9080 (2) I
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER -
CITY, OF CUPERTINO' 9080
INSPECTION DIVISION
JOB INSPECTION RECORD .
/1 /qZ PERMIT EXPIRATION
2
JOB ADDRESS a-O&O U— T 40 # PERMIT EXPIRES IF WORK
OWNER W__ CONTRACTOR IS NOT STARTED WITHIN
INSPE 10 DATE INSPECTOR INSPECTION RECORD ISO DAYS OF PERMIT ISSU-
FOUNDATION v v - ANCE OR 180 DAYS FROM
UFER
LASTCALLEO INSPECTION.
PR EG UNITE - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SL-AB
PLUMBING
ELECTRICAL - IssuA A E
MECHANICAL B G. ELECT, PL MECH. "
SL ❑ .
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - gpILDINO PERMIT -
- INFORMATION
WOOD FLOOR vnwnnon $IFT.
PLUMBING _ - -
MECHANICAL' '
ELECTRICAL - PERMIT TO -
FRAMING
INSULATION STORIES- TYPE CONSTH.
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF I_ SO,FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM BUILDING USE
- RES INO CON PB 011- '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ Cl ❑ .CD ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING '
GAS TEST
TRACT NO. PARCEL NO.
� � _
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.DATE ACG FILE NO.
FRAMING SAN # ZONING ENG,SITE NO,
INSULATION - _ PLUMBING
GAS
MECHANICAL . , 'FIRE SPHINX ENERGY T 24
. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' ' Y [:] N❑ ' r [3 . NE]
LATH—INTERIOR - ELECTRICAL FLOOD ZONE A.L.U.C.
LATH—EXTERIOR - FIRE DEPT. •Y❑ N❑ Y❑ N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING - / 3 BUILDING
SHEAR EXTERIOR - TEMPORARY PPROVALS
FIREWALLS ELECTRIC PLAN CHECK
GAS .FEE _
N0 TAPE
OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE-FOR INSPECTION BY PHONING 252-4505, ELECTRIC
r LU ONE WORKING DAY BEFORE REQUIRED.INSPECTION. PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE
IMPORTANT! CONST.rnx
PLEASE READ,REVERSE SIDE.BEFORE TOTAL
CALLING FOR FINAL INSPECTION. '
OFFICE,COPY: s - '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.' QUILDING PROJECT IDENTIFICATION PERMIT NUMBER
ADDRESSIRN APPLICATION & PERMIT 9080
Aou-
C BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
NAME PLAN CHECK VALIDATION
C {{�� DTV. ELECTRIC PERMIT 'FEE
lJ ORS PHONE
NAME
CONTRACTORS 6
I
NAME UTLETS-SWITCHES-RECEP 10.0011.00
sc.rvo 73 LIGHTING FIXTURES 10.0011.00To--
as
t1 -
Doo pgTORS - PPLIANCES-RESIDENTIAL 4.00
1175A PHONE PANELS 10.00 GATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR SL(,Q 13") ALG- PANELS'IOVER 200 AMPI 20.00
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ADDRESS erva- SPECIAL CIRCUIT 5.00 �� PERMIT VALIDATION
Tlp EMP.METER OR POLE INS. 20.00 PAID
ADDRESS rs MOTORS SEE FEE SC 01a A+
AOoflass
SERVICE CHANGE1 r_ yP
o o LICENSED CONTRACTORS DECLARATION TEMP.POLE
< u I hereby affirm that I am licensed under provisions of Chapter 9
Naw (commencing with Section 7000)of Division 3 of the Business and BLDG. E CH.
H G z Professions Cod- nd my license is in full fore t
o i G O License Class Lic.Number{ 3_ pity 0 �-., ®_ H
Dale_ �Contracl.,. N
st y 2J
¢ ¢ w a OWNER-BUILDER DECLARATION BUILDING PERMIT
U INFORMATION
uAKi;n s- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
Fw0 J Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
Code:Anycily orcounly which requires a permit to construct,alter, Q `� 7,f,�s
¢ ¢ a improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. II// VV '--�
D u requires the applicant for such permit to file a signed statement that T TOTAL PERMIT TO
n u,m he is licensed pursuant to the provisions of the Contractor's License
Fit Law.(Chapter 9(commencingwith Section 7000)ofDivision 3 ofthe Aa7. J�c`M�D�G
5 4 c Business and Professions Code)or that he is exempt therefrom and CITY. ' PLUMBING PERMIT FEE
¢ H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ; by any applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500)):
❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
sole compensation,will do the work,and the structure is not
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
properly who builds or Improves Ihemon,and who does such work FIXTURES-PER TRAP 5.00 O,l SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees.Provided that such improve-
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 BUILDING USE
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ El ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,BusinessLAWN SPRINKLERS- 1 INC 8.00 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 A.I 1,00
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STOR 00 t/1 00
the Contractor's License Law. 9I TRACT NO, PARCEL NO.
❑ lam exempt under Sec.-,R&P.C.for this WATER HEATER W/VE ill 6.00
reason
Owner Date WATER SYSTEM Pgqvon ACC.DATE ACC.FILE NO,
WORKISRs'COMPIiNSATION DECLARATION WATER TREATING EQUIPLI'Ll 5.00
I hereby affirm that I have a certificate oI consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof fsec.380C.7Ar No. Compny ��ea2 vu_
J.
O edified copy is hercb furmsed. FIRE SPRINK ENERGY T-24
Z Z S Certi t d cop is f e '1 the c I inspect, s is'
O Applicant MISC.- REFER TO ORD. Y [] N❑ Y p NC]
~ ua I PERMIT ISSUANCE 10.00 0 FLOOD ZONE A.L.U.C.
LU LU CERTIFICATE E SAIIOTINS FROMWORKF.RS'
CLO COMPENSATION INSURANCE PL CO TR. U TOTAL �S� Y❑ NE] YC] N -
(This section need not be completed if the permit is for one
„ 0 Z hand red dollars IS 100)or less.)
V O 1 certify that in the performance of the work for which this per- CITY MECHANICAL Pkall FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as ID
O w become subject to the Workers'Compensation Laws of California. lyll i
0. Date-Applicant ALTER OR ADD TO MECH. rvf6; 0' BUILDING /e-3
>_ so NOTICE TO APPLICANT: If,after making this Certificate of Ex. ry
L.. ? emption,you should become subject to the Workers'Compensation APPLIANCE ps 5.00 PLAN CHECKp�ssAT-
provisions of the Labor Code, you must forthwith comply with FEE O e�
V . such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I .) 6.00 SEISMIC FEE a �'D
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the
i
er Performance MICROFILM
3097. ance of the work-for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address - ELECTRIC 9
I certify that 1 have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 W✓
information is correct.I agree to comply with all city and county PLUMBING S
ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.Or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over I00,000BTU)SEE FEE SCH. MECHANICAL
( above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
granting of this il. _ MECH.CONT. LIC.NO. MECH. s
MCLAA
C T TOTAL
Signature of Applic 11Contractor Dain r� K. 1" 398TOTAL
OFFICE COPY
I