11290I.
POST THIS CARD NEAR FRONT OF. BUILDING 1'
CITY, OF CUPERTINO
INSPECTION DIVISION Iry�p
JOB INSPECTION RECORD r
21 �h��/ �/� x A•C -� UNITp� LOT
JOB ADDRESS Jk #
I
OWNER CONTRACTOR
_ PERMIT NUMBER
11290
" "
PERMITT EXPIRATION' y
'
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
40 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM*
LASTCALLED INSPECTION.
,
INSPECTIONDATE SPECTOR
IN PECTION RECORD '
FOUNDATION
_
.. ,. -.
UFER' ..
PREGUNITE 1
. •
PERMIT VALIDATION
.,.
Q123j�(p W
1 ,
'
- ISSUA E DATE `
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
-
ELECTRICAL ;_• "' -
MECHANICAL -
E
PLG.
❑
OO.NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
- •
BUILDING PERMIT
INFORMATION
WOOD FLOOR."
vALUATION s/FT.
f :� ,.
PLUMBING--'
MECHANICAL _
ELECTRICAL'
... ,..
PERMrtrT „F,,,,,•
FRAMING
INSULATION
HIES .
'DLC.
TYPE ,( NSTH.'-
..
GROUP
RES, UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF 1 `
p
SD. FT, fLDOR AREA
TOTAL ACREAGE
DIAPHRAGM .•
•.
4^
BUILDING BE
•' RES IND• c PB 00";
E:3 El
EL ElASSESSOR
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
PARCEL NO.
-'
ROUGH.t
PLUMBING
GAS TEST'
_
TRACT,NO;
PARCEL NO.
MECHANICAL,'
ELECTRICAL`` - -- - j✓- f
FINALS DATE INSP.
„ACC, DATE
ACC. FILE NO.
FRAMING _
SAN # I
ZONING
ENG, SITE No.
,
INSULATION -
PLUMBING
GAS -
FIRESPRINK
0 ry ❑
ENERGY T YC
N❑
MECHANICAL -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
FLDGOZONE
'v N❑
AL.U.C.
.
Y I] N❑
LATH-INTERIOR -
ELECTRICAL
LATH-EXTERIOR .'
FIRE DEPT. Q„` _
SHEETROCK--
GRADE ".
FEE SUMMARY
SHEAR INTERIOR s'
BUILDING -
BUILDING
SHEAR EXTERIOR
TEMPO RAR. APPROVAL
FIREWALLS -
ELECTRIC,, _
PLAN CHECK
FEE
-
GAS'
SEISMIC FEE '.
NO TAPE OR PLASTER UNTIL'ABOVE HAS BEEN SIGNED
OCCUPANCY
OCCUPANCY OF'BUIL'DING IS NOTPERMITTED UNTICBUILDING'FINAL ISSIGNED BY BUILDING INSPECTOR.
• MICROFILM -
ARRANGE FOR INSPECTIOMBY PHONING 252-4505,
0�WORKINGDAYBEFOREREQUIRED;INSPECTION
Z PLEASE GIVE.JO.B ADDRESS WHEN, PHONING.
— SEE PERMIT FOR EXPIRATION DATE —
ELECTRIC
r
PLUMBiNc-
MECHANICAL'
a
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR,FINAL INSPECTION.
TOTAL
7 f l
:.. OFFICE COPV
I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUI LDI NG PROJECT IDENTIFICATION,
--
- •
APPLICATION & PERMIT .
BUILDING - ELECTRICAL- PLUMBING --MECHANICAL
PERMIT NUMBER
1129
aUDING•
LL
ADDRESS
�'Lt•-��O' SJLW&-NS LR gLV4
OWNER'5 pp
NAME 1 o Jvi 130
JJI CA$L.1 OLby' PHONE
QTY. ELECTRIC PERMIT FEE
I
PLAN CHECK VALIDATION,
/ I
Y
DATE OF APPLICATION
coNrRAcroR's
MAME - p
. LEi uc'N.LIt5 ��
UTLETS -SWITCHES-RECEP 10.0011.00 0 —
F" LIGHTING FIXTURES 10.00/1.00
ADDRRActoR's�If RESS ass'1j Com^a1 ('Qr�1j -Q�Q�t Lela
QAJ'P6 t INO \ /'E PHON[r4•b-19t
-
PPLIANCES- RESIDENTIAL 4.00
PANELS' - --. '10.00
ARCHITECT _
O
OR
ENGINEER N A J♦ ucrva.
.
PANELS (OVER 200 AMP) - 20.00
PLAN CHECK FEE P.C. NO.
'
r SIGNS TRANS. - 3.00
ARCH. OR ENG. `
ADDRESS
. - ZIP
SPECIALCIRCUIT5.00
P5gpy IODATION
A�'!F'1f��LLJJ
pppp�
(S "'• v
I` �// 4�
City o� . 'I:
EMP. METER OR POLE.INS. ® 20.00
APPLICANT'S- -
ADOREss
L¢ AS CtEtiwT ARr_WQ_:
`
�-• MOTORS SEE FEE.SCH.
_`—__.SERVICE CHANGE �-T O'; 1-' 20.00
LICENSED CONTRACTORS Df:CLARA'TION
..-a„ n� (`sJ2?�1141V
1 hereby affirm that I am licensed under provisions of Chapter 9
ISSUAN E DATE
6
(commencing with Section 7000) of Division 3 of the Business and
Profcesions Code NY , my liwnsc Is in full forcgtAp g y
License ass L1 Lia NunsM1 r d`J _ 11
yyy
e
E C
PLG. M
❑
.
Contractor
-
BUILDIIG PERMI
(�
OWNER.GUILDER DECL Ti6N
I hereby affirm than 1 am exempt from the Contractor's License
LawCodei Any city or countng azon.(Sic.uiresa enoBusinessanstruct, alonster,
city Or countywhiny structure Penni ttoconsuacl,alter•'
improve, demolish, nr repair any Smit toff prior to its issuance, also
im mires the applicant
requires the applicant for such permit to file a signed statement elm
he is licensed pursuant n the provisions of the Con Divisi 's License
oaf the
(Chapterand
and Professions Code) or that he is exempt therefrom and
BusinessProfessionsCode) lh Seelion is exempt therefrom
INFORMATION
MISC. - REFER TO OR
VALUATION'
{� Q
/
$/FT.
MIT ISSUANCE. 10.00 ,
ELEC. CONTR. LIC. NO.
ELEC.
TOTAL
PERMIT
/ -
_
QTY. PLUMBING PERMIT FEE I
STORIES
TVP NSTR.
thei alis
the basis for the alleged exemption. Any violation oto
j
by any applicant fora permit subjects ($50R-licanuoacivil penalty
a cion malty
of not more than five hundred dollars ($$00)J: '
,ALTER-DRAIN-WATER(EA.) 5,00
❑ 1, as owner of the, property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT.. DEVICE - 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law docs not apply to an owner of
property who builds Or improves thereon, and who does such work
himself or through, his own employees, provided that such improve
meats are not intended or Offered for Sul,. If, however, the building
FIXTURES - PER TRAP 5.00
SO. FT. FLOOR AREA
TOTAL ACREAGE
.
GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is Sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.).INDUSTRIAL
ID 1, as owner Of the property, am exclusively contracting with
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
- BUILDIN USE
RES IND PB Other
❑ ❑ ❑ ❑
WASTE INTER. 30.00
licensed contractors to construct the project (Sec. 7044, Business
aEd Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
-
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
AEcEE.E./1 PARCEL NO.
,
contracts for such projects with a conlr:mtpds) licensed pursuant IoSEWER-SANITARY-STORMIE•
the Contractors License Law.
QOft/10. 00
TRACT NO.
PARCEL NO.
❑ Iamexemptunder Sec.-,B.&P.C. for this
reason
WATER HEATER W/VENT• 6.00
Owner - Date
SYSTEM 0 C,1
WATER f5:40
ACC.DATE
ACC, FILE NO.
WORK F.RS'COMPENSATION DECLARATION
WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to sel Ginsnre,
or a Certificate of Workers Compensation Insurance, or a Certified
copythe[�pf/Sg��}jlJ1Q Lab.C.).� },
Policy No.LgS2(WW1ppanyVS Zwyi&.iV
,IfU r11Flf?i}IO
ZONING
ENG, SITE NO.
FIRE SPRINK
v N
❑ ❑
ENERGY T-24
v N
❑ ❑
❑ Certified copy is hereby furnished.
A Eu Certifie is le with t • City inspection division.
, cant
- MISC.- REFER TO ORD.
CERTIFICATE OF EXEMPTION FROM WORKS. RS'
PERMIT ISSUANCE 10.00
FLOODZONE
A.L.U.C.
PLC. CONTR. LIC. N0.
PLG.
TOTAL
• COMPENSATION INSURANCE-
(This section need' not be completed if the permit is for one
Y ❑ N ❑
Y ❑ N ❑
hundred dollars ($100) or less.) '
I certify that in the performance of the work for which this per.
mit is issued, 1 shall not employ any person in any manner so as to
QTY. MECHANICAL PERMIT /�p 'FEE
i'�ulj
FEE SUMMARY
BUILDING
become subject to the Workers' Compensation Laws of California.
Datt ApplicantALTER
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
emption, you should become subject to the Workers''Compensaimn
,•
J OR ADD TO MECH. 5,00 ,S�
'
APPLIANCE s"L-T Jo5:00
PLAN CHECK
provisions of the labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked'.
FEE
AIR HANDLING UNIT (TO 10,000q F.M.) 4.00
AIR HANDLING UNIT (OVER 10A00GF.M.)L6.00 Un0
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00
the performance of the wo for which this permit is issued (Sec.
3097, Cie.C.). -
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.0 0
UN IT (OVER 100,000 B.T.U.)9.50
ELECTRIC
�• '
N
Lender's Nam
Lender's AddressHEATING
I certify that I have read this application and stale that the above
VENTILATION FAN (SINGLE) 4,00
information is coffee[. I agree to comply with all city and County
Ordinances and state laws relating to building, Construction, and
PLUMBING
BOILER- COMP(3 H.P. Of 100,000 B.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL'
hereby authorize representatives of ,this city to enter upon the
above-mentioned properly for inspection purposes.
MISC.- REFER TO ORD.
,
(We) ago. t0 save, indemnify and keep harmless the City -of
Cupertino against liabilities, judgments, casts and expenses which
may in any w y accrue against said City in'Conserucnee of the
CONST. TAX
PERMIT ISSUANCE - 10.00 �'
n h' permit.
q 2(,
LIC. NO.
r777
'
MECH.
TOTAL - �S u
TOTAL
7��
tgnature of Applicant/Contractor Dae
OFFICE COPY