11604 v POST THIS CARD NEAR FRONT OF BUILDING
PFRMIT NUMBER
CITY OF CUPERTINO' 11604
INSPECTION DIVISION
JOB INSPECTION RECORD
'��'//11 -�j, /D y� ��//'' (/� PERMIT EXPIRATION
JOB ADDRESSP`07g5 SIC✓M- LeA UNIT# LOT#
il-y1 nc� PERMIT EXPIRES IF WORK
WITHIN-
OWNER L�.ck I v�W CONTRACTOR -� - IS NOT STARTED INSPECT N DATE INSPECTOR NSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION �j 1 }(b M&Ck 0IFc1E1w 4 tjdjjrq> ANCE OR 180 DAYS FROM
UFER V Mel et• [4�2c1SQ� LAST CALLED INSPECTION.
PREGUNITE D - 3V , PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED a T u •k/ �er
UNDERGROUNDSLAB N`�Q�COTI"Q ~°� wFuYt °u
' PLUMBING A, � y ono• 7e
� '• �'
ELECTRICAL 3 "y _ �" / �/�G -.IssuANCE GATE
MECHANICAL ,7 _/�?-�' Of/9'J /ZV C ^�'J BLDG. E C PLG. MECH.
7A ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �_ 98 ^ tK eu DING PERMIT
WOOD FLOOR crcES INFORMATION
VALUATION $/FT.
PLUMBING
MECHANICAL /
ELECTRICAL PERMIT TO
FRAMING /,/,/
INSULATION ISTo IES ps• R.
occ.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SOFT FLOOR AREA TOTAL ACREAGE
I � DIAPHRAGM
BUILDING USE
RES - WD CON PB Omcr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ I] ❑ ❑
ASSES50HS PARCEL NO. .
ROUGH
PLUMBING
GAS TEST - TRACT NO.• PARCEL NO.
MECHANICAL _
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC FILE NO,
FRAMING SAN *
INSULATION, PLUMBING ZONING, ENG.SITE NO.
GAS
MECHANICAL
FIRE SPRINK ENERGY T.29.COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NE] Y ❑ No
' LATH'—INTERIOR ELECTRICAL f LOOD ZONE A.L.U,C,
LATH—EXTERIOR FIRE DEPT. Y[:]. N❑ Y 0 N
R ❑
SHEETROCK GADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GASFEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
1
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LLJ
0� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! coNsr.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. :CP
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - - PERMIT NUMBER
BUILDING APPLICATION & PERMIT 11604
e
ADDRESS
ZC9 -�4 E�fL BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
"AME PHON-�J - -Z+6 DTV. ELECTRIC PERMIT FEE
CONTRACTOR'S
NA ,O � ? _ OUTLETS-SWITCHES-RECEP 10.00/1.00 O-o Sr
V' 'LO wS _TAC LIC.NO / s LIGHTING FIXTURES 10.00/1.00 6
CONTRACTOR S APPLIANCES,RESIDENTIAL 4,00
,N/7 /OORE55
-\` E41 PNONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P,C.NO,
OR
ENGINEER ,,//��
/ SIGNS TRANS. 3.00
ADDRESS G' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
zhv i0 EMP.METER OR POLE INS. 20.00
APPLICANT s MOTORS SEE FEE SCH.
q / 61-✓ --)iw SERVICE CHANGE 20.00
w o O LICENSED CONTRACTORS DECLARATION _I
a u I hereby affirm that 1 am licensed under provisions of Chapter 9 n (', E DATE
(wnunencing with Section 7000)of Division 3 of the Business and
¢ a LD EL CT. PLG. MECH.
F w m Professions Code, my license.is in full Wrec unFnl' _1 S` ❑ ❑
Z O y - License Class Lie.Number 2 Y .J n
m F Date Contractor _ lr If & IRi A
E, y f BUILDING PERMIT
¢ ¢ ¢ OWNER-BUILDER DECLARATION -
o a u INFORMATION
wH I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
0 w VALUATION S/FT.
H ,.o; Law for the following reason,(Sec.1031.5,Businessand Professions PERMIT ISSUANCE 10.00 _
Code:Any city or county which requires a permit to construct,alter, p/(r S
Qau ¢ ImprOVe,de1110I1Sh,Or repair any StrnCtare,ptlllr tO IIS issuance,also ELEC CONTR. LIC.NO. ELEC. / `V OOO
o Ci LL requires the applicant fur such permit to file a signed statemm�t that TOTAL e.�RMIT TO
A. E:
he is licensed pursuant to the provisions of the Contractor's License 7eENf 0,6z
H z i Law(Chapter 9(commencingwith Section 7000)of Division 3 oflhe
¢ Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
ic = $ the basis for the alleged exemption.Any violation of Section 7031.5 STO IES T P CONSTR.
e. by any applicant for a perout subjects the applicant ton civil penally ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the 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 does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedoroffered for sale.If,(however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6,00
or improvement is sold within one year of completion, the owner- GAS EASYSTEM-OVER 4 (EA) 200
builder will have the burden of proving that h - . , .
e did not build or im. BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pa Other
❑ 1,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',License Law does not apply
to an owner of property who builds or haPRhves thereon,and who ILAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ lam 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.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsent to self-insure, ZONING
or a Certificate of Workers'Compensation Insurance,or a carti fed ENG.SITE N0.
copy thereof(Sec.3800,Lab C.).1- �S
Policy No. - Company-/"1
0 / ❑ Certffedcopy is hereby furnished. FIRE SPRINK ENERGY T 24
Z `-.X`. ❑ Certified co y is file�a hth'athe city fns etion division.Applicant MISC.- REFER TO ORD.
� y CER 'FICATEOFEXEMPI'ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
Ill �_ ws,H iNSA1ION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL o (This section need not he completed if the permit is for one TOTAL V❑ N❑ V❑ N❑
Z) Z hundred dollars IS 100).,less.)
U O 1 certify that in the performance,of the work I'or which this per. CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
al Date Applicant 'ALTER OR ADD TO MECH. 5.00 BUILDING S-SO
} m NOTICE TO APPLICANT: If,alter making this Certificate of Ex-
F 2 emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must Ii rdiwith comply with FEE
U such provisions or this permit slhall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE �7S
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the perf3097, ormance of the work for which this permit is issued(Sec. HEATING'UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name H EAT(N G UN IT(O VER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 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 PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMPI3 H.P.Of 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100000 BTU(SEE FEE SCH. MECHANICAL
above-mentinned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against Babilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said qty in consequence of the
gmnlin Of llhis erm t. MECH.CONT. LIC.NO. - MECH.
TOTAL TOTAL Soo
to um of Apphc t/Contractor Little
OFFICE COPY