12747 (2) POST THIS CARD NEAR FRONT OF BUILDING
rPERMCITY OF CUPERTINO
PERMIT NUMBER
IT
12747
INSPECTION DIVISIONJOB INSPECTION RECORD
EXPIRATION
JOB ADDRESSd �.�/R Wo a6S C,7- UNIT# LOT# /
PERMIT EXPIRES IF WORK
OWNER (,(/ - F/- -,('OC , CONTRACTOR, (f IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT,ISSU-
FOUNDATION 1 S 461341111op 1 /* _ ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PREGUNITE
PERMIT VALIDATION -
' _
6 _ _LA Z, r
POU NO CONCRETE UNTIL ABOVE HAS BEE SIGNED
UNDERGROUND /SLAB
PLUMBING -
jUf 3 _
ELECTRICAL' - I ISSUANCE DATE
BL G. ECT. PLG. MECH.
MECHANICAL CI D )p ❑ ' ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FL OR INFORMATION
PLUMBING VALUATION S/FT.
P
MECHANICAL �,
ELECTRICAL PERNUT TO, -
J
FRAMING 7-{
INSULATION sroalEs TYPE coArvsTR.
02
OCC.GHOUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
$0 FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM - -
' BUILDING USE
POO � � I1 Ll �7 C. � - � IO �N � 0,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED '
ROUGH ASSESSORS PARCEL NO.
PLUMBING _ _
Tq ACT NO. PARCEL NO.
GAS TEST �
MECHANICAL
ACC,DATE ACC.FILE NO.
' ELECTRICAL ,t_ _ FINALS DATE INSP.
FRAMING ,y SAN » 0 '
z1A' ZONING ENG.SIT6.IJO�I
INSULATION iZ,Q-g PLUMBING a�
GAS 664
_
'� FIRE SPNINK ENERGY L}<
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ,It24il "� `
LATH-INTERIOR ELECTRICAL FLOOD ZONE ALU.C.
LATH-EXTERIOR I'L-LZ-g'J FIRE DEPT. v "� ° ❑ N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR, II '� BUILDING
SHEAR EXTERIOR 111NEZTEMPORARY APPROVALS BUILDING
FIREWALLS - ELECTRIC _ PLAN CHECK
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY . . .SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU
� ONE WORKING DAY BEFORE REQUIRED INSPECTION.• PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY'
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
_BULLDING PROJECT IDENTI FICATIOrN , PERMIT NUMBER
nOREi9 // APPLICATION & PERMIT -
G 7lC41X1W1900S BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 12747
• DwNE6'a PLAN CHECK VALIDATION
�A NAME /Gt7q- WDIM PRONE OTY. ELECTRIC PERMIT FEE
CONTRACTORS [[// UTLETS-SWITCHES-RECEP 10.00/1.00
uc.No. /(O LIGHTING FIXTURES 10.00/1.00
CONrnACTOR PPLIANCES-RESIDENTIAL 4.00
Ao E
RONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
EN /
GINEER/i//E�K/GL (..�(//�y�'fi/� 67141
LIC.No. SIGNS TRANS. 3.00
ARCH OF ENG.,.^� `^w,�� ui,4W PERMIT VALIDATION
ADDRESISOF Gf/ S [;K✓IL/ "/vG SPECIAL CIRCUIT 5.00
LO zlv EMP-METER OR POLE INS. 20.00
ADDRESS
AvvucANTx MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 {7/t.fir/ �1�
o o LICENSED CONTRACTORS DECLARATION • x'111 /��
< i w I hereby affirm that I am licensed under provisions of Chapter 9 ,. .. ISSUA CE GATE
N< m (commeneing with Section 7000)of Division 3 f the Business a xBUDf21( ELFF.CTt( PLG. MECH,
H 0 a: Professions Cad nd my licenx is in full fo Ad 63 Q j Ij ❑f ��j Q ❑
a o'� - License CI' Lic.Number J / II�XVI
o w F w Dale Contractor UtIllII�
o i U OWNER-BUILDER DECLARATION L IN TR" ATIONIT
K
g LL H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
e. 0 Law for the following.eason.(see.703 t.5,Businessand Professions VALUATION $/FT.
r - PERMIT ISSUANCE 10.00
u,� Code:Any city or county whiny structure,
requires une p Prior
t a construct,issuance,
also
e, Q 0
improve,demolish,or repair any atrneturt,poor to its uwance,also ELEC.CONTR. LIC.NO. ELEC. e/
Edits requires the applicant for such permit to file a signed statement that TOTAL
u w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
H z i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
x H the basis for the alleged csemplion.Any violation of Section 7031.5 STORIES TYPE CONSTR.
e , by any applicant fora permit subjectsS500)licant to penalty
of not mon than five hundred dollars the ap. ALTER-DRAIN&VENT-WATER (EA.) 5.001:
❑ 1,as owner of the properly,ar my cmphoycex with wsgcs us BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole cumpenuume,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 v
Code The Contractor's License Law does not apply to an owner of �J
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT FLOOR AREA TOTAL ACREAGE
himself or through his own employees.provided that such improve- GAS-EA.SYSTEM 6.00
ments are not intended or offered for sak.If,however,the building 3 /G
or Improvensenl is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 l
builder will have the burden of proving that he did not build or im- BUILDING USE `
Prove for purpose f.k.). INDUSTRIAL WASTE INTER3000 'RES IND WN mer
PB O
❑ 1,as owner of the property,um exclusively contracting with . . DU ❑ ❑ El ID
licensed contractors to comin.et the project(Sec. 7144,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Calc The Contractor's License Law docs not apply
to an owner of prope-ty'who builds or improves thereon,and who LAWN SPR INKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractors)licensed f orsuunl to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,R&P.C.for this WATER HEATER W/VENT. 6.00 ,
reason
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACG FILE NO.
WORKERS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure.
or a certificate of Works Corp lion Insurance, a re 'Tied ZONING ENO.SITE NO.
Copy thcrtof(Sec.3800,Lab.0
Policy No. Ccmpm 0 l
O ❑ Cerlill py is here Y ,dished.
'Z Z ❑ Cmlif d py fi d the d inspection division. FIRESPRINK ENERGY T 24
� O Applicant MISC.- REFER TO ORD. Y[] NF] I Y ❑ No
CER ICATI°017 F. .AIPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W 1 COMPI)NS TION INSURANCEPLG.CONTR. LIC.NO. PLG.
❑ (Thu section need not be completed if the permit is for one TOTAL Y❑ N Y❑ N 0 /
Z hundred dollars IS 100)or les.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
TL 1- mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensalion Laws of California. '
wData A Meant - BUILDING
ALTER OR ADD TO MECH. 5.00 l 7 f�
} y NOTICE 'TO APPLICANT: If,after making this Certificate of Ex-
? emption.you should became subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK II
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this perout shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 p
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE /
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
r
the perfonanc,of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.0.). HEATING UNIT(TO 100,000 B.T.U.) 8.D0
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I some m comply with all city and county PLUMBING
ordinances and state laws relalinz to building construction, and BOILER (3 H.P.or 100,0008.T.U.) 6.00
hereby authorize representatives of ink city to enter upon the BOILER-COMP IOser 100,000 BTU)SEE FEE SCH.
'e above-mentioned property for inspection purposes. MECHANICAL
(we) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
rtin ) q
Cupeop most liabilities,judgments, costs and expenses which CONST.TAX
f the
may in fi way accrue luirut said CH in ammyuo PERMIT ISSUANCE 10.00
granum of is permit ce MECH.CONT. LIC.NO. MECH.
j TOTAL TOTAL /
Signa[ of Appant/C mctor Date
OFFICE COPY