8269 (2) p POST THIS CARD NEAR FRONT OF,BUILDING
CITY 0 ,CUPERTINO VCRMIT'NUM1,BER
INSPECTION DIVISION (1366,
JOB INSPECTION RECORD ,
� 5 � 40—'. 7 PERMIT EXPIRATION
JOB AD'BU ftee.DRESSIeA UNIT# •LOT# PERMIT EXPIRES IF WORK
' OWNER CONTRACTOR fi' , IS NOT STARTED WITHIN
INSPECTION DATE INS ECT0R INSPECTION RECORD 180DAYS OFPERMIT ISSU-
FOUNDATION - _NCE OR 180 DAYS FROM
LIFER (y'- Z�r_ � LAST CALLEDI NSPECTION.
PREGUNITE PERMIT VALIDATION - •'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING - _ /�J/� •.
ELECTRICAL ISSUANCE DATE ! '
MECHANICAL -N BLDc.. ELECT. -PLG. MECH.,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
- 'INFORMATION
WOOD FLOOR vA LunnoN $/FT.
PLUMBING
MECHANICAL
• ELECTRICAL. I'- PERMIT TO
7
7 FRAMING D. Aa(.' Y'- L'%.r+" •,
INSULATION 'STORIES TYPE CONSTR,
I -/):-6S�
I, _ `OCC.GROUP RES.UNITS
! PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - �-
4 A ROOF O FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
.. - 'HES No CON PB D'na
7' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED As0ssoREl El El
.ROUGH
PLUMBING,
GAS TEST- - - , TRACT NO. PARCEL NO.
MECHANICAL fj - - cAcc.DATE. . Acc.FILE NO.
ELECTRICAL �* FINALS DATE INSP. -
FRAMING _z,.,Y SAN # 1' ZONING ENG.SITE NO,
INSULATION PLUMBING '
t GAS .. ,
I MECHANICAL _ FIRESPRINK • ENERGY T-2,1
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - '., Y "� ° "�
'� FLOOD ZONE AL.U.C.
LATH-INTERIOR .ELECTRICAL vQ -,N❑ .v,I] Na
LATH-EXTERIOR - FIRE DEPT: '
SHEETROCK GRADE - FEE SUMMARY
SHEAR INTERIOR BUILDING .
SHEAR EXTERIOR ( _ iIIv -TEMPORARY APPROVALS BUILDING.
FIREWALLS ELECTRIC - PLAN CHECK'
GAS - FEE'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY +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
F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ,n /
O� PLEASE GIVE JOB ADDRESS WHEN PHONING:
Z
. t.
I
I� I MECHANICAL,
- SEE PERMIT FOR EXPIRATION DATE - '
I IMPORTANT! CONST.TAX"*' .,
PLEASE READ REVERSE SIDE BEFORE, TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY `
AQPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATIO •� PERMIT NUMBER
BUILDING APPLICATION & PERM( 8369
4018
'�
I Os ,�- BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OOvIIR S PLAN CHECK VALIDATION
DATION
ME
o CITY. ELECTRIC PERMIT FEE
lTY IJY\(J_ VHONE 1' 1
CONTRACTOR aoroRpps l UTLETS-SWITCHES-RECEP 10.00/1.00
Vd S+1 %PNL uc.No, LIGHTING FIXTURES 10.00/1.00
f,ONTRACTOR3 APPLIANCES
4.00
ADD
I REss II PHONE Q S PANELS 10.00 DATE OF APPLICATION
fY ARCHITECT PLAN CHECK FEE .NO.
on PANELS (OVER 200 AMP( 20.00
ENGINEER
- uc,No. SIGNS TRANS. 3.00
ARCH,ss EOR NG' - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zm rrEMP.METER OR POLE INS. 20.00
C AlsPLICANT'S MOTORS
/bDRE55 SEE FEE SCH.
,E C. SERVICE CHANGE 20.00 Z0, AUG 13 1985
o O LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 �I/
a v v I hereby affimi that I wn licensed under provisions of Chapter 9 c)-+ o/I1311ree7EUDATE
it a (commencing with Section 7000)of Division 3 of the Business and DG. ELEC PLO. CH
Professions Codc,:uul my license is in full force and effect,
z o License la. Lie.Numbb�
O
Date , Contract a44Z w
a rg a BUILDING P RMIT
¢ re ic OWNER-BUILDER DECLARATION INFORMATION
wH I hereby affirm that 1 am exempt from the Contractor's License IMISC.- REFER TO ORD
a- 0 Lew for the following reason.(Sec.7031,5.Businessand Professions PERMIT ISSUANCE 10.00 OALUATION E/FT.
� - Code:Any city or county which requiresa permit to construct,alter, 'n/yy
¢ u Q p improve,demolish,or repair any structure prior to its issuanm,also ELEC.COrvTR. LIC.N0. ELEC. , (/U/ �OHIM.
('I DLL requires isic the licensed
pursuant
for such permit to❑Ic a signed statement that TOTAL OE
y.i w 0 is licensed pursunt tri the provisions of the Contractor's statement
Li chat (((///���///)--- F
1 bii Law(Chapter 9(commcncing with Section 7000)of Division 3 ofthe
4 o Business and Professions Code)or that he is exempt tlioretrom and CITY. PLUMBING PERMIT FEE
re I- S the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
T R by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5150- W
of not more than five hundred dollars(SS001.):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec..7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
i Code:The Contraclor's License law does not apply to an owner of
property who on or improvty thereon,and who does such work 2- FIXTURES-PER TRAP 3.00 s- 50.Fr,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedoroffered for sale.If,however,the building GAS-EA:SYSTEM-1 INC.40UTLETS 8:00 6'1,
or improvement is sold within one year of cotraction,the owner- GAS--EA.SYSTEM-OVER 4(EA.) 200 /
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 R IND CON PB ot"r
❑ I,as owner of the property,am exclusively contracting with
licensed contractors to mmttnct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCELNO�
1:1 El
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
contracts for such projects with a conbactogs)licensed pursuant to SEWER-SANITARY-STORM EA.200fOl 0.00 TRACT No. PARCEL No.
the Contractor's License Law.
❑ l am exempt under Sec.-.B.&P.C.for this WATER HEATER W/VENT 6.00
cantQ
Owner\ Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE No.
WORK IiRS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00
' 1 hereby affirm fl Dl ,ave a rinni0ciae of cuhsent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'ff,,QOmpensation Insurance,or a terrier!
copy thereof(Sec.3800,Lail.C).
Policy o. Company
Q ❑ Ce fled copy is h achy furnished.
FIRE SPRINK ENERGY T-14
Z Z 62 Cenlfi•d copy fie 'th the city ns{f;etion division.
O Applicant - MISC.- REFER TO ORD. YE] IN E] YL] N[]
CC rn - PERMIT ISSUANCE 10;00
r' CERTII'I(A'M 1P li E PTION PROM WORKERS' = FLOOD ZONE A.L.u.C.
W �_ Cosi']ON INSURANCE PLG.CONTR. .. LIC.NO. PLC. ' ❑ ❑ ❑ ❑ 'l
CL O ('This section need not be completed if lire permit is for one TOTAL Y N Y IN IJ
--) Z hundred dollars IS l W)or less.) +
U O 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL V mit u issued,1 shall not employ any person in any manner so az to
become subject to the Workers'Compensation Laws of California.
O at Date AppBnnt 5.00 BUILDING
>_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex- " ALTER OR ADD TO MECH. u
F F 2 emption,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK
I provisions of the Labor Code, you must forthwith comply with
U such provisions or this profit shall be deemed revoked. Y AIR HANDLING UNIT(TO 10=C.F.PA) 4.00 FEE
Z CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOWC.i 6.00 SEISMIC FEE a d3
1 hereby affirm that there is a construction lending agency for I 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
Lenders Name HEATING UNIT 100,000 B.T.U.)9.50 I '
r Leader's Address ELECTRIC
r I certify.that I have read this application and state That the above VENTILATION FAN (SINGLE) 4.00
. Information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, end BOILER
6.00
hereby authorize representatives ec this city to enter uWn'the BOILER-COMP (Over 11X),000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection Purposes.
(We) agree to Ltv4 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 inconsequence of the PERMIT ISSUANCE 10.00 0
lira L'afthol", . MECH.CONT. LIC.NO. MECH.
TOTAL (�.Ct - TOTAL
�- Signaluma pplicant/Contzactcr I to O
t OFFICE COPY
1