C 8480 (2) 1. ,C. - ' .. :2:»
POST THIS ARD NEAR FRONT OF1*BUILDING
'� +'• t � l , '�t U}, PERMIT NUMBER
CIIJ OF CUPERTINO
INSPECTION DIVISION
- JOB INSPECTION RECORD F
JOB ADDRESS-gill/I ✓� (ie� •I- +• 'PERMIT�EXPI RATION •I
F't':UNI=�:K LOT# M 1 SIF ./�'P(
OWNER ! :�RMyT EXPIRES IF WORK -
NTRAcroR • //, I;p,NOT,ST ARTED-WITHIN i
MSP.ECTION;- °. c';: DATEs': '.INSPEC OR. ;:�;',_ ;''�:.INSPECTIONAECORD'!�,`,�;;A ,•,r; 160 DAYS OF PERMIT ISSU-
FOUNDATION ` 7� ANCE OR 180 DAYS FROM
LIFER4`fh 2�.d IAST CALLEDI NSPECTION.
PREGUNITE 73
V • PERMIT VALIDATION ,
V i
'POUR N&CONC ETE UNTIL'A OV �HAS'BE N SIGNED . ccs' r- - '•
s zsrF«atc
UNDERGROUND /SLAB S
PLUMBING / •Y "
ELECTRICAL .
ISSUANCE PATE
MECHANICALG r9� J BL G. ELECT. P MECH.
\ / f
o G El. El
DO NOT POUR FLOOR UNTIL'ABOVE-HAS:BEEN'SIGNEDI 9 g °EBUILDING ERMIT'v:,;'!
WOOD FLOOR ' ,'INFOR TION"I".,
PLUMBING � � o/L - VALUATIONS •$/FT:
MECHANICAL-
ELECTRICAL
ECHANICALELECTRICAL PERMIT TO „
FRAMING
INSULATION ST IES: TYPEC tSTR.'�
y G I
OCC.GROUP RES.UNI
,PLACENO;SUBF.EOOR`UNTIL ABOVE:HAS'BEEN'SIGNED
• ROOF SO.FT.FLOOR AREA TOTAL ACREAGE,,
` . DIAPHRAGM
11 r KaP'1� �'y3BUILDING USE
RES IND CON PB , Olner
','-APPLY NO,R 00 FIN G+UNTI L�ABOVEMASlEEN SIGNED" ❑ 1:1 , ❑ ❑ :, ❑;;,
ROUGH ASSESSORS PARCEL N0.•5.(.ij: .
PLUMBING 1 •v �. ,';'`•,"+�'�„}
GAS TEST WL' ,TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL „- ..• - Acc.DArE Acc FILE No.':
FINALS-
FRAMING
INSULATION q,29_yy PLUMBING �O_ - ZONIN�` . ,ENG.SITE NO'.,
GAS /• ..•:.'*akn,.: + -
FIRESPRINK ENERGY.THA
- MECHANICAL � � fkre......
.;'COVER NO,WORK,UNTIL{ABOVE HAS.-BEEN SIGNED. HEATING Y ❑ "❑ Y ❑ N❑' '
LATH-INTERIOR ELECTRICAL _ 6 FLOOD ZONE A.L.U.C.
LATH-EXTERIOR FIRE DEPT. Y❑ "❑ Y ❑ N❑
SHEETROCK - --
SHEARINTERIOR GRADE -,FE_E,SUMMARV.' I
BUILDIN
SHEAR EXTERIOR TEMPOR RY APPROVALS BUILDING ` ^„
FIREWALLS JELECTRIC PLAN CHECK
GAS FEE t�
NO TAPE OR PLASTER UNTIL-ABOVE.HAS,BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR.
MICROFILM
r
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
'--w FW ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
I
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
j
h
APPLICANT,TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ..
BUI LDI NG PROJECT I DENTI FIC N PERMIT NUMBER
' UIL ONG - - , APPLICATION & P IT
ADDRESS i (,•
k-T-I I STcJ-a6 C.I . BUILDING-ELECTRICAL-PLUMBIMECHANICAL 8480
N
•" AER'S PLAN CHECK LIGATION
'
NAME OTY. ELECTRIC PERMIT FEE p1 (J
1kLN1&%_Lk PHONE
NAME AcroAs UTLETS-SWITCHES-RECEP 10.00/1.00Cl 3 ��
LIC.NO.
. LIGHTING FIXTURES 10.00/1.00 rl�D %yJ\ V L- `Dn1SC
ADDRESS TOR's APPLIANCES-RESIDENTIAL 4.00
R*Fe�.A- JG PHONE�d-)--j`)(, PANELS 10.00 DATE OF APPLICATION
/
ARCHITECT (OVER 200 AMP( 20.00 PLAN CHECK FEE P.c..No.
3kOR
ENGINEER
.NO.' ISIGNSTRANS. 3.00
ARCH,OR ENG. - -
ADDRESS A4.V,6-11) SPECIACCIRCUIT ' 5.00 PERMIT VALIDATION
Z4k-3 14piri,a \ D zap TEMP.METER OR POLE INS. 20.00
APPLICANT'5 -
ADDRESS MOTORS SEE FEE-SCH, J
' 1'
'02 SERVICE CHANGE 20.00
TEMP.POLE AID ��S /f
Hoo LICENSED CONTRACTORS DECLARATION
� 30.00 '
a v w I hereby affirm that I am licensed under provisions of Chapter 9
waw (commencing with Section 7000)Of Division 3 of the Business anA ASSIAT CE O`a MECH.
H N z Professions Code,..�ndpry license is in full force a of a 1. ' , - ❑ ❑ ❑
z°m- License Class_76-�Lic.Number
O w t Date Q--i T-ar..'_Contractor p�s,
y¢w a OF A
OWNER-BUILDER DECLARATION - VI`7 - NG PERMIT
K°A ° MISC.- REFER TO ORD INFORMATION
; G 1 hereby affirm that I am exempt from the Contractor's License
w u O 4 Law for tire following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
- PERMIT ISSUANCE 10.00
twit Code:Any derayor countyWhichany requires epermit o its osruct,aaeq 1� .� V
et O improve,detnDlish,or repair any structure,prior ID its issuvnce,also ELEC.CONTR.. LIC.NO. ELEC.' - �J
°u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO.
A w he is licensed pursuant to the provisions of the Contractor's License E
La.(Chapter 9(commencingwith Section 7000)of Division 30flhc
4 ° Business and Professions Code)or that he is exempt therefrom and GTV. PLUMBING PERMIT FEE
M H o the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE,CONSTR,
n ;m by any applicant for a permit subjects the applicant fou civil penally eV/�fV/
of not more than five hundred dollars($500).): ALTER-DRAIN& VENT-WATER'(EA.) 5.00 ' �' '.
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP . RES.UNITS
intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 �.-
Code:The Contractor's License Law does not apply to an owner of -
properlywhobuilds or improves thereon,and who does such work FIXTURES,PE R
IXTURES-PER TRAP- 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself re of inch his own employees, Ir.11,howev such improve- -
memsaremeitissoldoroffuoneyeaxlm.Icompleveq the building GAS-EA.SVSTEM-1 INC.40UTLETS 6,00 Q er/
Or improvement is sob within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.00 / Jul sP
builder will have the burden of proving that he did not build or ins BUILDING USE
prove for 1,aso neeose of tire
INDUSTRIALWASTE INTER. 30.00 RES IND El PB Diner
❑ d as owner of the property,and exclusively(se contracting with 11 1:1
licensed contractors In construct the.project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions property Contractor's License Law does not apply
to tr owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 3 AZ6 ,� .2o ^33
contracts for such projects with o canlraclofs)licensed pursuant to - "
theare exempt
License Law. SEWER-SANITARY-STORM EA.200f1/10.00 TRACT NO. PARCEL No.
1m
❑ laexempt under Sec..,B.&P.C.I'or this
reason WATER HEATER W/VENT 6.00 -
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 '
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation(ossein ce,or a certified
- copy thereof(Sec.3800 Lab.C.I
Policy Nn. Company LAW=fid-�� 1 ,ia � e. -
Cl Certified copy is 11 ruby furnished. - FIRE$PRINK ENERGY T44
Z Z- ;❑ Ce NiOed copy filet.with the cit inspection division.
0 Applicant ��+-r^'r =tze> MISC. REFER TO ORD, r, N v N� i
Cc CERTWICATEOF FXEMPrION(:ROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.G.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG,
OL Z ' ('this section need not be completed if the permit,is for one TOTAL '.Y[] N[:] Y [3 No
U 0 hundred it,,]]...($100).r less.)
I'certily that in the performance of the work for which this per. CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,1'shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California. '
Ed Dau ApplicantBUILDING ,� ��of
} to NO"CICU TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
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'HANDLING UNIT(TO 10J=C.F.M.) 4.00 '
CONSTRUCTION LENDING AC17NCY AIR HANDLING UNIT(OVER 10MC.F.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 H EATI NG UNIT(OVER t 00,000 B.T.U.)9.50
Lender's Address - ELECTRIC
I'certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
informationOivaea s correct. 1 agree tog to b 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
hereby authorize representatives of (his city 10 enter upon the 'BOILER-COMP(Over 100,000 BTU I SEE F EE SCH. MECHANICAL.
herby autioriz property forimsp of
[purposes.
(M'e) agree o save, " demnify d ep harmless the City of MISC.- REFER TO ORD.
Cupertino a So- es,ju Cnts, costs a expenses which PERMIT ISSUANCE 10,00 CONST.TAX '
may in a :wuy a ag st said.City in sequence of the
grand this p L MECH.CONT: LIC.NO. MECH.
"At __
.i -=i' DIAL TOTAL p�,l
Si, cure of.Applica Contractor Dale
OFFICE COPY t -