8692 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
' CITY OF CUPERTINO "8692
INSPECTION DIVISION
/ ^�}-� fI1, IJOB INSPECTION RECORD '
JOB ADDRESS 1111s222 Ll2 2 ," �' LY�,2� UNI # LOT-#,— ,PERMIT EXPIRATION
J/' •PERMIT EXPIRES IF WORK
OWNER 'c _I CONTRACTOR Q IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- •
FOUNDATION - - :�+ 'ANCE OR 180 DAYS FROM
UFER LASTCALLED INSPECTION. .
PREGUNITE + .PERM KRIMON, --
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBINGCupertino .
ELECTRICAL -
IssuANCE GATE
MECHANICAL , el.0c. ELEcr. MEc .
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE'HAS BEEN SIGNED BUILDING PERMIT.
WOOD FLOOR - INFORMATION
PLUMBING'' VALUATION SIFT.
MECHANICAL
ELECTRICAL P RMIT To
FRAMING - ( � 'eys
INSULATION - STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF SO:ET,FLOORAREA -TOTAL ACREAGE ,
DIAPHRAGM
BUIL USE
CON
IND CON PB OIneI
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ' ❑
ROUGH. ASSESSORS PARCEL NO.
PLUMBING '
GAS TEST - TRACT NO, PARCEL NO.
MECHANICAL -
ACC.DATE ,; 'ACC.FILE NO.
ELECTRICAL 4rNWG�
DATE INSP:
FRAMING - ZONING ENG.SITE NO.
INSULATION FIRE SPRINK ENERGY T 2<COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED Y ❑ N❑ Y ❑ N❑FLOOD ZONE A.L.UA.
LATH—INTERIOR
LATH—EXTERIOR FIRE DEPT. - Y❑ N❑ Y 0 N❑
SHEETROCK GRADE - FEESUMMARY
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 .
UCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR: MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ' ELECTRIC
I'J ONE WORKING DAY BEFORE REQUIRED INSPECTION, T
H�
0 - PLEASE GIVE JOB ADDRESS,WIIEN PHONING. PLUMBING
z
- SEE PERMIT FOR EXPIRATION-DATE - MECHANICAL
IMPORTANTI' CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENT]FICATI ON _ PERMIT NUMBER
_,X BUILDINCy APPLICATION & PERMIT
ADDRESS �1b3 W,t kens /hIer 8692
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
O.N ER's PLAN CHECK VALIDATION
NAME ^T .�,��.� DTV• ELECTRIC PERMIT FEE jp FO 1 PHONE QA
CONTRACTOR
ts, UTLETS-SWITCHES-RECEP 10.00/1.00 e�
I..EY1��1.1R-� mS LIC.N0.��f`j0 LIGHTING FIXTURES 10.00/1.00 MpY 211957
CONTRACTOR S �' PPLIANCES-RESIDENTIAL 4.00
L'eiJQntc�A 1'11r1�V� E PANELS 10.00GATION
pg we'"',
anCNITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No, SIGNS TRANS. 3,00
ARCH.OR
ADDRESS END SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S �� J
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
w9
0
Foo LICENSED CONTRACTORS DECLARATION - TEMP.POLE 30.00
a u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
a< a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MEC .
F
D. Professions Code,and my license is in full force and effect. ❑ ❑ ❑
aim° License Class Lic.Number -
F w F J Date Contractor
¢ Y F J
X ¢ a 4 OWNER-BUILDER DECLARATION BUILDING PERMIT
°'° MISC.- REFER TO ORD INFORMATION
F
g; w I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
u o¢ Law 1'or the following reason.(Sec.7031.5.Business and Professions
- PERMIT ISSUANCE 10.00
Code:Any city or county which structure permit Io consuanc ,also
¢ ¢ ¢ ° improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.
°u requires Ilse applicant for Such permit to file a signed statement that TOTAL
e m x he is licensed pursuant tO the provisions of the Contractors License PERMIT TO
F z <
Law(Chapter 9(commenciagwith Section 7000)of Division 3 ofthe
E P° Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
X H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP AES.UNITS
their Sale compensation,will do he work,and the structure 0 no[
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law dues not apply to an owner of
Property who builds or improves Thereon,and who Ines net,work FIXTURES,PER TRAP 5.00 SO.FT,FLOOR AREA TOTALACREAGE
himself or through his own employees.Provided that such improve-
mentsarenotintended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6,00
or improvement is sold within one year of completion,the owner-
builder will have he burden of proving that he did not build or am- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for Purpose of sale.). E IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project(Sec. 7044,BusinessLAWN SPRINKLERS-1 INC 5 VB600 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply V.B. .
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 contractor(s)licensed pursuant to
he Contractor's License Law. SEWER•SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO,
O I am exempt under Sec. ,ILA P.C.for this
reason WATER HEATER W/VENT 8.00
Own`,r Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent Ns self-insure,
or a CCrtil¢ate of ZONING Workers'Compensation Insurance,or a certified' ENG.SITE N0.
I copyy[sRgpf es83}SQQ„Lab.y N,
Polis: 1IJJdd�r 4 ,i'L.b. �10.M rtRs^^
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGYTIa
Z Z Certified copy is filed with the city inspection division.
F O PPIEat I MISC.- REFER TO ORD. Y ❑ No Y C] NO
C y CERTIFICATE:OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00LU FLOOD ZONE A.L.U.C.
ION
C• o (This section need not be completed if thepermitis for one PLG.CONTR. LIC.NO. TOTAL Y[] NC] Y[] N0
U O hundred dollars IS 100)or less.)
I certify that in the Performance of the work for which this per. FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE
become subject to the Workers'Compensation Laws of California.
U.1 Dae Applicant -JALTER OR ADD TO MECH. 5.00 BUILDING
>_ W NOTICE TO APPLICANT: If,after making this Certificate of Ex '
I- ? emption,you should become subject to the Workers'Compensation J APPLIANCE 5.OQ PLAN CHECK
provisions of the Labor Code, you must forthwith comply with U FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.RM.) 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(See. MICROFILM
3097,Civ.C.). - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lenders Address (OHEATI NG UNITVER 100,000 B.T.U.)9.50 ELECTRIC
1 Certify that I have read this application and stare ilial the above VENTILATION FAN (SINGLE) 4.00
Information n correct I agree to comply with all city and nt, "d BOILER-COMPO H,P,or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building eOn ter upon
and
hereby authorize representatives inspection
on this to enter upon the BOILER•COMP(Over 100.000 BTUI SEE FEE SCH, MECHANICAL
above-mentioned property for inspcmion purposes.
agree st save, t keep hnrndess the City Df MISC.- REFER TO ORD.
ape a to E e, ies,j:dgmcd Is, costs and expenses which CONST.TAX
m' in a c e agait City in cmiscy utnce of the PERMIT ISSUANCE 10.00
anti MECH.CONT. UC.NO.
5-21-8 TOTAL i TOTAL
ignature of Applicant/Contractor Date
OFFICE COPY