil 01 LJ ❑ . El E)DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION'
VAWATION
Pl•UMBING $/FT.
MECHANICAL
ELECTRICAL PERMIT TO
FRAMINGC
STORIES TYPE CONSTR,
INSULATION ! ,!
.00C.GROUP RES,UNITS
1PEA'CE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
gh
ROOF . $O,FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
R[5 IND CON PB ORF"
RAPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El 0 1:1 0
ASSESSORS P ARCEL N0.
PLUMBING ROUGH
GAS TEST TRACT NO PARCELING.
MECHANICAL
.
ELECTRICAL FINALS ' DATE INSP. NCCDATE ACF FILE NO.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING '
GAS
MECHANICAL FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS'BEEN SIGNED HEATING Y ❑ NC] Y ❑ NF]
FLOODZONE A,L.U.C.
LATH-INTERIOR � � ELECTRICAL � v Q N� v I] N❑
LATH-EXTERIOR FIRE DEPT.
SHEETROCK GRADE - FEESUMMARY
SHEAR INTERIOR BUILDING �y�i$
SHEAR EXTERIOR " TEMPORARY APPROVAL BUILDING
FIREWALLS ELECTRIC PLAN CHECK '
GAS FEE
IND TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
uj
1" ONE WORKING DAY BEFORE REQUIRED INSPECTION.- PLUMBING
�r Z� ' `; PLEASE GIVE JOB ADDRESS WHEN PHONI-NG.
• - SEE PERMIT FOR EXPIRATION DATE - ' MECHANICAL
TAX
IMPORTANT! CONST.
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
• 'BU I LDING PROJECT I DENT[FICATION PERMIT NUMBER
171 aUILDIrvG . APPLICATIONS& PERMIT
ADDnESS /0135 sr4*.,/1 ;:. . 133 9
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNERS '« r PLAN CHECK VALIDATION
NAME `� `-�� ply, ELECTRIC PERMIT FEE
J , BK2V)ii CyIrYD r. PHONE
NAME Tons UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
Tt/Ln LIGHTING FIXTURES 10.00/1.00
ADDRESST,opgR):�/a/ G,l44NA OA AV< APPLIANCES-RESIDENTIAL 4.00
G IEc(/w7O O++o F, PXONE996-3 zz PANELS 10.00 DATE OF APPLICATION
ARCHITECT 1 PLAN CHECK FEE P.C.NO.
OR Lila Ewisjwtf[ tE Nb• PANELS (OVER 200 AMP) 20.00
ENGINEF
LIC.No. ISIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
3.
ADDRESS 983 TJJuFs;,a,ICi.•T dWD
W Cylyk ZIP S e TEMP.METER OR POLE INS. 20.00 pPAD
AP
ADDRESS PLI MOTORS SEE FEE SCH. t
S$
SERVICE CHANGE 20.00 Oil-
0
sj/// 'J
woo LICENSED CONTRACTORS DECLARATION p1` /JO I- �/
Lit
a u u I hereby affirm that I am licensed under provisions of Chapter 9 + of `15811UPrANCE DATE
N z w (commencing with Section 7000)of Division 3 of the Business and -
Q y L G. ELECT. PLG. MECH.
H m z Professions Code,.&d my license is in full foqq��..aaEl El
z o m - License Class_p_Lic.NumbeoJSfn flee Z
0 m w Uate �J-2 j/-8�' Contractors+�!'h
a YBUILDING PERMIT
w OWNER-BUILDER DECLARATION INFORMATION
Sae. MISC.- REFER TO ORD
X
; LL NI hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
u 0a1 Law forthe following reason,(Sec.7031.5,Business and Professions PERMITISSUANCE 10.00 22
ry Code:Anycityorcoumy which requires a permit to construct,alter, to..
Q 7OO
a¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
i u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
ww$ he is licensed pursuant to the provisions of the Contractor's License
>w Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe �T�rnl IVA-LC
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
r$ the basis for the alleged exemption.Any violation OfSec ion 7031.5 STORIES TYPE CONSTR.
TR by any applicant for a permit subjects the applicant to a civil penalty gLTER-DRAIN&VENT-WATER (EA.) 5.00 d.d7 '� "�.
of not more than Ove hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole com punsalion,will do the work,and the stnuct are Is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 SQ FT.FLOOR AREA TOTAL ACREAGE
himself or through his awn employees,provided that such improve.
meatsare not intended oroffered for sale.ILImweveglhebuilding GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA) 200
Y„2tl builder will have the burden of proving that hu did not build . . .
or im- BUILDING USE
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 docs 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 contractor(%)licensed pursuant to SEWER-SANITARY-STORM EA.200tt/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to sell'-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereoffSec.3800,Lab.C.)/>♦ETA)A
Policy No. ComPany.aC.=1K^ft!l lm1 Celt,
O ❑ Certified copy is hereby famished. FIRE SPRINK ENERGY T 24
Z ZC1 Certified copy is filed will, the 1 city inspeclion division.
j= MISC.- REFER TO ORD.
O_ Applicant��Y�pe4byN/ Y [DN❑ Y E] N❑
a- IPERMIT ISSUANCE 10,00
� -
CERTIFICATE COPE EXEMPTION FROM WORKERS' FLOOD ZONE AL.u.c.
W COMPEiNSATION INSURANCE PLG.CONTR. LIC.NO. PLG. y E] N❑ Y C3 N❑
Z fhhis section need not be completed if fife permit Is lo,one TOTAL
hundred dollars(5100)or 1 SS.)
U O 1 certify that in the performance of the work for which this per- pTV. MECHANICAL PERMIT FEE FEE SUMMARY
k- mil 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.
d Datc Applleant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT; 11,after making this Certificate of Ex
I.. ? en,ption,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 1000C.F.NL) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMICFEE
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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
LendCer's Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
_
I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information n correct.1 agree to comply with all city and county PLUMBING
.� ordinances and state laws relating to building construction, and BOILER•OJMP(3 H.P.Dr 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. 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, costsxnd expenses which pERM1T ISSUANCE 10.00 CONST.TAX
may in any way accrue,against id Cily in consequence of the
grllnlingof•tlimpermit MECH.CONT. LIC.NO. MECH.
1 R./[x! OJLOUL) TOTAL TOTAL I7 CZp
Signator of Applicant/Contr for Dale
OFFICE COPY