11427 � r
POSTTHIS CARD NEAR FRONT OF BUILDING
PFRMIT NUMBER
CITY OF CUPERTIN6 '11427
INSPECTION DIVISION'
•JOB INSPECTION RECORD
, PERMIT EXPIRATION
JOB ADDRESSW7`/5 s{ZylnS 6K6ek UNIT# LOT#
PERMIT EXPIRES IF WORK '
OWNERae,meb CONTRACTOR /I IS NOT .STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION_
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB / q
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG. - ELECT. pLG. M�.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUIriLDDII[[J G PERMIT
WOOD FLOOR .N.00 MATION
PLUMBING
VALUATION T.
_�
MECHANICAL
ELECTRICAL
FRAMING - �7
INSULATION STORIES TYPE CGNSTR,
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 Otlm,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ED
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST TRACT NO, PARCEL NO.
MECHANICAL
ELECTRICAL � FINALS DATE INSP. ACC.OATE ACC.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 N[]
LATH-INTERIOR ELECTRICAL FLOOD ZONE A,LU.C.
LATH-EXTERIOR -0FIRE DEPT. Y • Y C] N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING s
'BUILDING
SHEAR EXTERIOR
TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING'.
Z' MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE.-
CONST.TAX
• IMPORTANT! . .
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
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS n
D7 C�('TCl/C�µ(` `,e� ✓ABUILDING-ELECTRICAL-PLUMBING-MECHANICAL 11427
OWNER'S / PLAN CHECK VALIDATION
"AME DTV. ELECTRIC PERMIT FEE
G�MCOPHONE
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
NX
//�� '''(,
L Q C 6"S . 1IC.NO.-L-1 7 LIGHTING FIXTURES 10.00/1.00
Co"TRACTOR'S PPLIANCES-RESIDENTIAL 4.00
kNin
F) '�II11 '] �'r
`( VO HONE{.� 2.�� PANELS 10.00 DATEAPPLICATION
ARCHITECT PANELS (OVER 200 AMP) 2000 PLAN CHECKK FEE P.C.NO.
OR ,
ENGINEER
•LIC.No. SIGNS TRANS. 3.00
ADDREOR SS E"O' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS- 20.00 FAWD
ADDRESS
S
AMOTORS SEE FEE SCH. ml
ORE
SERVICE CHANGE 20.00 n- r, � 1
Goo LICENSED CONTRACTORS DECLARATION N .I � �J
a u v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUAPICODAIltino
� ¢a
(commencing with Section 7000)of Division 3 of the Business and BLDG. C C PLG. MECH.
r G ZO Professions Cod and y license is in full force and qff I
z0 G License Class Lic.Number 144 1_L - ❑ ED El0 Dale CoRUactorJ{LLLLO
a m s BUILDING PERMIT
ce ¢O i U OWNER-BUILDER DECLARATION INFORMATION -
F
;LL m I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION $/FT.
Fu0¢ Law for the fallowing reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
Code:Any cityor county which requiresa permit to construct,alter,
JJJ ��Q
2 to ¢ 0 improve,demolish,or repair any structure,prior 10 its issuance,also ELEC.CONTE. LIC.NO. ELEC. J /
G LL requires the applicant for such permit to file A signed statement that TOTAL PERMIT TO
w $ he is licensed remount to the provisions of the Contractor's License
i �'v
I �Q}��R S./_��,
HzLaw 9(commencing with Section 7000)of Division 3 of the l, O !V
¢ Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
Ge r o the basis for the alleged exemption.Any violation ofSeclion 7031.5 STORIES TYPE CONSTR.
by any applicant fora permit subjectslhe applicant macivilpenally ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(55001.):
❑ has owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
' their sole compensation,will do Ore work,and the structure is not OCC.GROUP RES.UNITS .
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SG.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mealsarenotintendedorofferedforsale.If,however,lire building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the 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 for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Other
❑ I,as owner ol'tire properly,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 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 a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ Iamexemplundcr Sec. ,B.&P.C.fnr this WATER HEATER W/VENT 6.00
reason
Owner Data WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORK ERS'COMPE:NSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a cartilicale of consent to scl6inwne' _ ZONING ENG.SITE NO.
or a certificate of Workers'Connpemotion Insurance,or a certified
�( copyrreeof(See.,? -0 pab.Y.11.,,
O ❑ Cerliliedcopy, Ire b fur Shad FIRESPRINK ENERGY T 24
Z Z D Certified op I w r the MISC.- REFER TO ORD.sp lion division.
Applicant s � Y❑ N❑ Y ❑ N❑
~ wPERMIT ISSUANCE 10.00
� CENTI FICEX ,MOTION FROM WORKERS' FLOOD ZONE 0.L.u.c.
i W COMPF� COMI'IiNSA'1'[ON INSURANCE: PLG.CONTE. LIC.NO. PLG.
4. O 0his section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ INC]
:) Z hundred dollars 1$100)or less.)
U O 1 certify that in the performance of the work for which this per, OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mit 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.
EL Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} US NOTICE TO APPLICANT: If,after making this Certificate of Ex-
♦- ? emplion,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(OVER I0,000OF.M.) 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 UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read this applicationand state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING
-�9 ordinances and state laws relaling to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby autioned representatives of this city es enter upon the - BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection of
purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cgawastiliabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00CONST.TAX
may aceruc ag In t said Ci in consequence of the
Spe niL MECH.CONT. 'LIC.NO. MECH.TOTALTOTAL -ZoSiplicanl/Contras or Dalc
OFFICE COPY