11869'-POST THIS'CARD NEAR FRONT OF BUILDING
-_
CITY OF: CUPERTINO
PFRMIT NUMBER
",
Q
11869
:INSPECTION DIVISION
JOB INSPECTION RECORD `
/V/WO /[Iit4
PERMIT EXPIRATION
JOB'AD DR ESS ',F - U IT# LOT# -
-
PERMIT EXPIRES IF WORK
OWNER _ CONTRACTOR
IS NOT STARTED WITHIN
18oDAYS OFPERMIT ISSU-
ANCE OR 180 DAYS, FROM
LASTCALLED INSPECTION.
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION
a
..
UFER
-. PERMIT.VALIOATTON '
PREGUNITE-
J
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
.,UNDERGROUND/SLABIV
.;
ISSUANCE DATE J
PLUMBING -
- -
1. r
ELECTRICAL tI'
- -
BLDG.
ELECT.
I PLG MECH.
MECHANICAL '
i
.❑
❑.
❑ ❑
DO'NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
,. . - r'•- -
BUILDING PERMIT ,.
INFORMATION
' WOOD FLOOR
VALUATION
/ ^'wI •��
SIFT.
,
PLUMBING ..
MECHANICAL` - -
PERMIT TO
ELECTRICAL
FRAMING.
'
sroRlrs
rvPE comsr R
INSULATIONT}r
OCC. GROUP
RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$O. FT. FLOOR AREA
TOTAL ACREAGE"
ROOF
I
""•
DIAPHRAGM
-
BUILDING USE
'Omer
,
HES ;NO ICON 'PR
El ❑ 1 ED ❑ 0'
APPLY,NO ROOFING UNTIL.ABOVE HAS BEEN SIGNED
ASSESSORS PARCEL NO.
,
ROUGH
`
PLUMBING -
GAS TEST -
TRACT NO.
PARCEL NO,
--
MECHANICAL
ACC.OATE
.ACC. FILE NO.
'ELECTRICAL-•
FINALS DATE. INSP.
FRAMING - —
SAN .# •r.-
ZONING
ENG, srteNO,
-
INSULATION _
PLUMBING'
' r
GAS
NFIRE SPRINR-;
� F E,
❑ENEHGYT-24• .
Y'' -NE]
MECHANICAL I,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
FLOOD ZONE
Y❑ NO
aL. u.c.•
Yo No
ELECTRICAL
"
h.I
LATH -EXTERIOR :a,."_
FIRE DEPT.' �' -
SHEETROCK•
GRADE
FEE SUMMARY
SHEAR,INTERIOR - -
BUI LDING3f' V -`d"T
BUILDING
`
SHEAR EXTERIOR,
TE PORARY APPROVAL
FIREWALLS
ELECTRIC-
PLAN CHECK
FEE. ..
/ l -�•,
...
GAS . •
SEISMIC FEPI
4 i
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
JOCCUPANCY
OCCUPANCY OF BUIL DING IS NOT PERMITTED UNTIL BUILDING FINAL -IS SI GNEDBYBU ILDINGINSPECTOR.
MICROFILM'•
ARRANGE FOR INSPECTION BY PHONING 252,4505,
eLEcrRIc,
rPLUMBING
LU 'ONE -WORKING DAY BEFORE REQUIRED INSPECTION
H
I,
O`� PLEASE GIVE JOB ADDRESS WHEN PHONING .
.: '
•MECHANICAL
Z -
;SEE PERMIT FOR EXPIRATION DATE —
'
covsT..Tax'
IMP.ORTANT'!
PLEASE READ REVERSE SIDE BEFORE '
TOTAL
CALLING FOR FINAL INSPECTION.
-'' QFFICE COPY -I
APPLICANT TO FILL IN INFORMATION WITHIN •RED'LINES - USE BALL POINT PEN ONLY
HUI L61 NG PROJECT I DENTI FICATION-
- -
-
APPLICATION '& PERMIT
ILDING- ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
ampsBUILDING -
aoouEss'
OwNE 's -
NAME
PHONE2� !3(•'')
OTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
r ,
-
-
DATE OE APPLICATION
CONTRACTOR S
NAME
6 l Ill.
OUTLETS - SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00 `•
CONTRACTOR's 1
ADDRESS G
POZ�390)'/J
APPLIANCES -RESIDENTIAL 4.00
PANELS IO.OD
ARCHITECT -
OR
ENGINEFR
-LIC. No.
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS., 3.00
ARCH. OR ENG, "' 'PERMIT
ADDRESS
SPECIAL CIRCUIT ' 5.00
VALIDATION
TEMP. METER OR POLE INS. 20.00
ZIv
(l\il•',�t_j1'�
APPLI CANTSES- -
ADDRESS p
„ - -
MOTORS v SEE FEE SCH.
SERVICE CHANGE 20.00
LICENS ED CONTRACTORS DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9
' -
ISSUANCE DATE
(commencing with Section 7000) of Division 3 of the Business and
P ol'essons Cod tend lyy Ilcm+I lis in Cull fur-
License ClassO- Lic. Number
- r, r
f)BLDG.1
(^' '"
ELECT.
❑
PLC. MECH.
❑ ❑
-
Datc_Q.(LZLGL_Conlrador -
-
j �. BUILDING PERMIT
INFORMATION
'/ V "O/WNoF~R-BUILDER DECLARATION -
I hereby Pollo that I um exempt c.7 front the ncxlactois License
Law for the following countywhi Sec. 703se permit tocodProftssians
Code: Any City Dr county which structurep prior ots iYum¢ce, also
improve, demolish, or repair any structure, prior to its issuanec, also
requires the applicant for such permit to file a Signed statement that
he Is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 Of the
Rusiness and ProfessionslCode) or that he is exempt therefrom and
Pihl
MISC. - REFER TO ORD -
PERMIT ISSUANCE 10.00
VALUATION.
/
/S-QO
ELEC. CONTE.. LIC. NO.
- -
TOTAL
TOTA
PERMIT TO
S� 6 -Al, /
QTY. PLUMBING PERMIT . FEE
STORIES
TYPE CONSTR.
he basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant toa civil penalty
of not more than live hundred dollars ($500).):
"
ALTER -DRAIN -WATER (EA.) 5.00 .
❑. I, as owner of the property, or my employees with wages as
I heir sole compensation, will do the work, zinc[, the structure is not
intended or offered for salt (Sec. 7044, Rusiness and Professions
BACK F LOW PROTECT. DEVICE 4.00
DCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, CON D. 5.00
Code: The Contractors License Law does not apply to an owner of
property who index or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
merits are not intended or offered for sale. If, however, the building
F IXTUR ES - PER TRAP 5.00
sn FT. FLooR AREA
'
TOTAL ACREAGE
GAS -EA. SYSTEM-11NC.40UTLET3 6.00
O AmprovemenI is sold within one year at completion; the owner-
builder will have the burden of proving that he did not (mild or ins
of the p
prove 1, as owner
❑ of the property, exclusively contracting with
GAS - EA. SYSTEM - OVER'4 IEA.) 2.00
BUILDING USE
RES IND CON PB Other
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE'INTER. 30.00 ,
. 704 ,
d Contra t the project (Sec. 7044, Rosiness
he
licensed Contractor, to The
1. Professions Code: The Contractor's License Law docs not apply
m an owner of property who builds Orimpuwes thereon, and who
LAWN SPRINKLERS- 1 -1 NC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00 -
ASSESSORS PARCEL NO.
r
-
}
contracts for such projects with u comrumorfs) licensed I+ursuam to
the Contractor's License Law. -
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
O I am exempt under Sec. ,B.&P.C. for this
reason
WATER HEATER W/VENT 6.00
Owner - Dale
WATER SYSTEM 5.00
ACC.OATE
ACC. FILE N0.
WATER TREATING EQUIP, 5.00
WORK 17RS'COMPCNSATION DECLARATION
1 hereby affirm that 1 have a certificate of consent t. vlt-insure,
or a certificate of Workers' Compensation Insurance, or a certified
-
ZONING
ENG. SITE N0.
copy thereof (Sec. 3800, Lab.C.).T
I'olicy No. Company
-
I] rtifltA Ish rehy famished. -
t�pCLe�rt[j1¢coI�Eled with the ms�edi°` Ivision.
Applicant LZ �r `\ /`'y.
•. - _ •
FIRE SPUNK
'y ❑ N❑
ENERGY T-24
y ❑ N❑
MISC.- REFER TO ORD.
CERI'IFICA'1'E OF EXEMPTION FR wO
PERMIT ISSUANCE 10.00
FLOODZONE
A.L.U.C.
CONTE. -LOC. NO.
-
PLG. -
TOTAL
COMPENSATION INSURANCE .PLG.
I'I'his section lived not he completed 11' the pennil is to' one
Y ❑ N ❑
Y ❑ N ❑
-
hundred dollars(5100) or less.)
I certify that in the performance of the workfor which this per-
mit is issued, I slm[I not employ any person in any manner so as to
OTY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
become subject to theWorkers'Compensation Laws of California.
Dale Applicant
'DO
ALTER OR ADDTO MECH. 5.00
NOTICE APPLICANT: II', utter making this Certificate of Ex
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must Forthwith comply with
such provisions or this permit shall be deemed revoked
APPLIANCE 5.00
PLAN CHECK
FEE
.7.111
AIR HANDLING UNIT (TO 10=CF.M.) 4.00
AIR HANDLING UNIT (OVER IODOOC.F.M.) 6.00
SEISMICFEE
' CONSTRUCTION LENDING AGENCY
I hereby af1'irni that there is a construction lending -agency for
EXHAUST HOOD (WITH DUCT) 5.00 :
-
lhe.performance of the work for which this permit is issued (Sec.
3097, Civ.C.1.
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UNIT (OVER 100,000 B.T.U.)9.50
ELECTRIC
Lender's Name
-
Lender's Address
I certify that l have read this application and stale (hal the above
VENTILATION FAN (SINGLE)
information is correct. I agree to comply with all City and county
ordinanceS and state laws relaling to building construction, and
PLUMBING
'
BOILER-COMP(3H.P.or100,000B.T.U.) 6.00 -
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
. M_ ECHANICAL
hereby authorize representatives of this city to.enter upon the
above-mentioned property for inspection purposes. -
MISC. - REFER TO ORD.
,
(We) agree to save, indemnify and keep Inutile hecity of
abilities, judgments, -rsls and unser which
crueagainstmid ty in c quencOof the
CONST. TAX
PERMIT ISSUANCE 10.00it
�
y
lmbt/Cmntalttor
MECH. CONT. LIC. NO.
MECH.
TOTAL
TOTAL
�17nt/Contr
for
OFFICE COPY