12737 (2) I
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO
' n INSPECTION DIVISION 12737
JOB INSPECTION RECORD
q C �-• PERMIT EXPIRATION
JOB ADDRESS LU / 0 7 /"/�iR W ao L- CT, UNIT# LOT#
r/ w � ^� PERMIT EXPIRES IF WORK
OWNER ? S d C, corvrRACTDR ,/,Q,v �d�f 7' IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU-
FOUNDATION _ e:t`�PT'CpyL P(eF� ANCE OR 180 DAYS FROM
LIFER
6 LASTCALLED INSPECTION.
PREGUNIT PERMIT VALIDATION
v>L s T_
Z3
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING - � � �1 / I
ELECTRICAL C JJ
ISSUANCE DATE �
MECHANICAL _ BLDG. EL9cb EPLG. BECH.
611
Bi "
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION $SFT.
PLUMBING
MECHANICAL - -
ELECTRICAL - PERMIT To
FRAMING "
INSULATION sroRlEs TYPE corvsrR.
j r✓ ��-
11" —�= C.GROUP RES.UNITS
I
PLACE NO SUBFLOOR UNTIL ABOVE-HAS-BE€N'SIGNED
$O,FT.FLOOR AREA TOTAL ACREAGE
ROOF
y 4
DIAPHRAGM -
BUILDING USE
R[SINU CON .PB 00"APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - C7 El El D E
ASSESSORS PARCEL NO.
ROUGH —/ 0
PLUMBING r
7 `dly KFL ,�c t Y TRACT NO. PARCEL NO.
- GAS TEST / J
MECHANICAL -(ice 98 a- 3 L G 14
1J
ELECTRICAL FINALS DATE I INSP. ACC.OATE ACCFILE NO
FRAMING �(�.. SAN # Z2 IQ 2 J.
INSULATION 0 \-7- PLUMBING y,�• - ZONING ENG.SITE NO.
GAS
MECHANICAL I FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIWD HEATING _ _g Y L] NE:] Y � No �
_
LATH-INTERIOR _ � ELECTRICAL FLOOD ZONE AL.UC.
LATH-EXTERIOR FIRE DEPT. Y0 No 1 Y ❑ No
SHEETROCK I - GRADE FEE SUMMARY
SHEAR INTERIOR, BUILDING
SHEAR EXTERIOR , TE PORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK '
G •%2Z.' GAS FEE '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ;ELECTRICONE WORKING DAY BEFORE REQUIRED INSPECTION. G,.PLEASE GIVE JOB ADDRESS WHEN.PHONING.
CAL"— SEE PERMIT FOR EXPIRATIONDATE —
AX � ,•IMPORTANT! ?SPLEASE READ REVERSE SIDE BEFORELF�rwl..+.e
CALLING FOR FINAL INSPECTION.'
OFFICE COPY -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATI ON - PERMIT NUMBER
ADr .rESS APPLICATION & PERMIT 12737
ADDRESS
RQ r�r,� G,7- BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNE 'S tiff PLAN CHECK VALIDATION
NAME �/ OTY. ELECTRIC PERMIT FEE
1111_Z)' PHONE
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
. e03O
LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
ADDRESSi APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE PX.NO.
OR u!U a Llc.NO 611#140 SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
savr� cQv2
LOS
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT MOTORS SEE FEE SCH. PAsI� //__ . i n
ADDRESS -lT `'�ffr�•r�'
SERVICE CHANGE 20.00 /\
O o LICENSED CONTRACTORS UECLARAI'ION
a o 1 hereby affirm that I i m licensed under provisions of Chapter 9 ISSUANCE DATE
P sa
z "' (commencing with Section 7000)of Division 3 of the Business and
PLG. MECH.
r O a: Professions Cod c d my license u in Cull for nd f t i{y�kf ElElO i o License I s Lic.Number III��GT..J11C��_
Detc Contractor
Py BUILDING PERMIT
a0 NIi R-BUILDf:R DECLARATI
o d U INFORMATION
X
0 I hereby affirm That 1 am exempt from the Contractor's License MISC.- REFER TO ORD
LL O j Law for the following reason(Sec.703 1.5,permit
tote a Professions VALUATION f/FT.
� - PERMIT ISSUANCE 10.00
Code:Any city or county which structure permit tot$issuance,
alter,
SE sa Q improve,demolish,or repair any structure,prior to ib iaruenw,alw ELEC.CONTE. LIC.NO. ELEC.
o LL «quirts the applicant for such permit to file a signed statement that TOTAL
A w$w he is licensed pursuant to the provisions of the Contractor's License PERqMIT TO
tie Law(Chapter 9(commencing with Section 7000)of Division 3 ofrhe `�,O WL
a Business and Profcisions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
r $ the basis for the alleged exemption.Any violation of SectioR 7031.5. STORIES TYPE CONSTR.
d ; by any applicant fire permit subjects(SSOOplicanr IDA civil penahy ALTER-DRAIN -WATER IEA.) 5.00 y
of not mom than five hundred dollars(my em: �16A
O Las owner of the property,or my employes with re is not
BACK FLOW PROTECT. DEVICE 4.00
/heir solo compensation,will do the work,and the structure is nm OC GROUP RES.UNITS
intended or offered for side (Sec. 7044. Business and Profession DRAINS-FLOOR,ROOF,AREA,COND. 5.00 _ 3
Code:The Contractor's Licenw Law does not apply to an owner of -
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 Sp PT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 -3,97a�
or improvement is sold within one year of completion, the owner GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
RES IND CON PB ORE.,
move 1,aso neer of thel. INDUSTRIAL WASTE INTER. 30.00 r`ei ❑ ❑ ❑ ❑
I ❑ I,as owner of the property.am exclusively contracting with
licensed contractors to construct the project ISec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCELNO.
and Professions Code:'rhe 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 contracrorts)licensed purwant to
ore 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 7? "1
Ratio,
Owrser Date WATER SYSTEM - 5.00 ACC.DATE ACG FILE NO,
WORK HRS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm that I have a certificate ofronsent to self insure, ZONING ENG.SITE NO.
or a certificate of Workers'Coin on Insumncc r a cerlifieJ
copy thereof ISec.3800,Lab.C. O
policy No Company
0 ❑ Cerlil d vpy is hembf mished. I FIRESPRINK ENERGY T 24
z Z ❑ Certi d co is file it11 the 'lv inspection divisian. ❑
F O Applicant MISC.- REFER TO ORD. Y ❑ N❑ El Y N
N CER 7ICATE E E - IPTION FROM WORKERS' PERMIT ISSUANCE 10.00 .FLOODZONE A.L.U.O.
W COMP17NSA IONINSURANCE PLG.CONTE. LIC.NO. PLG.
EL Z (This section need not h completed if the permit is for one TOTAL Y[:] N❑ Y 1:1N❑
hundred dollars IS 100)or lexis)
U O I certify that in the performance of Ne work for which this per- Q.n. MECHANICAL PERMIT FEE FEE SUMMARY
' H mit is issued, 1 shall not employ any person in any manner w as to
Ow become subject to rhe Workers'Compensation laws of California.
a Dare-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
(... Z emprion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
C..) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO MCF.M-) 6.00 SEISMIC FEE
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,Ctv.C1. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender's Address' ELECTRIC
I certify that 1 have read thls.,plic.lion and state that the above VENTILATION FAN (SINGLE) 4.00
t information is Correct.I agree to comply with all City and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-CDMP(3H.P.or 1DO,DOO B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned properly for inspection purposes. BOILER-COMP (Ores 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 �'77J 0
in any way rue•against said City in consequence of the �•
anng of this pc ni MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL E
S' amrt Of nNiC Contractor at
OFFICE COPY