10892 sTTHISCARDNEARFRONTOF'BJJING
CITY OF CUPERTIN � ��, .'ERMITND�
INSPECTION DIVISION �g��
NUMBER
`
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS� I I�l`�' UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER CONTRACTOR STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION ^1 - LASTLED INSPECTION.
LIFER
P ATION
PREGUNITE
JUN 4!� 1988
POUR NO CONCRETE UNTIL ABOVE HAS BE SIGNED
PLUMBING
UNDERGROUND /SLAB
City of t;upertino
'
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLG. MECH,
El 1:1 ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR � VALUATION SIFT.
PLUMBING - ,VALUATION
f:
ELECTRICAL PERMIT To
FRAMING 444 P
ST .1
TYPE CONSTR.
INSULATION
OCC.,GROUP - RES.TITS
` PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED rL /
SO.FT FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM 4g 111 If' /J
/
BUILDING USE
RES IND CON' PB ON¢I
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑� El El El
ASSESSORS PARCEL NO.
PLUNG 'I
ROUGH 711 0 3/
GAS TE
pTRACT NO. PARCEL NO,
GAS TEST F-;2.
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING —�. SAN it - ZONING ENG SITE NO.
INSULATION _ PLUMBING . �•
GAS
FIFE SPRINK ENERGY T-24
MECHANICAL
Y ❑ N❑ Y ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A,L"U,C,
LATH-INTERIOR ELECTRICAL -%Z7^ v❑ N[] Yo N[]LATH-EXTERIOR FIRE DEPT.
hT
>747 SHEETROCK GRADE F FEE SUMMARY
SHEAR INTERIOR - _ BUILDING ,
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ' SEISMIC FEE '
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
t
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Iw ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 3
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX :>l.
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. f
OFFICE COPY
APPUCANT TO F 1_ IN INFORMATION WITHIN RED LIM S - USE BALL POINT PEN ONLY'
.1 BUILDI NG PROJ ENTI FICATION PERMIT NUMBER
ADILDIN07 Ar APPLIC ON & PERMIT O
ADDRESS
D a t' Cf-/ BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNEH'6 7LJ PLAN CH VALIDATION
"AME / TV. ELECTgIC PERMIT FEE al(JN
PHONE /,..,� /JA
CONTRACTOR'sSgf�r�u�7ana/ Cd7re fr. UTLETS•SWITCHES-RECEP 10,00/1.00
NAME Vitt of
LIC.No. LIGHTING FIXTURES 10.00/1,00
C•ONTRACTOR'S/I2g0a Sora --sILV APPLIANCES-RESIDENTIAL 4.00
ADDRESS G/
,/C HO NE 252" Q PANELS 10.00 DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO.
on
ENGINEYYJ�/^i Cpm TJP�J IIf// I` PANELS (OVER 200 AMPI 20.00
ER
/GLQ LIC.NO. S97z1-(&;, SIGNS TRANS. 3.00 y
ARCH.OR ENG,j20 LfO Serra �A�s/VQ/G SPECIAL CIRCUIT .5.00 PERMIT VALIDATION
ADDRESS iLLO '
EMP.METER OR POLE INS. 20.00
APPLICANTS a MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
wo O LICENSED CONTRACTORS DECLARATION
a Z w 1 hereby affirm that 1 am licensed under provisions of Chapter9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLD ELECT. PLG. MECH.
�i Professions Code,a my license is in full force' f ec�
o i T D License CI ss Lic.Number ❑ ❑ ❑
w Date 1 Contractor / / ✓ /' -
T
E � BUILDING PERMIT
a W a OWNER-BUILDER DECLARATION INFORMATION
O D MISC.- REFER TO ORD
E:
;n H I hereby affirm that I am exempt from the Contractor's License - VALUATION S/FT.
FLL0 J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
fww� Code:Any city or county which requires a permit to construct,alter,
le a,Q O improve,demolish,Dr repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
u F O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
X$a- he is licensed pursuant to lite provisions of the Contractor's License
H z> Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom andQTY. PLUMBING PERMIT FEE
M = $ the basis for the alleged exempt ion.Any violation of5ection 7031.5 sTO S TYPE CONSTR.
i3 by any applicant for a permit subjects the applicant to.civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S500)J:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 O C.GROUP REs,yNlTs
their sole compensation,will Jo the work,and the structure is not RET
ITS
or offered for ale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Cantrstor'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.FLO R AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- r••.
ments are not intended oruffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 1
or improvement is 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 ho- BUILDING USE
RES
prove for purpose of the
IND CON PB Other
INDUSTRIAL WASTE INTER. 30.00
❑ as owner of the property,am exclusively contracting with 11 C1 El
licensedd contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6,00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to anowner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a conlramor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT N PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner � =1Date 0dh? WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WO RKERS'COMPEN.A I DECL WATER TREATING EQUIP. 5.00
I Iieleb from that I have a cetlifKale of cmnsem mself-insure,
or a cert i fie le of Workcrs'Compess�at ion
/IInnsurrarm- or•aa,c�erY(ied ZONING ENG.SITE N0.
copy there Sec.3800,Lab.CJ'WrJ's/1J'/� /HHC44 1
Policy No. Company
IJ ❑ Certified copy is hereby furnished. FIRE SHRINK ENERGY T-24
Z Z 13 Certified copy i filed with the city inspection divisions . MISC.- REFER TO ORD,
No
CC y CERTIFICATE OIr EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 _7000 ZONE A.L.U.C.
COMPE
SION
W 0 (This section need nott be completed Ee -
lf the permit is for one PLG CONTE. LIC.NO. TOTAL Y N Y N❑
CIL
7) Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this Per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
U. F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
Q i Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex-.
I- Z emplion,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 his permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
1 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 HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I Certify that I have read this application and stale 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 to building construction, and BOILER-COMP(3H,P.or100,000B.T.U.) 6.00
hereby authorize representatives of his city to enter upon the BOILER-COMP Over 100,000 BTU)SEE FEESCH. MECHANICAL
above-mentioned grope y for inspection purposes,
(We) agree t0 sa , indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against ities, mut Costs and expenses which CONST.TAX
may in any we true agai sai City in consequence of the - PERMIT ISSUANCE 10.00
granting of thi r ` J PCH.CONT. LIC.NO. MECH. TOTAL
/ D/ TOTAL
Signa ureo pplicant/Contractor to