9357 POSTTHISCARD,NEAR FRONT OF BUILDING , pENMITNGM EH
` •CITY£ OF CUPERTINO
INSPECTION DIVISION '
9357
a•, « JOB INSPECTION'RECORD
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t �
7,,> 3 PERMIT EXPIRATION
Z004r�/ v� GKK u
JOB ADDRESS UNIT#�" " # PERMIT, EXPIRES IF WORK '
OWNER �Gj CONTRACTOR IS' NOT 'STARTEO'WITHIN
•. INSPECTION ' DATE INSPECTOR INSPEC ON RECORD . -.'180 DAYS,OF:PERMITASSU-
"FOUNDATION ' a ANCE OR '180 DAYS FROM
-LAST CALLED•INSPECTION ,
' UFERr .,
PR EGUNITE 'PeRMITVALIDnnoN "s '
POUR NO CONCRETE,UNTIL ABOVE HAS-BEEN SIGNED
UNDERGROUND=/SLAB,'
PLUMBING i ¢ � 5
ELECTRICAL I ISSUANCE ATE°
MECHANICAL .. - B4Dc." 'ELecr. vca , MECN.
I 00 NOT POUR FLOOR;'UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT WOOD FLOOR'FLOOR-' = "i- . ^ INFORMATION
PLUMBING ZI 1, 'vnwnnoN SrEr
MECHANICAL',
RMIT TO
FRAMING: _
,STORI'S iTYPE ]ONSTR
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NSU L'ATION," ?n.
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-OCC.GROUPf "RES.UNITS'
•
PLACE NO F
AC SUB L00R UNTIL ABOVE HAS BEEN SIGNED '
ROOF _ , , $O,FT FLOOR AREA TOTAL ACREAGE
fv 4.1' I
yyyy DIAPHRAGM .E r ,• r
BUILDING,USE
Ii ES IND CON " PB O lur
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED., ASSESSUH PARCEL NO."
ROUGH ,� ' . . ,�,-
PLUMBING'
GAS TEST ::.•s• .I. - TRACT NO. , PARCEL NO
MECHANICAL
ACC.DATE. ,. ACC.FILE NO.
ELECTRICAL' -z2'&S FINALS . ' DATE INSP. ,
'FRAMING', . ��1_ SAN #
} - -TONING 'ENG.SITE NO.
' INSULATION - PLUMBING x J
GAS FINE SPRINK. ENERGY T"2J
MECHANICAL-_1, :y
'COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v,Q "-❑ v Q N❑
LATH—'INTERIOR. ELECTRICAL-` �: ''FLoaO zoNE n.L:u.c.; a
{'. LATH-EXTERIOR - ��" FIRE DEPT. v❑ N❑ `' v `] NO t
SHEETROCK' � ' _ GRADE ,+ '•• .'FEE SUMMARY
SHE'AR'INTERIOR BUILDING 'r, • <
RUILDING
' SHEAR EXTERIOR .: " ,. "TEMPORARY APPROVALS. �
Y`
FIREWALLS ELECTRIC 1. ELECTRIC - �/ — PLANCHECK
.''' - GAS ;•i
FEE r
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY •' =i, sti .SEISMIC,FEE
OCCUPANCVOF BUILDING ISNOTPERMITTED UNTILBUILDING"FINAL.ISSIGNEDBY BUILDING INSPECTOR. '
MICROFILM
;ARRANGE FOR'INSPECTION BY PHONING 252-4505, ELECTRIC ,
F_ ONE WORKING DAY BEFORE REQUIRED'INSPECTION PLUMBING
0 PLEASE GIVEJOB ADDRESS WHEN PHONING. . ,
Z MECHANICAL°''
— SEE PERMIT FOR•EXPIRAT.ION DATE '=
IMPORTANT! CONST.TAX
".
PLEASE READ REVERSE SIDE BEFORE ';TOTAL .
CALLING FOR.FINAL INSPECTION.
T' tOFFICE COPY K - `
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL,POINT PEN ONLY
B "BUILDING PROJECT IDENTIFICATION
PERMIT NUMBER
gI,LD,Nr, - APPLICATION'&-PERMIT. ����
ao REss
BUILDING-'ELECTRICAL-PLUMBING-MECHANICAL
OwNEH'S r' a-rL �. -c - - AN CHECK VALIDATION
NAME DTV. ELECTRIC PERMIT FEE
CONTRACTOR'S
NAME � UTLETS=SWITCHES-RECEP 10,00/1,00
ft�e- O�>1- Lic.No. .i K,I�� LIGHTING FIXTURES10,00/1.00
CONTRACTOR
TORS
AODSS ,J I APPLIANCES-RESIDENTIAL 4.00 -
5 ;��A o L$ vfi-9/yam
PRONE 9' ✓ PANELS 10.00 DATE OF APPLICATION
ARCH TECTPLAN CHECK FEE P.C.NO.
etw r
we wewt
-tic.rvo PANELS (OVER 200 AMPI 20.00 is SIGNS TRANS. 3:00
ARCH,OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
rF EMP,METER OR POLE INS. 20.00 n n �•,J
_
APPLICANT'S
SS �r MOTORS SEE FEE SCH.
ADDRESS ADOH -
SERVICE CHANGE 20.00
o ¢ i
M. Z. LICENSED CONTRACTORS DECLARATION - - TEMP.POLE 30.00
Be
u I hereby affirm that I am licensed under provisions of Chapter 9 - ' ISSUANCE DATE
"' '(commencing with Section 7000)of.Division 3 of the Business and
a a BL ELECT. PLG. MECH.
D i Professions Code,' my license is in full for •'i of�e�tz
zo - License Cl'sLic.Number �¢Q��)Z� ED
-
4 m - Dale Contractor A"r1c � ❑
r
s, m - BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION
¢ w u INFORMATION
is 3. e N - I hereby affirm that I am exempt from the Contractors License _ MISC.- REFER TO ORD
at Fn00J Law for the following reason. 7031.5,Business and Professions ' PERMIT ISSUANCE - - ,. 10.00 VALUATION $/FT.
Code:Any city or county which requires a permit to construct,alter, /�^ _^'
2 ¢¢ p improve,demolish,Or repair any shuchve,prior to its issuance,also ELEC.ODNTH,. LIC.NO. ELE0. o V `
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT O
A w re w he is licensed pursuant t0 the provisions or the Contractor's License -
H i Q
Law(Chapter-9(commencing with Section 7000)of Division 3 ofthe
4 o Business and Probations Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ r m the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TY CONSTR.
w. m- by any applicant for a permit subjects the applicant toa penalty civil pelty - DRAIN-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($5000.):
O- 1,as owner of the properly,or my employees withwages as BACK F LOW PROTECT. DEVICE 4.00 - OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not,
intended or offered for sale (Sec. 7044, Blsiness and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who dues such work FIXTURES•PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.If,however,the handing GAS-EA.SYSTEM-I1NC.4OUTLETS 6.00
or improvement is sold within one year of bCompletion,the owner- GAS EASYSTEM OVER 4 (EA.) 200
builder will have the uden rof proving that he did not b - . -
uild or am- 2.00 . D1111 BU Chat,LOIN USE
Piave for purpose of stile.). R11NO PB OM ,
❑ I,as owner of.the property,am exclusively contracting with. - INDUSTRIAL WASTE INTER. 30.00 ❑
licensed contractors to construct the'project(Sec.7044,Business LAWN'SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSO B ARCEL NO.
and Professions Code:The Contractor's License Law does not apply - - - '
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with it contractor(s)licensed pursuant m' SEWER-SANITARY-STORM EA.200ftI10.00
the Contractors License Law. - TRACT NO. -PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 . ACC.DATE ACC.FILE NO.
WORKI:RS'COMPENSATION DECLARATION WATER TREATING EQUIP. -5.00
hereby affirm that I have a certificate Of puumit Itself-insure. - ZONING ENG.SITE NO. .
or a certificate of Workers Compensation Insurance,or a Certified
copy the jjSec.3800,Lab.GC�..�� �//yy
Policy N _4 '"ompany$�gR1.
0 ❑ Cc if al c y h rch 11 rnished. ,FIRE SPRINK ENERGY T-24
❑ Cer" d C y fit with h 'I s division,
Applicant NE]
MISC.- REFERTOORD. y � N( v ❑ NE]
PERMIT ISSUANCE 10.00
� - CERTIFICATIi OF EXEMPTION FROM WORKERS' FLOOD ZONE a.Lu.C.
LLI > COMPENSATION INSURANCE. PLG.CONTR. - LIC.NO. PLG, - - . Y NE) Yo ❑ ,
D' 0 (This se,hon need not he completed if the permit is for one TOTAL N
Z'• hundred dollars IS 100)or less.) ' -
L) 0 1 certify that.in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE- FEE SUMMARY "
LL I- mit is issued,I Shall not employ any person in any manner so as to
O W become subject LD the Workers'Compensation Laws Of California. J)
Q. Date Applicant ALTER OR ADD TO MECH. 5.00 'BUILDING ma.
�(f
�- W NOTICE TO APPLICANT: If,after making this Certificate of F,x.
F Z 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 HANDLINGUNIT(TO 10=C.F.M.) 4.00
.CONSTRUCI'JONLENDINGAGENCY ' _ AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE 0
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 LSee. MICROFILM
3097,Civ.0.). - HEATING UNIT.(TO 700,000 B.T.U.) 8.00
Lender's Nome H EATI NG UNIT I OV ER 100,000 B.T.09.50
Lender's Address ELECTRIC
I certiry'that l have read this application and state that'the above VENTILATION FAN (SINGLE) 4.00
j information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
E hereby authorize representatives of this city to enter upon the
shave mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)BEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORO.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 - CONST.TAX -
may,io any wa accrue against said City in of the
gr g 11 k t. t MECH.CONT. LIC.NO. MECH.
- TOTAL TOTAL // 55
Siglal 1 Applican/Contractor U
Ibi
DIS OFFICE COPY