11129 „ . 'P.OST.THIS.CARD NEAR FRONT OF BUILDING ,
I'Ii RMIT NUMBER
'CITY OF CUPERTINO 1.1129
INSPECTION DIVISION'
-JOB INSPECTION RECORD
����Q/ ' PERMIT EXPIRATION
• - JOB ADDRESS '- 'ONIT# LOT# 1
EXPI RES IF WORK
OWNER CONTRACTOR - IS. T. STARTED WITHIN
INSPECTI N ATE INSPECTOR _ INSP C ION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION. - - _ •ANCE OR 180 DAVS.FROM
.
- - '�-
LAST CALLED INSPECTION.
LIFER .
PREGUNITE - PERMIT VALIDATION
POUR NO CONCRETE UNTILABOVEHAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING -
u
ELECTRICALr - - ISSUANCE IiA IE
_ MECHANICAL' _ - • et;pa ELEcr. PLc. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ; '- BUILDING PERMIT
r � .WOOD FLOOR - - - INFORMATION'
VALUATION,
PLUMBING - - -
MECHANICAL I
ELECTRICAL - PER ITTo
FRAMING • '
' -STORIES TYPE CONSTR.
INSULATION. /' .yy� I. 60
- OCC.GROUP RES.UNITS -
PLACE NOS UBFLOO RUNTIL ABOVE HAS BEEN SIGNED +- I
SO.FI,FLOOH AREA , TOTAL ACREAGE
ROOF .. .
'�..,. DIAPHRAGM .•'1 1
BUILDING USE
RES IND CON PB Ober
-APPLYING ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PA13CEL NO.
ROUGH
PLUMBING ' - - ' •3y - - TRACT NO. 'PARCEL NO.
GAS TEST•
MECHANICAL •: -
ELECTRICAL - FINALS - DATE' INSP. ACC DATE ACC,FILE NO'
FRAMING. , .' SAN # zONING ENG.sITENO.
-
'INSULATION PLUMBING'
- GAS -
FIRESPRINK ENERGY T 24
• - MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - v ❑ , NE] Y ❑ ,N❑
FLOOD ZONE A.L.11.C.
LATH—INTERIOR - ELECTRICAL
LATH-EXTERIOR - FIR&DEPT. Y❑ NE] .y ❑ N❑
SHEETROCK GRADE - FEE SUMMARY
SHEAR INTERIOR ' 'BUILDING
- SHEAR EXTERIOR - TEMPORARY APPROVALS BUILDING
FIREWALLS.” -I ELECTRIC - - PLAN CHECKr 1 '1
GAS ' FEE. +^'
NO TAPE OR,PLASTER UNTIL ABOVE HAS,BEEN SIGNED OCCUPANCY SEISMIC FEE
'- TOCCUPANCY,OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDINGINSPECTORt MICROFILM ;
ARRANGE FOR INSPECTION'BY PHONING"252-4505;' M ELECTRIC
� FONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING _. .
. Z PLEASE GIVE"JOB.'ADD,RESS;WHEN PHONING.
— SEE'PERMIT'FOR EXPIRATION DATE — MECHANICAL c
X" IMPORTANT! coNsr.rnx
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
BUILDING PROJECT IDENTI FICATION -, - PERMIT NUMBER
BUILDING APPLICATION & PERMIT- A q n
-� arDREss r BUILDING- ELECTRICAL-PLUMBING-MECHANICAL I I G
O NER'S PLAN CHECK VALIDATION
NAME •' OTY. ELECTRIC PERMIT FEE
PHONE
rvrmacrDRsPrfi
NAME UTLETS-SWITCHES-RECEP10.00/1.00
LIC.No, LIGHTING FIXTURES 10.00/1 00
nooeesS' APPLIANCES-RESIDENTIAL 4.00 .�
PHONE PANELS 10.00 DATE OF APPLICATION
ARceOecr - PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.NO.
DR
ENGINEER
' - Sec.NO, SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT - .. 6.00 PERMIT VALIDATION
ADDRESS ,
iIP -EMP.METER OR POLE INS. 20.000
APPLICANTSDURESSMOTORS SEE FEE SCH. ` •tt/"�-n�
SERVICE CHANGE 20.00
o O o LICENSED CON'I'RACfORS DECLARATION rlI/1' Gf'
¢u w I hereby affirm that I am licensed under provisions of Chimmi-9 I�yAH'Oa(ZIA720
H < m lu>mmmtgng with Section 70007 of Division 3 of the Business and y _ BLDG. 'ELECT. PLG. MECH.
H w z Professions Code,and my license is in full force and effect. J / n 1 ❑ .❑ ❑ ❑
2 o m- License Class Lie.Number
9 y Date Contractor • '
¢ ¢¢ OWNER-BUILDER DECLARATION .. '1` Clf Of CuDer.InO BUILDING PER
¢ w - INFORMATION
Aoao - MISC.- REFER TO ORD
X 3 I hereby affirm Thal 1 am exempt from the Contmetdr's License VALUATION '$/FT.
H ¢ 0< Law for the following reason.(See.7031.5,Business and Professions PERMIT ISSUANCE 10.00 6�
w Code:Any city orcounty which requires a permit to construct,alter,
Q ¢ ¢ 0 improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
a
O ¢ requires the applicant for such permit to file a signed Statement that TOTAL t PE MIT i0
K m¢ Ile is licensed pursuant to the provisions of the Coatrnctor'I:License _ T
r'ii Law(Chapter 9(commencing with Section 7000)of Division 3 of the (N `L' /u d4F
a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT - FEE
I i o
¢ I- o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONS R.
a �-- byanyapPlieant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($5000.):
❑ 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 (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 5.00
Code:The Contractor's License Law does not apply to an owner at
�! property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5,00 z FLOOR AREA Torat ACREAGE
himself or through his own employees,provided that Such improve-
' ments are not intended or offered for sale.If,however,the building AS-EA.SYSTEM-1'INC.40UTLETS 6.00 -
or improvemmutis sold within one year of completion,the owner- GAS-EASYSTEM OVER 4 (EA) 200
builder will have the burden of proving that h . - . .
e did not build or im. BUILDING USE
Prove for purpose of sale.). INDUSTRIAL WASTE I NTER. 30.00 RES IND CON PB Omer
❑ 1,as owner of the property,am exclusively contracting with 1:11:10 1:1 • ❑
licensed contractors to consro" the proiect(Sec.7044,Business LAWN SPRINKLERS-1 INC 6 V.B. 6.00 ' ASSESSORS PARCEL NO. ,
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 A, � .00 ^
contracts for such projects with a contraclops)licensed pursuant to
the Contractor's License law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT,NO. PARCEL NO.
❑' lam exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT I `� 6.0 -
reason -
Owner (y ry' JgjIL'i(_ tiuc WATER SYSTEM ACC.DATE ACC.FILE NO.
WORK Ii RS'COMPENSATION TTI::CLARATItWATER TREATING EQUIP, I y .00' t
I hereby affirm that I have a certificate of consentdR self-insure,
s or a certificate of Workers'Compensation haumnce,or it certified. - ZONING ENG.SITE NO.
- cnpy thereof(Sec.3800,Lab.C.). ,
Policy No. Company
O Cl Certified copy ishereby furnished! FIRESPRMK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. -
O Applicant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ .N❑
~ wPERMIT ISSUANCE 10,00 v FLOOD ZONE L.U.C.A.
CC •CERTI FICATE Op EXEMPTION 17 ROM WORK Ii RSI
lL �_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
d O (This Section need not be completed if Ore permit is for one TOTAL - Y❑ N❑ Y ❑ N❑
Z hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL,F' m
mil is issued,I shall not employ any person in any manner so as In -
U- become subject to the Workers'Com ensalion laws of-California.
O w ) pBUILDING 4-V
M Date-Applicant - ALTER OR ADD TO MECH. 5.00 O
- } m NOTICE TO APPLICANT: If,after making this Certificate of Ex-
f" Z emPtion,you should become subject to the Workets'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 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a constructio olending 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 -
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC30
V
I certify that I have read this to applicat and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
- ordinances and state laws relating m building construction, unci BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 V
hereby authorize representatives'of this city to crier upon the BOILER-COMP (Over 100,000 BTU)SEE-FEESCH, MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in.consequence of the PERMIT ISSUANCE 10.00
grunting f this permit MECH.CONT.. LIC.NO. MECH.
TOTAL'
'Sig tumof ADPH atContrxcmr TOTAL W 7�
OFFICECOPY -
J POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO Pfl�%%Ir NUMBER
INSPECTION DIVISION 11129
JOB INSPECTION RECORD
��'J• PERMIT EXPIRATION JOB ADDRESS ///aJ�����"�-�'�✓�S �� UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER �//� u. ('-N £" CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
I)l L
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND / ' I7 // ' •/
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLG, MEEK
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
0 FT FLOUR AREA TOTALACREAGE
ROOF
, . DIAPHRAGM
BUILDING USE
RES IND CON PB Olu.�
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ El
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST L TRACT No. PARCEL No.
me
MECHANICAL .P kec.
ACC.DATE ACC.FILE No.
ELECTRICAL � �.-� FINALS DA E INSP.
FRAMING / SAN #
ZONING ENG SITE NO.
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY T34
MECHANICAL v ❑ N[:] r ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.LU.L.
LATH—INTERIOR ELECTRICAL
LATH—EXTERIOR FIRE DEPT. Y NY ❑ N❑
SHEETROCK GRADE - FEE SUMMARY
SHEAR INTERIOR BUILDING BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I ISEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
f 11 LU
PLUMBING
� ONE WORKING DAY BEFORE REQUIRED INSPECTION. -
1 PLEASE GIVE JOB ADDRESS WHEN PHONING.
�r Z
— SEE PERMIT FOR EXPIRATION DATE — MECHANUgA. _Bi CaP.arur:0
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
:APPLICANTS POSTING COPY
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