8955 POST THIS CARD NEAR FRONT OF BUILDING
PFRMIT NUMBER
CITY OF CUPERTINOQQa
INSPECTION DIVISION UJ��
JOB INSPECTION RECORD
AN
JOB ADDRESS e �oLOT#
PERMIT EXPIRATION
T#
PERMIT EXPIRES IF WORK, -
OWNER CONTRACTOR IS NOT STARTED-WITHIN
IN PECTION DATE INSPECTOR SPECTI RECORD 780 DAYS OF PERMIT FROM
FOUNDATION LAST AL 180 DAVE TIO .
UFER LAST CALLED INSPECTION.
PREGUNITE PERMIT VALIDATION,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB MAY G '. 1986
PLUMBING
ELECTRICAL �b
MECHANICAL - ,BLDG.. EL CT PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED . ' BU LDING PERMIT
INFORMATION
WOOD FLOOR '' vA 710 - $/FT.
PLUMBING _ _„ ,
I //�P• I
MECHANICAL � ' `
rT
ELECTRICAL P M
FRAMING
STORIES TYPE CONSTR.
INSULATION
OCC.GROUP RE$,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF _ t SO.FT,.FLOOH AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
^ HES IND •CON PB Omer
/ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑'• ❑ ❑ ❑ ' ❑
ROUGH / JASSE55GRS PARCEL NO.
PLUMBING /
GAS TEST
TRACT NO, PARCEL NO.
� - � '
MECHANICAL -
ACC.DATE ACC.FILE NO.
ELECTRICAL -s.� FINALS � DATE �INSP.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION - �, PLUMBING, '
GAS
MECHANICAL FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING. ❑ "❑ Y ❑' NEI
FLOOD ZONE A.L.U.C.
' • LATH-INTERIOR ELECTRICAL '
LATH-EXTERIOR FIRE DEPT. Y❑ NEI yo No po Pre
SHEETROCK GRADE . 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
LICCUPANCYOF,BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDINGINSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
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
BU CDI NG PROJECT IDENTIFICATION PERMIT NUMBER
T/4 ADIDRESS 22563 OoDR(D c APPLICATION & PERMIT 8955
CUPCRT/A/0 CA 15014 BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S
NAME q25-6345 PLAN CHECK VALIDATIO
\� -TAI-P)/�G LUNLT sS�_9499 DTV. ELECTRIC PERMIT FEE
PHONE � � W
CNAMEONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 0
LIC.No, LIGHTING FIXTURES 10.00/1.00 0 —
ADDDRESS roll's APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
OORRCHfTECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC,No, SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 ,PA.
ADDRESSTs MOTORS SEE FEE'SCH. - q
SERVICE CHANGE 20.00 AIA V rj
00
1946
0
°.
r o o LICIiNSEU CON'T'RACTORS DECLARATION TEMP,POLE 36.6o
aP.
0 u 1 hereby affirm that I am licensed under provisions of Chapter 9 IS 1kIF1
N a N (commencing with Section 7000)of Division 3 of the Business and _
B EL PL H.
r h z Professions Code,and my license is in full force and effect. 11 ❑
z 0 m — License ClassLie.Number
o m H w Date Contractor
¢ seid 7 BU DING PERMIT
M rt w u OWNER-BUILDER DECLARATION NFORMATION
w ;e H 1 hereby affirm that 1 am exempt from the Contractor's License MISC.— REFER TO ORD
ac Law Law for the followingreason. 703 t.5,Businessand Professions VALUATION $/FT.
r — PERMIT ISSUANCE 10.00 G O
Codes A,d city or county whiny requiresaure permit o its issuance,
ce,alAfter,
Q a¢ D Improve,den101ISI1,Or repair any SIfIICIIIIe,prior to IIS ISSnanCe,a150 ELEG CONTR. LIC.NO. - ELEC. /,�
y %m u requires the applicant for such permit m flle'v signed statement that TOTAL V PER
TO
he is licensed pursuant to the provisions of the Contractor's License
La
zt Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
¢ Business and Professions Code)or that he is exempt therefrom:md OTY. PLUMBING PERMIT FEE
DE = the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a 3 — by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dolWrs(5500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE - 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or ofi'efed for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:Tile Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does Such Work FIXTURES-PER TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such Improve.
meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.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 Jul. BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 R IND CON PB Other
❑ I.as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed 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 an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
commis for such projects with a contractors)licensed pursuant In SEWER-SANITARY-STORM EA.200f1/10.00
theContractor'sxeLicense Law. TRACT NO. PARCEL N0.
1a
❑ Tum exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Uate a WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKER 'COM SNSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a Certified ZONING ENG.SITE NO.
copy Ihercaf(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- ' REFER TO ORD. ❑ ❑ ❑ ❑
F O Applicant Y N Y N
XN C17R IT FICAIIi 017 EXEMPTION F ROM WORK ERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE, PLG,CONTR, LIC.NO. PLG.
CL,CL Z IT'his section need not be completed if the permit Is for one TOTAL Y❑ N[_ Y [:] N❑
hundred dollars IS 100)or Ies0
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued,1 shall not employ any person in any manner so as to
O w become subject to the Workers'Compensation Laws of California.
y Date ApplicantBUILDING
} N NOTIC17 1'0 APPLICANT: If,after making this Certificate of fix 'ALTER OR ADD TO MECH. 5,00 J V
F 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 this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE ` z)
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,CY.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 3o
Lender's Address ELECTRIC
I certify Chat I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
informalion is correct. I agree to comply with all city and county PLUMBING
'•, ordinances and stale laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.) 6,00
hereby authorize representatives of this city 10 enter upon the BOILER-COMP (Own 100,000 BTU)SEE FEE$CH. MECHANICAL
.bow-mentioned property for inspection purpoxs.
(We) agree m 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 accrue against so' City in consequence of the
granting of t pemtil. 11/ 1& MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL �Lv
Sign lure of pplicr on motor Date
OFFICE COPY
1