13912 (2) POST THIS CARD NEAR FRONT OF BUILDING%
� PFRMI!NUMBER
CITY OF CUPERTINO, 1391.2
INSPECTION DIVISION
^'° I JOB INSPECTION RECORD
c/ •:r•
PERMI7Uf�EXPIRATION
/ JOB ADDRESS a OUxs J� r r�'Gm"�-- UNIT# LOT#{' v Y
PERMIT EXPIRES IF WORK
OWNER /s CONTRACTOR �GG co ISNOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
' UFER '
PREGUNITE - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED "
'UNDERGROUND /SLAB ,\
- PLUMBING .
ELECTRICAL I. 'ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLG. .MECH.
�o a o 10
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION S/FT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING
'STORIES TYPE CONSTR.
INSULATION
^� OCC.GROUP RES.UNITS
9Y 1�• I• •l
PLACE NO SUBFLOOR UNTIL EEN SIGNED
ROOF SO,FT.'FLOOR AREA TOTAL ACREAGE
/ DIAPHRAGM
V D 5 C }RESIND BUILDING
CONUSEPel OIL—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 F-1 cl 1 ❑
ASSESSORS PARCEL NO.
'ROUGH
PLUMBING ----- TRACT NO. PARCEL NO.
�
GAS TEST a ✓ "-'�«- '-7 - • -
.' A
MECHANICAL. - _ u�2 i� G�L•tyl_.2d 6 Lcyi-
ACC,DATE ACC.FILE NO.'
' ELECTRICALFINALS DATE INSP.
FRAMING ' �sp, SAN 4#,, zoNlrvG ENG.SITE NO.
INSULATION - - PLUMBING _
/ GAS' 11V MECHANICAL -
FIRE SPRINK ENERGY T.24
' - � i
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v [:] NE]
.LATH-INTERIOR ELECTRICAL FLOODZONE A.L.uc.
LATH-EXTERIOR - FIRE DEPT.' Y b. NE] 10 No
SHEETROCK -a- _ GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING -/
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING ! .j `
FIREWALLS ELECTRIC PLAN,CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEISMIC FEE 0� '
OCCUPANCYOF BUIL DING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM
I
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC {I
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING. /'gym
Z E - MECHANICAL
SEE•PERMIT FOR EXPIRATION�DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE '
TOTAL 7`
CALLING FOR FINAL INSPECTION. j.
OFFICE COPY - -_
I
..._ —. a ,. .
FINAL GRADE__
ROUTE SLIP
Fiie No. . .i _ - ••e '
Date"" ; ' _I � -;,
Location //
Subject __ ., •.'✓.
Notes —_
APprove "�
Date nspectorP.
d- «
D APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
r BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BuDMINc APPLICATION & PERMIT 1391 Z
BRIL
DEMI /
as I L BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
Ow •Els
1 NAME (-
1+ �/ PLAN CHECK VALIDATION
r PRONE l46 �I LI OTY ELECTRIC PERMIT FEE
N�AMEwRAcaoRs q UTLETS-SWITCHES-RECEP 10.00/1.00 - 1/a3 T.7
lI�X1%1- CO,- �LIICNO. /1 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR5 ,
ADDRESS Cup f' PPLIANCES-RESIDENTIAL 4.00 � -
10a5 S1VLey)5Grk- LN(0 -iqIJ PANELS 10.00
ARCHITECT, DATE OF APPLICATION
OR PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE PC,NO.
ENGINEE I^
NO.�`fi� SIGNS TRANS. 3.00
ADDRESSRCH,OR ENL, yoww
ADDRESS r0. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
Pi erne d ZI ✓✓✓ �" EMP.METER OR POLE INS. 20.00
ADDRESSTs ff7� MOTORS SEE FEE SCH. �v - L-jJ �I
a 1p V CxILOI SERVICE CHANGE 20.00 k
a,ai - y/ /o/�j
F a a LICENSED CONT RACTORS DECLARATION _ / N+ J
< u 1 hereby affirm that 1 am licensed under provisions of Chapter 9
N&w (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
Professions,Cad d my license is is full for BLDG. ELECT. PLG. MECH.
License❑❑❑ ss Lia Numbe
am I Dao Contractor��
E ¢w g OWNER-BUILDER DECLARATION BUILDING PERMIT
w i A u I hereby afrom that I am exempt from the Contractor's License, MISC.- REFER TO ORD INFORMATION
HLLo4 Law for the following reason,(See.7031.5,Bustumand Professions PERMIT ISSUANCE VALUATION S/FT.
Y Y Y 4 permit to commer.alter, 10.00 ��/
mi Code.An cit or county which requires
¢ at ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEO.CONTR. LIC.NO. ELEC.
O u out the applicant for such permit to File a signed statement that TOTAL 60 PERMIT TO
A w $m he is licensed pursuant to the Provisions of the Contractor's License
z Law(Chapter 9(commencing with Section 7000)ofDivision ofthe
4 o Businea and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ H the basis for the ralleged exemption.Any violation of Section 7031.5 a STORIES TYPE CONS
d ; by any applicant for
velou l dollars the applicant tOacivil PenaltyALTER-DRAIN 5.00
of not more than Five twofold dollars(my employees
❑ e as owner at 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 rs not
intended or offered for sale (Sec. 7044, Business and Profession, DRAINS-FLOOR,ROOF,AREA,COND. 5.00 3
Code:The Contractor's License Law don not apply to an owner of
properly who builds or bnproves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT,FLOOR AREA TOTAL ACREAGE
! himself or through his own employees,pfuvided that such improve- -1 g
ments are not intended or offered for ake.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 im- BUILDING USE
prove for Purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with ® El El F-1 1:1licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Calc: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 `�6 4-,3� -Q�d
contracts for such projects wi Bi a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.2008/10.00 TRACT NO. PARCEL NO.
O lam exempt underSoc.
reason ,B.&P.C,to,this I WATER HEATERW/VENT 6.00 "07P,
Owner Dam WATER SYSTEM 5,00 s'-'
ACC.DATE ACG FILE NO.
W'ORKERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP, 5.00
I hereby of Orm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
aPYthereof(Sec.3800,Lab I^.
Policy Company 4'
❑ �ertilied espy is hereby fumi FIRESPRINK ENERGY T 24
Z 2 Certified�ayAyn_6ley wBh the city inspection division.
F O APPlicam_ ,d',' �Q''..YY�- MISC.- REFER TO ORD. r ❑ N❑ Y ❑ N❑
CC i2 CERTIPICATEOF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L-U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO: PLG.
CL o (This section need not be completed if the permil is for one - TOTAL Q �e Y❑ N❑ Y ❑ N❑
Z hundred dollars(511X)or bass.)
V Q 1 certify that in the performance of the work for which this per, DTV. MECHANICAL PERMIT FEE FEE SUMMARY
UL I- mit Is issued,I shall not employ any person in any manner so as to
0 w become subject to the Workers'Comperlation Laws of California.
a Dat` Applicant ALTER OR ADD TO MECH. 5,00 BUILDING J
�a. WNOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z emPtion,you ilmuld become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the tabor U Code, You must forthwith comply with FEE such provisions or this permit shell be deemed,evoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE a67
1 hereby affirm that there is a construction lending agency for I EXHAUST HOOD(WITH DUCT) 5.00
the performance oP41 ,work for'Iv1ych this yerent is issued(Sec. MICROFILM
3097,Civ Cy 4.�I iC..-. I HEATING UNIT(TO 100,000 B.T.U.) 8.00 -
Lender'S Name 99A-sl /
Lenders Address - _� HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC /6a -
1 certily that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 .)-
f \ information is correct.I agree to comply with all city end only PLUMBING q
ordinances and state laws relating to building construction, and BOILER-CONP(3 H.P.or 100,000 B.T.U.) 6.00 �oC
hereby thofiac representatives of this city es enter upon the BOILER-COMP (Over100,000BTU)SEEFEESCH. MECHANICAL 3-f°�'
above-mentioned
ss
Property for inspection)unle .
(We) agrttao save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, cosh and expenses which _
may N any way accrue against aid City N consequence of the
PERMIT ISSUANCE 10.00 O CONST.TAX
I granting Of this Permit. MECH.CONT. LIC.NO. MECL H.
TOTA3S-`' TOTAL x307
s Sigre natuof Appbrant/Contractor Ualc
OFFICE COPY