8706 POST THIS CARD NEAR 'FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 870
1 INSPECTION DIVISION
JOB INSPECTION RECORD
Gbury �� PERMIT EXPIRATION 1
JOBADDRESS /] n UNIT# /p LOT# PERMIT EXPIRES IF WORK '
OWNER I-� 1 ! L'7: �1' 1 CONTRACTOR SI,_Mry1,11,1.' `fylS` IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR .INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION 7
ANCE OR 180 DAYS FROM
UFER
LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB / }
PLUMBING (,Q
ELECTRICAL ISS N�/4r
MECHANICAL HL ELECT, PLG. MECH.
El Il E3
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $IFT.
PLUMBING -
MECHANICAL
ELECTRICAL PRRM1T>O 1
• FRAMING
STORIES TYPE CONS R.
INSULATION I
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF 50.FT FLOOR AREiOTALACREAGE
DIAPHRAGM
9uILD usE
' RES IND CON
PB 0IM1er
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 0 ❑ El ❑
ROUGH BN -Z';-Se' - ASSESSORS PARCEL NO.
PLUMBING S. Y\ - T-lais, ctv ..
cns resr TRACT NO. PARCEL NO,
-
MECHANICAL
ELECTRICAL' —1U-$' FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING �Q,Q" _ SAN *
INSULATION 4!r PLUMBING r.�- ZONING ENn.SITE No..
GAS
FIRE SPRINK ENERGY T 2
MECHANICAL /
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Yo N[] Y [] N�
LATH-INTERIOR ELECTRICAL C FLOOD ZONE A;LU.0
LATH-EXTERIOR FIRE DEPT. Y❑ N[] Y ❑ No
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDIN
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 NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, +ELECTRIC
o� •ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
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
•
J
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - PERMITNUMBER
ADILDINy APPLICATION & PERMIT
' v ADORES•.o� O 7 OC
O�� W�3t.+2nr � BUILDING -ELECTRICAL-PLUMBING-MECHANICAL U
OWNER'S /L� PLAN CHECK VALIDATIO
NAME �•y�VV"-�J C`_ (/ 01((7`
M. ( /{1K-OC'31 N� vHONE�S� I�Ep QTY. ELECTRIC PERMIT FEE �� L o
' CONT ACTORSNAME �j UTLETS-SWITCHES•RECEP 10.00/1.00 ` o t /
Svrn^I Lie No.J LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S R•s /'j�('�/� PPLIANCES-RESIDENTIAL 4.00
a� /�Z7L�IUJNE �.$'JS' PANELS IO.00 DATE OF APPLICATION
08RCHITECT - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEEP.C.NO.
ENGINEER
Lie.NO �- SIGNS TRANS. 3,00
ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20,00
APPLICANT MOTORS SEE FEE SCH.
ADDRESS SAM
SERVICE CHANGE 20.00
w o O LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
<u v 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
Z"' (commencing with Section 7000)of Division 3 of the Business and
,n a BLDG. ELECT. PLG. MECH.
H � Profeuions Code, m license is in full fMAO
z o,y, - Licens Lic.Numbe
4
Zr
w Uute Contractor
- A'®11LDIN0 PERMIT
¢ w a OWNER-BUILDER DELLA
¢ u INFORMATION
X ; ` N 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD ALUA
Huoa Law for the following reason,(Sec,7031.5,Businessand Professions PERMIT ISSUANCE 10.00 S/FT.
Code:Any cityorcuunty which requires a permit to construct,alter,
Q a Q Q Improve,dem°IISh,or repair any Structure,prior to Its Issuance,also CLEC.CONTE. LIC.NO. ELEC.
um¢ requires the applicant for such permit to file a signed statement that TDTAL P MIT TO
wto 0i he is licensed pursuant to the provisions of the Contractor's License Of CllDpe}�Ik(
Law(Chapter 9(commenciagwith Section 7000)ofDivision3ofthe (T/0�
a Ilusineu and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
f S D
¢ I- $ lire basis for the alleged exemption:Any violation of Section 7031.5
malty STORIES TYPE CONSTR.
i ; by any note(]rat for permit dollars tile sent tuacivil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more Than five hundred dollars($500).):
❑ 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 slruclure is not 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 such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
1-07 mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year of completion,lire ownGAS-EASYSTEM OVER 4 IEA) 200
builder will have the burden of p . - . .
roving that he did not build or in,. BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with . .
❑ ❑ ❑ 0 0
licensed contractors to construct the project(Sec.7044,Business I LAWN SPRINKLERS- i INC 5 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 (EA.) 1.00
contracts for such projects with a contractems)licensed pursuant to SEWER-SAN EA.200k/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ l am exempt under Sec..,R&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner _ Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK Ii RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent m self-Insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy therep4��Se ab.CJ.
Policy No.6:/WyLEsT.'!S/Apar
O ❑ Certified copy is here by Ishe
A CertiO nth�(��f[.�cit e t division. FIRE SPR INK ENERGY T14
Zp A'ISp I,at-< L,Y ' ys� ynvw.g s� M15C.- REFER TO OR Y[] N❑ Y ❑ NF
F y �au+'f" PERMIT ISSUANCE 10.00
LU - CERTIFICATE OP I AX COMPENSATION
FROM WORKIi R$' FLOOD ZONE A.L.u.C.
W � CUMI'ENSATION INSURANCE PLG.CONTR, LIC,NO. PLG. '
CL Z( This Section need not be completed if the permit is for one TOTAL Y❑ N� V [:] No
hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner u as to
U W become subject to the Workers'Compensation Laws of California. p
u Oatc ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
} t4 NOTICE,TO APPLICANT: If,after making this Certificate of Ex-
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of lire Labor Code, you most forthwith comply with FEE
U such provisions or this perit'shall be deemed revoked. AIR HANDLING UNIT(TO 10MCF.M.) 4.00
CONST RUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE 77
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5,00
the performance of(lie work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name
H EATI NG UNIT(OVER 100,000 B.T.U.)9.50
Lender's NameAddress ELECTRIC
I certify that I have read(tis application and state that the above VENTILATION FAN (SINGLE) 4,00
4 information is correct.1 agree to comply with all city and county BOILER-COMP13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
,ordinances and state laws relating to building COnslfueliDIL and
hereby'authori>e representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP to.,100,000 BTU)SEE FEE SCH. MECHANICAL
(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 arm way c ainst Said City in consequence of the
ung° MECH.CONT. LIC.NO. MECH.
S S/ S TOTAL TOTAL 7 d7
Signature of Applicant/C°nlracmr Date
- OFFICE COPY