14755 POST THIS CARD NEAR-FRONT OF'BUILDING
PERMIT NUMBER
CITY ,OF CUPERTINOAA
INSPECTION DIVISION: T755.
JOB-INSPECTION RECORD
PERMIT EXPIRATION
Imo'•+=l JOBADDRESS.- "��3 �fo � 'e .�P�O UNIT# _LOT#
/J / PERMIT EXPIRES IF WORK ;
OWNER ✓. S Lir//CA 't_' _A CONTRACTOR 06 �a C , �`@,C. '
Q S�o IS NOT STARTED WITHIN '
INSPECTION DATE I INSPECTOR SPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE: ANCE OR 180 DAYS FROM ,
UFERALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF - PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS?
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - o • ,- *-9j /
UNDERGROUND /SLAB Ra C. /tf-'t %•
PLUMBINGF•t{L.'�,,v--
ELECTRICAL clWA avl /Z�2L14y ISSUANCE.DATE
MECHANICAL _9L7 •S, 7- T DO ELECT PLG. MEC.
r�ARvo 10
0 ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED L-1 BUILDING PERMIT
WOOD FLOOR Ani FORMATION
• PLUMBING _
VAtUATION � $11T.
MECHANICAL CIIDBit100
ELECTRICAL
FRAMING - .r•�c'~.f-i .'t
INSULATION - STORIES TYPE, ONSTR.
• - ,. OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
so.Fu n,ouR AIIIA T.TAL ACREA9E
ROOF NOTE:NO FINAL)NSP.SHALL BE MADE BEFORE -
' DIAPHRAGM THE CONSTRUCTION TAX IS PAID
v S BUILDING USE
ROOF SHEATHING RES IND CON PB om•„
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED_ FINALS DATE INSP. El ❑ ❑
ROUGH SAN.N A55ESSURS PARCEL NO.
IN PLUMBING ELECT.ENERGY
-
TUBS 8 SHOWTRACT NO PARCEL NO
ER PAN - PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL - ACC.DATE ACC,F ILE No
u•�' .BUILDING ENERGY
FRAMING - ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG SITE NO.
GAS TEST GAS -
MECHANICAL FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° ❑ "� ''❑ '"❑
EXTERIOR SHEAR ELECTRICAL RELEASE - FLOOD mNE aL.0 C.
INTERIOR SHEAR FIRE DEPT. Y❑- "❑ ' L N❑.
SHEETROCK- GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH - • TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY., SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC-
F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
59 If 2/2-
APPLICANT
/ZAPPLICANT TO FILL IN INFORM N WIT R D LINES - USE BALL POINT PEN ONLY
B I LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
aDILD"G APPLICATION & PERMIT A :
ADDRESS'
1 au w G�r BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 4
OWNER'S ('// , PLAN CHECK VALIDATION
MAN,
A E'"� , Foyl a 1/L`c r • ls QTY. ELECTRIC PERMIT FEE
• ��j0 PHONE
CONTHACTOM
27
'19
E - �-�' _ ''// UTLETS-SWITCHES-RECEP 10.00/1.00
hF- fbf N/Y�LI..No.73Ir'/-72-' IGHTING FIXTURES 10.00/1.00 C -
CONTRACTOR S f, NTRAC OR'S
AD REss U,fL/y (' PPLIANCES-RESIDENTIAL 4.00 - -
00 K� �'� PHONE f/ "0311' PANELS 10.60 DATE OF APPLICATION
OR
in PANELS (OVER 200 AMP) 26,00 PLAN CHECK FEE P.C.NO.
ENGINEER
uc.No. SIGNS TRANS. 3.00
AUD.Ess ENa. SPECIAL CIRCUIT 5.66 PERMIT VALIDATION
zIPEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
AODRE55
SERVICE CHANGE 20.00
wO o LICENSED CON'T'RACTORS DECLARATION
a u I hereby affirm that I con licensed under provisions of Chapter') .�j ISSUANCE GATE
r z"' (,commencing with Section 7000)of Division 3 of the Business and
y 6 y BLDG. ELECT. PLG. MECH.
O z Professions Code,a ly d my I' rise is in full lure nJ of ec. �i ❑
' 0. ; License Class_'_4 f Lie Nwnber QMV
om Dates A'I fes-Contractor_ C
a.y f J Ot BUILDING PERMIT
¢'ono OWNER-BUILDER DECLARATION INFORMATION
. 3: LL w 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
HLL0 J Law for lire following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE 10.00 d VALUATION
W Code:Any city or county which requires a permit to construct,alter,
n' Q 2 G improve,demolish,or repair any structure,prior to its issuance,also EC.CONT / LIC.NO, ELEC.
eaca O requires the appliwnl for such permit Io file a signed stalemcnl thatR ,l J F /)/3 S/�Z TOTAL PERMIT TO
" he is licensed pursuant to tire provisions of the Contractor's License
i> Law.(Chapter 9(commeneingwith Section 7000)of Division 3 of the G
< Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ =$ the basis for the alleged ex to tion.An
g P the
eapplica of Section penally STORIES TYPE CONSTR.
by any applicant fore permit subjects $500).licam toacivil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more Than C.1 hundred dollars(myeni:
❑ I,as owner of the property,or my employees with re is not
BACK F LOW PROTECT. DEV ICE 4.00 -
their sole compensation,will do the work,and lire structure is nut OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
Property who builds or• improves thereon,and who does net,work F IXTUR ES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE himself'or through his own employees.provided that such improve.
mems
mProve-
mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or int- BUILDING USE
prove for purpose of sale.). I INDUSTRIAL WASTE INTER. 3000 RES IND CON PB borer
❑ 1,as owner of the property,am exclusively contracting .
wiol 1:10, ❑ ❑ Ellicensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00ASSESSORS PARCEL NO.
and Professions CodeA lie Contractor's License 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 conlmetol(s)licensed pursuant tO SEWER-SANITARY-STORM EA.200ft 1
the Contractor's License Law. / 0.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sac.-,BAP.C.for this WATER HEATER W/VENT 6.00
Cason
Owner Dale WATER SYSTEM 5.00 - ACC.DATE ACC.FILE NO.
WORK F-RS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to sell'-insure.
or a certificate of Workers'Com cruet on Insurance,or a mrtil'ml ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ.�-T/Y?« Z
Policy No. Company ��J
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 f le Certified copy is filed with the city inspection division.
O A'opl'I`'ant MISC.- REFER ORD. 'Y [:] NE] Y F] NE]
~ r
Cr CERTIFICATE OP EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 .FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
Z (This section need not be completed if lire permit is for one TOTAL Y❑ NO Y 0 IN ED
hundred dollars IS 100)or less)
0 O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
W U mit is issued,I,shull not employ any person in any nmnner so as to
become subject lO the W'orken'Compensation Laws of California.
y
Date-Applicant ALTER OR ADD TO MECH. 5A0 BUILDING
} GO NOTICE TO APP L ICA N'I': If,after making lir is Ce M i ficum of I'x-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=r-F.M.)' 4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.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(Sec. MICROFILM
3097,GY.C.). - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name' - HEATING UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC oz/"<
Lender's Address
• . I certify that I have read this application andstate lh:n lie above VENTILATION FAN (SINGLE) 4,00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COlVP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorise representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.to
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way acct a against said City in consequence of lire
ranting of this penult MECH.CONT. LIC.NO. MECH.
3 2 TOTAL TOTAL
Signature of Applicant/Contractor Date
OFFICE COPY