13073 (2) r POST THIS CARD NEAR FRONT OF BUILDING
^- � yJ • • � T PERMIT NUMBER
CITY OF Cl UPERTINO � �
INSPECTION DIVISION
JOB INSPECTION RECORD '
/ PERMIT EXPIRATION
JOB ADDRESS �� 'k—P09 ✓ "�-� UNIT# 'LOT# J "
PERMIT EXPIRES IF WORK
OWNER ,�,J CONTRACTOR z IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECU9, 180 DAYS OF PERMIT ISSU-
FOUNDATION 1115.rl ANCE OR 180 DAYS FROM
UFER J LASTCALLED INSPECTION:
PREGUNITE PERMIT VALIDATION
PAID '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB Jul .9 1T}q `
PLUMBING
ELECTRICAL
=5T
MECHANICAL ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FL OR INFORMATION
VALUATION SIFT.
PLUMBING _ ..
MECHANICAL .3.
PERMIT TO
' ELECTRICAL
s
FRAMING
STORIES TYPE CONSTR.
INSULATION J.
WdYTL S rJ occ.GROUP RES,uNlrs
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED kr-4 I Lk
- - _SQ FTFLOOR AREA TOTAL ACREAGE
RODE
'f
DIAPHRAGM
BUILDING USE
RES IND CON PB O,hel
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ ❑ ❑ ❑
ASSESSORSPARCELNO.
ROUGH kf CAy % IJ
PLUMBING _ - VIA '
GAS TEST TRACT NO. PARCEL NO.
'
MECHANICAL _
l!
ELECTRICAL - - FINALS DATE INSP. Acc.DATE ACC.FILE NO,
FRAMING' SAN #
ZONING ENG.SITE NO.
INSULATION II . .� (� PLUMBING _ �" wwr
GAS d
FIRE SPRINK ENERGY R20
MECHANICAL Yo No Y ❑ NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNEDjS, HEATING S
FLOOD ZONE A.LUF.
LATH-INTERIOR ELECTRICAL
LATH-EXTERIOR FIRE DEPT. Y E] N� YL
N�
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR ('�- BUILDING - BUILDING 'r
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC -y�-?r-l- PLAN CHECK
S GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS gEtN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX f
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
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING - o APPLICATION & PERMIT 13073
ADDRESS -
1� �i1435' CFIAA_SAN LANE LOT S BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S ~�
PLAN CHECK VALIDATION
NAME 1- QTY. ELECTRIC PERMIT FEE
y �S
PHONE
997
�Z
CONTRACTOR
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
SVe_V :(. uCNo. JILIGHTING FIXTURES 10.00/1,00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCM ECT
OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
Vs;,rC_L LIC.NO SIGNS TRANS. 3.00
ADDRESS ENG. -PERMIT VALIDATION
ADDRESS Y`1PAID A e 1'1
ZIP EMP.METER OR POLE INS. 20.00 YJ
APPLICANT'S MOTORS SEE FEE SCH. � y "
ADDRESS f In
SERVICE CHANGE 20.00
w
00 LICENSED CONTRACTORS DECLARATION �j/ /
Ci d f Ino
a u u I hereby affirm That I am licensed under provisions of Chapter 9 ISS AN
, y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. 1 PLG. MELH.
F wD z Professions Code,and my license is in full force and effect. ❑ ❑
Z D V,- License Class Lic.Number
o Z H w Date Contractor
a m BUILDING PERMIT
Ic w OWNER-BUILDER DECLARATION INFORMATION
Xo MISC.- REFER TO ORD
3 A 1 hereby affirm that 1 am exempt from lire Contractor's License VALUATION SIFT.
_ a.t < Law forthe followingmason.(See.7031.5.Business and Professions PERMIT ISSUANCE -10.00 q
Code:Any city orcounly which requires a permit to construct,alter,
2 to¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /
O LL requires the applicant for such permit to file a signed statement that TOTAL ^ PERMIT TO
E
$ he is licensed pursuant to the provisions of the Contractor's License
F z a
Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe
i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
It 1- � the basisfor lhealleged exemption.Anyviolation orSeclion7031.5 STORIES TYPE CONSTR.
by any applicant fora permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 pr7`, SNi��
of not more than five hundred dollars(5500).):
❑ 1,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 offered far sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R-
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 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered fiGomle.If,however,the building GAS-EA.SYSTEM-I INC.40UTLETS 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' RES ]NO CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 II9I
❑ I,as owner of the property,am exclusively contracting with IJ- ❑ ❑ ❑ ❑
licensed Contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCEL 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 3 6�-/O-Q,3
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-,B&P.C.for this WATER HEATER W/VENT 6.00 / /
reason
Owner DACC
are WATER SYSTEM 5.00 . TE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a Certificate of consent to self-Insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.L Policy No.-Company��
o ❑ Certified Copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified co is filed with the cit inspection division. MISC.- REFER TO ORD. y I❑ N❑ v ❑ N❑
O APPlicant�
y PERMIT ISSUANCE 10.00 FLGOOZONE A,L.U.C.
LU CERTIFICATE E TION INS FROM WORKERS'
IL _ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
_
Q. O (This section need not be completed if the permit is for one - TOTAL Y❑ N❑ Y❑ Is
::I Z hundred dollars 18100)or less)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P mit is issued,I shall not employ any person in any manner so as to
OL) become subject to the Workeri Compensation Laws of California.
11. Mute Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} ED NOTICE TO APPLICANT: If,after making this Certificate of fix
F ? emplion,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,O00C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT OVER 1Q000 C.F.M.) 6.00 SEISMIC FEE �Fl+
1 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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.501 ELECTRIC
Lender's Address
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Ovar 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, Casts and expenses which" CONST.TAX y 4O�
may in any way accrue,against said City in consequence of the PERMIT ISSUANCE 10.00 oC 0
gmnlingoflhis permit MECH.CONT, 71C.NO. MECH,
TOTAL TOTAL
Sig tur of Appli ontractor Unit,
OFFICE COPY