C 8439 iPOST THIS CARD NEAR FRONT OF BUILDING '
• P RMIT NUMBER
CITY. OF'-CUPERTINO
^ JINSPECTION DIVISION 8
JOB INSPECTION RECORD 7 . t
- rR ;. r .
T PERMIT EXPIRATION `
/0! StoKo i9✓ .
JOB ADDRESS UNIT,# LOT# .pERM1T•EXPIRES IF WORK
OWNER.: CONTRACTOR � � SIS NOT^STARTED WITHIN
INSPECTION DATE INSPECTOR, INSPECTION RECORD . 180 DAYS OF PERMIT ISSU-
• FOUNDATION - ANCE'OR 180 DAYS FROM, a
UFER :CAST CALLE D I NSPECTION: -
'PREGUNITE - " PERMIT VALIDATION
- POUR NO CONCRETE UNTIL ABOVE HAS BEEN,SIGNED
UNDERGROUND./SLAB
PLUMBING . - a',•' :a ',� fi2Y G,/� ✓ 3• U �• ,.
ELECTRICAL IssuamcE Dare
MECHANICAL. ,',i, f - B ELECT. I PLG. MECH.~
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING,PERMIT -,
WOOD FLOOR" .f INFORMATION
`PLUMBING' t - .D VALUATION.' - $/FT._, '
J _
MECHANICAL': s .- . ,. , c `• .,,, J':i'tjd .
ELECTRICAL - -" PERMIT TO
FRAMING
-
INSULATION STORfIE TVPECONSTR_
� - f .- .. - •,
_ .. -
OCC.GROUP" RES.UNITS '•
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.® ROOF '• • P SOFT FL00R ARLA TOTAL ACRIAOE•
DIAPHRAGM t; ti
U BU ILOING USE
fi -RES 'IN0 CON' PB 0"....
. - •. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED E 'El ' El 11 ❑"
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST
TRACT,NO. PARCEL NO;.
' � - � • � - � - '
MECHANICAL
ACC.DATE ACC:FILPNO. '
'ELECTRICAL - FINALS DATE
"FRAMING - SAN.#'
ZONING ENG.SITE NO.
INSULATION - PLUMBING
GAS
FIRE SPRINK ERG
MECHANICAL,
. MECHANICAL. ;w1' Ya "N�, . 'r,❑ s24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH-INTERIOR - ELECTRICAL ) LF LooDZONE, A.L.u.C. 'G•
LATH-EXTERIOR. FIRE DEPT. p y Y N❑ ° Y.❑ 'N❑
i' SHEETROCK` - GRADE •. _ -
FEE SUMMARY,
SHEAR B444- S
; ''BUILDINGSHEAR EXTERIORTEM RA , 9
FIREWALLS ELECTRIC .° PLAN CHECK - ""'r' '+-'•- 'e -
. GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - +SEISMIC FEE'
�4
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BV BUILDING INSPECTOR. p'.., .
MICROFILM
ELECTRIC
UI
ARRANGE FOR_INSPECTION BY PHONING 252-4505,
UI y.
ONE WORKING DAY BEFORE REQUIRED INSPECTION 'PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
' SEE PERMIT FOR EXPIRATION'DATE ` MECHANICAL
CONST.TAX '
IMPORTANT! A .
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
BU I LDING PROJECT I DENTIFICAT16N PERMIT NUMBER ,
BUILDING APPLICATION_ SICK E VUPERMIT / 8439�^
AooREs v [+ y
BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
�A OW R k I /'l Ativtr 1 ,A O/V/l . PLAN CHE VAyI TION!
AME' /TT /\ 55-F TY• ELECTRIC PERMIT - FEE ' j6�71 �f 7/�L(�
PHO J _34
CONTRALTO
N ME �l ��SSB OUTLETS-SWITCHES-RECEP -,10.00/1.00 _
( LIGHTING FIXTURES 10.00/1.00
r:ON ACTOR'S
-A s � APPLIANCES-RESIDENTIAL 4.00
go ONE 9 PANELS 10,00 DATE OF APPLICATION
ARCHITECT n �I r
I ENcwEER �� /1M I l�}.J CA. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO,
uc.NO., SIGNS TRANS, 3.00 -'
ADDRESS ENc. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT'S
ADDRESS MOTORS SEE FEE SICK P�
SERVICE CHANGE 12 n yvi0.00
r
02 LICENSED CONTRACTORS DECLARATION TEMP.POLE
a u u 1 hereby affirm that I am licensed under provisions of Chapter 9 ,
y G m - ISSUANCE GATE
(commulCl S io 70001 in Division Sof the Business and MAY 2BLDG. ELECT. PLG. MECH.
H z icenssloyys o Zvi V,y cmc is in full for Se � 8
o i m o Datensylfl' Can Nuryl�ef
H Date Cnntmn City of Cupertin
¢ a fea NER-BUILDER DECLARATION - BUILDING PERMIT
wu
K
;LL y I hereby affirm that 1 am exempt from the Contractor's License MISC.— REFER TO ORD I TIO
u Wi
O ¢ Law for the following reason.(Sec.7031.5,Businessland Professions VALUATI N
— w PERMIT ISSUANCE -
x0 Code:Any city or county which requires a Permit to construct,alter,
"!9'B6
Qat QO p improve,d¢mOI15M1,O!repair any SIrrlClurC,Pflnr to its ISSU;IIICe,also ELEQ CONTR., LIG NO. ELEC. y- ,
iL o LL requires the aPPIICmt IVT SnCII permit IO file a signed Statement that TOTALPirting
6 w o9,A he is licensed pursuant to file provisions of the Contractor's License PERMIT TO
I-zr Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe
P 4 o Business and Professions Code)or that he iv exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r$ the basis for the alleged exemption.Any violation of ScE9ion 7031.5 STO IES TYPE CONSTR.
a ; � by any applicant faro permit Subjects the applicant toacivil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00
of :1,as than flue hundred dollars(my ctp1:
❑ 'L a owner at the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
intended compensation,will(S 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,GOND. 5.00
Code:The Contractor's License Law does 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 TOTAL ACREAGE
• himself or through his own employees.Provided that such Improve
Hunts are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 (EA.)'. 2.00
builder will have the burden of proving that be did not build o_r im- - . - BUILDING USE
prove for purpose of sale.). - RES IND CON PS Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ 11 ❑ 1:1
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B..' 600 ASSEgSOR SPARCEL N0.
and Professions Code:*file Contractor's Lice sc 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 contractors)licensed pursuant to -
fill,C'ontractor'sLicense Law. SEWER-SANITARY-STORM EA..200tt/10.00TRACTND. - PARCEL NO..
❑ l an,exempt under Sec._,BAP.C.for this
.,on WATER HEATER W/VENT 6.00
Owner UulcWATER SYSTEM 5,00 ACC.DATE ACD.FILE NO.
n WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP.. 5.00 .
I hereby affirm that I have' cur "cateofconsent to self-insure,
ion InZONING
or a cern ate of Worker' rapef s lsuranceor a, FS ified ENG.SITE NO.
copy rhe CJ. {.
Policy N �Il Pfa any�/
0 ❑ C copy is by fardishe FIRESPRINK ENERGY T.
Z Z ertlf�e ' y 1. Th t di Si n
FO Z4
if of MISC.- REFER TO ORD. Y❑ . NE] Y ❑ N❑
N CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U.C.
LU >• COMPENSATION INSURANCE PLG.CONTR.- LICE NO. PLG
d O (This action need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
Z hundred dollars(81001 or less.)
V O 1 certify that in the performance of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
IL 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.
W Date Applicant ALTER OR ADD TO MECH: - 5.00 BUILDING
} m NOTICE TO APPLICANT: If,after making this Cerlificate of lilt-
F Z emption,you should become subject to the Workers'Compensation APPLIANCE ,-6:'90 PLAN CHECK
provisions of the Labor Code, you must fortluwith comply with V FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDINGACENCY - AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
,tile periknmencu of the work for which this permit i01SLIcd(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Address
HEATING UNIT(OVER 100,000 B.T.U.)9.50 W
Lender's Address '- ELECTRIC 'V
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 !
information n correct.I agree to comply with all city and county BOILER-COMPO H.P.or 100,000 B.T.U.) 6.00 PLUMBING
O oerelly cgs and late laws relating m building construction: and
hereby authorise roperty for
rins-of this City to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. ".�.
(We) agree to Save, indemni t' and keep hanuless le Ci y of M11 C.- REFER TO ORD.
Cupertino against liacoue e,)udgm ts, costs and exp Ares hick PERMIT ISSUANCE .yg;g0 3 ' CONST.TAX
A19
any way accrue agar sl Said ity in cons Ace f the --- /,�rys
got this permit MECH.CONT. LIC.NO. TMIECIT
OTAL ' `''J r}-4/ p�
o Applicant Con p to ( ' TOTAL ?
JF OFFICE COPY
1