8277 POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO MIT NUMI3EH
!4277
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 1 UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER Mr A,ki all 146 nceinCONTRACTOR - IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLG. MECH.
Elf, Of
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION SIFT.
,
MECHANICAL
ELECTRICAL It PE ITT
FRAMING
INSULATION S� RIs i -TYPE CONST .
r
i
- OCC.G UPf6 5'UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF , SO.FT_FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
'BUILDING USE
HL IND CON PB Oiner
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED t ❑ ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO
PLUMBING SS
GAS'PEST - TRACT NO. PARCEL NO.
MECHANICAL 325'-
ELECTRICALL FILE NO.
- '3 j - FINALS DATE INSP. ACC.OATE AC
FRAMING �.�• SAN # ,
INSULATION PLUMBING zoNING ENG.SITE NO.
GAS _
MECHANICAL FIRE SPRINN ENERGYh4G
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING (i- ./Y ❑ N Y ❑ N❑
LATH—INTERIOR ELECTRICAL FLOODzoNE A.L.U.C.
LATH—EXTERIOR FIRE DEPT. Y N❑ Y N❑
SHEETROCK GRADE
FEE SUMMARY
SHEAR INTERIOR
BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS VBUILDING I ,.
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
"r 1
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED By BUILDING INSPECTOR. MICROFILM �
ARRANGE FOR INSPECTION BY PHONING 252-450'5 ELECTRIC /
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING :
PLEASE GIVE JOB ADDRESS WHEN PHONING. I r
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANTI CONST.TA1. !
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 LDI NG PROJECT 1 DENTI FICATION PERMIT NUMBER
Ruuo,Nc - APPLICATION & PERMIT
AOOREss BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
O NER'
NAME PL CH ECK VALIDATION
. TV. ELECTRIC PERMIT FEE
MA s- Ml T HONE I/ 0
CONTRACTOR'S Q UTLETS-SWITCHES-RECEP 1.00
t LIC.NO. 3 R7 LIGHTING FIXTURES x/1.00
noONess TOR PPLIANCES-RESIDENTIAL 4.00
,. 1�14^ PHONE L- 5 PANELS 10.00 DATE OF APPLICATION
ARC ,i ECi PLAN CHECK FEE
OR PANELS (OVER 200 AMP) 20.00 P.C.NO.
ENGINEER ��
LIC.No. SIGNS TRANS. 3.00
ADDRESS ENG. '- SPECIAL CIRCUIT 5.00 9�P` 116 y:LlDnnoN
ZIP EMP.METER OR POLE INS. 20.00 MAR
I� EE 6,�
APPLICANTS MOTORS SEE FEE SCH, MAR 21 1985
l CV(,(- SERVICE CHANGE 20.00
0 0 o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 City Of Cupertino
or o F 1 Uochy affirm that I :un licensed under provisions of Chapter 9
i ISSUANCE DATE
y¢m (commencing with Section 70001 of Division 3 of the Business and LD LE T. PL MEC
H N Z Professions Co an-d+ny license is in full f n figc o-
z O m- License Class �1_Lie.Numbc {{'' ll_
4 N F Date Contractor �,,,e (,(
M Q w ¢ OWNER-BUILDER DECLARATION BUI DING P RMIT
' O'D MISC.- REFER TO ORD INFORMATION
w g aa H I hereby affirm that I am exempt from the Contractor's License
u O¢ Law for the following reason.(Sec.7031.5,Businessand Professions V ALU TION S/FT.
- < Codes An cit or count PERMIT ISSUANCE
Y Y y which requires a permit to construct,alter,
QQ¢ improve,demolish•or repair any structure,prior to its issuance,also EC. OATH LIQ NO.
ou requires the applicant for such permit to file a signed statement that TOTq Er
A w m he is licensed pursuant to the provisions of the Contractors License 1 In r PERMIT TO
z a
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
4 O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ ,- o the basis for the alleged exemption.Any violation of Section 7031.5 TO T P CO TR.
v ;m by anyapplicent fora permit subjects the applicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of nod more than five hundred dollars(8500).):
❑ L as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEV ICE 4.00
their sole compensation,will do the work,and dile structrlre is not OCC.GRO9P MES.UNITS
intended or offered for sale (Sec. 7044• Business and Professions DRAINS-FLOOR,ROOF,AREA,CO D. 5.00
Code The Contractor;s License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP
himself or through his own employees,provided that such improve-
SD.FT.PLOOR AREA TOTAL ACREAGE
ments are not intended or offered for sale.If.however.the building GAS-EA.SYSTEM-1 INC.4 OUTLF
R improvement is sold within one year of completion,Ore owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder,will have the burden of proving that he did not build or im- BUILDING USE
prove 1,aso neeose of sale.). INDUSTRIAL WASTE INTER. 30.00 R IN❑D C❑ON O Other
❑ L as owner Of dile property,he exclusively contacting with
and Pro colons Core 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 dons not apply
to anowner of property who builds or improves Increta,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contmetor(s)licensed pursuant to
the C-ame nLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ tum exempt
under
r Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5,00
ACC.DATE ACC.RLE NO.
WORK HRS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00 '
1 hereby affirm that I have a certificate of consent to self-insure.
or a certificate of Workers'Compensation Insurance,ora rt I ZONING ENG.SITE NO.
copy thelli( 00.Lab.CJ.
Policy NAi:/�/_S1Company
0 ❑ Cerhsed copy is hereby fum¢hed. FIRE SPRINK ENERGY Z Z t -Certif copy Is filed iif the city inspection div7sion.
F O Applicant � opy Is MISC.- REFER TO ORD. y [ N� v C] N[]
Cr L CERTI`PI-CAI Is
EX EMPIION FROM WORKERS' PERMIT ISS U ANCE O zow FLOOD ZONE A.L.U.C.
W COMPENSATION INSURANCE G.C NT LIC NO. PLO
CIL O (This section need not be completed if the permit is for one 0 TOTAL Y N� V N�
Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per-
LL H mit is issued, I shall not employ any person in any manner so as to OTY' MECHANICAL PERMIT FEE FEE SUMMARY
O C) become subject to the Workers Compensation Laws of California.
6 Dat` ApplicaAPPLICANT:
ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,afror making this Certificate sa Ex-
F ? provision you should become Co subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions io the Labor Code, you must drevoke comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER10=C.EM.) 6.00 ISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD WITH DUCT) r
the performance of the work for which this permit is issued(Sec -
3097,Civ.C,h HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lender's Address HEATINGUNIT(OVER100,000B.T.U.)9.50 ELECTRIC
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
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino ainst liabilities,judgments, costs and expenses which
in a way accrue against said City in consequence of the PERMIT ISSUANCE 1 CONST.TAX
gra mg oft is pen L MECH.CONT. LIC.NO. MECH.
OTAL
l acute of pp c" t/Contractor Date 1 ` L O l?01 TOTAL D
vw J 1
OFFICE COPY