12819 e r ,T
POST'ThCARD NEAR FRONT OF.BUILDING
I F PERMIT NUMBER'
CY
O.F. CUPERTINO 12819 '
INSPECTION;DIVISION '
JOB'INSPECTI N RECOR j
- ,PERMITEXPIRATION.,
JOB ADDRESSAIVI T LOT#
PERMIT EXPIRES IF WORK
TRA ` + IS NOT STARTED WITHIN ;
OWNER CON CTOR
INSPECTION DAT INSPECTOR v INSPECTION RECORD 180 DAYS OF PERMIT ISSU
'ANCE OR 180 DAYS FROM
FOUNDATION -
. � LAST CALLEDINSPECTION_.
UFER
'PERMIT VALIDATION
PREGUNITE t ,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED. - ' • �/'y
UNDERGROUND /SLAB a , +`
PLUMBING
'� - ' 15SUANCE DATE
ELECTRICAL, • ', • '
'MECHANICAL,, �' - BLDG. . ELECT. PLG. MECHf-.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR "- - INFORMATION
_ VALUATION $IFT.
PLUMBING
MECHANICAL "" T., r ` 'I ' F1 ^•
I'EHMR TO :'-
ELECTRICAL .
FRAMING - - ' -
INSULATION •a sTuz i TYPE coNsnv.
OCC.GROUP RES.UNITS'
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,FT,FLOOR AREA TOTAL ACREAGE •
'..:ROOF
DIAPHRAGM _ - " �•
BUILDING USE
RES IND _ CON PB Urge,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED r'. 0 "El, ❑- 'D E
' ROUGH r ASSESSORS PARCELING, i
PLUMBING' • I .' `
GAS TEST TRACT No, PARCEL No,
MECHANICAL Acc.DATE y ACC FILE NO.
^ ELECTRICAL7_17, inzZ FINALS DATE 'INSP.
FRAMINGIVgNO C(-U cr : .• 2 SAN # .
ZONING ENG.SITE NO.
• INSULATION PLUMBING.' - '• ,r
- GAS,
MECHANICAL ' 'O / FIRE SPRINK ENERGYT24Yo '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N Q NO
F L0002ONE ALU,C.
LATH—INTERIOR ELECTRICAL
LATH—EXTERIOR FIRE DEPT.-' J', Y E3 NY I] N❑
SHEETROCK•, — ,� GRADE', FEE SUMMARY
SHEAR INTERIOR . BUILDING — -.$• -
SHEAWEXTERIOR "TEMPORARY AP ROVALS BDILDING:.4,, cq',.`•cj _:
FIREWALLS _ ELECTRIC PLAN CHECK
..'.. •. GAS ' FEE,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL'ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ELECTRIC, . C,
L w ARRANGE' FOR INSPECTION BY PHONING 252-4505, . f `—
F— ONE'WORKING,DAY•-BEFORE'REQUI'RED,,INSPECTION - .. ' PLUMBING' :•:<,' :_
PLEASE GIVE'JOB'ADDRESSWHEN PHONLNG _
Z, .,+ ' •' MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE
CONST:TAX z
IMPORTANTI '
PLEASE READ'REVERSE SIDE'BEFURE' ."�T TOTAL
CALLING FOR,FINAL INSPECTION.
• OFFICECOPY ',.
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDVG P ROJECTIDENTI TION PERMIT NUMBER
APPLICATION & MIT
ADDRESS
_ 12:819
BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
/ NNMN
ERa /1/Pr PLAN CHECK VALIQATION
QTY. ELECTRIC PERMIT FEE {�ar,`G1(T\/1
6i�lx���-Nu he H 427 1`1sza
,FACTOR'S
JO E. OUTLETS-SWITCHES-RECEP 10.00/1.00
ffU01 C4CWfJb1CJqCJkC.NO. LIGHTING FIXTURES - 10.00/1.00
CONTRACTOR'S 27��ADORES5 tr VM"
— APPLIANCES-RESIDENTIAL 4.00
PRONE '
PANELS 10.0042 — DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
DR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
AARCH.OR DDRESS ENG SPECIAL CIRC1-IIT 5,00 • PERMIT VALIDATION
% .7,P - EMP.METER OR POLE INS: 20.00 PAID
APPLICANTS MOTORS SEE FEE CH. U^{ '
ADDRESS V _,�g87
SERVICE CHANGE .00 �x
ca at
3'
o D LICENSED
af iN that I a TRACTORS DECLARATION
of Plhl f1f no
a u v I hereby affirm that I am licensed under provisions of Chapter 9MAR A E
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r rofessions
Z PCotte, d y license is in full force,
z O y — License Clasjj Lic.Number_ (.Q.,[_J fs
Q m L Oahe �� Contract V
ams BUILDING PERMIT
rc a w a OWNER-BUILDER DEC AT ION INFORMATION
wo A D MISC.— REFER TO ORD
g u. H I hereby affirm that)am exempt from the Contractor's License VALUATION SIFT.
H ON Law for the following reason.(Sec.7031.5,Business and Professions - PERMIT ISSUANCE '10.00 .S�i r
Code:Any city or county which requires a permit to construct,alter, 3
Q a ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. ELEC, q
o u requires the applicant for such permit to file u signed statement that TOTAL / PERMIT TO
u w B he is licensed pursuant to the provisions of the Contractor v License ,�y p'
r z r
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe I,y ft'�AO� //l'/ 46 V
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE -
H o the basis for the alleged exemption.Any violatiodolSection 7031.5 STORIES TYPE CONSTR.
u ; m by any applicant for a permit subjects the applicant loacivilpenalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500),1:
❑ I,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,AR EA,COND. 5.00
Code:The Contaet.r'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 SQ FT,FLOOR AREA TOTALACREAGE
himself or through his awn employees,provided that such improve
ments are not intended or offered for sale.If,however,the building AS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 IEA.) Z.00 - BUILDING USE
builder will have the burden of proving that he did not build or int- RES IND CDN PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. . 30.00
EJ 1,as owner of the property,.,,I exclusively contracting will ❑1 ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 1044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I'he Contractor's License Law does not apply
to an owner of property who builds or improves themon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a ecruracmr(s)licensed pursuant to
the Contractor's License Law. - SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I ala exempt under Sec. B.&P.C..for this WATER HEATER W/V 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORKFRS'COMPI!NSATION DECLARATION ATER TREATING EQU . 195k7 5.00 -'
1 hereby'affirm that I have a certificate ofconsent Do self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereoffSee.3800,Lab.C.). (}- E ino
Policy No. Companyy meq_ i �N/�
O ❑ ert0ied copy is hereby furnished, I FIRE SPRINK ENERGY T-24
Z Cerf ifi o Y a d with Ih cifY inspection division.
ee..�� MISC.- - REFER TO ORD.
Ph nal' L1�) Y ❑ N❑ Y ❑ N❑
cc rn PERMIT ISSUANCE 10.00
LU — CERTII' ATIi OP EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
W COMI'ENSAI'ION I NSURANCE P .Co TR. IC.NO. PLG. ^ '
CLCI This section need not he completed if the permit is for one TOTAL �.�/ Y El ❑ Y [:] NE]hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per, QTY. MECHAN AL 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 Lows of Cul iforniu.
ED Date - Applicant BUILDING �j Ob
a ALTER OR ADD TO MECH. 5.00 r�(
} to NOTICE moon,TO APPLICANT: If,after Diking this Certificate sa Ex-
Z caption,you the L become e, you
to the Worker Ccomply with APPLIANCE 5.00 PLAN CHECK
provisions io the Labor Code, you muss forthwithcomply with FEE
CJ such provisions or this permit shall be Deemed revoked ,. AIR HANDLING UNIT 1 .000GF. 1 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT IOVE10 .16.00 SEISMIC FEE - a
I hereby affirm'that there is a construction lending agency for EXHAUST HOO DCT) 5.00
the performance of the work for which this permit is issued(Sec. 'MICROFILM
3097,Civ.C.L HEATING UNIT( O 100, B.00
Lender's Name HEATING UNIT(O ,000B.T,U.19,50 ELECTRIC 9 ;0_
Lender's Address
• I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4,00
information is correct. 1 agree to comply with all city and county PLUMBING �Q.
ordinances and state laws relating to building construction, and s BOILER-COMPI3 H.P.Dr 100,000 B.T.U.) 6.00
herebhereby authorize representatives forties of this city to enter upon theaboveBOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICA1-
y
authorize
property for inspectionr this
purposes.
- (We) agree to Cave, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
PERMIT ISSUANCE 10.00
\� way accrue ai st said City in consequence D the -
nl I of tl i MECH.CONT. LIC.NO. MECH. -
TOTAL / TOTAL 333
.i of Applica ontrado Da _
OFFICE PY'