C 9189 (2) POST THIS CARD NEAR FRONT OF BUILDING
�
CITY OF CUPERTINO CFRM1tIT NUMBER� ER
INSPECTION DIVISION
JOB INSPECTION RECORD
1155 !-laaf�r-sin I• JRMIT EXPIRATION
JOB ADDRESS V1 UN IT# LOT#
IF
ORK
RES
OWNER C' ' ` CONTRACTOR ; �m� 'S S NOT STAPERMITIRTED WIT HIIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - - ANCE OR 180 DAYS FROM
UFER :
LAST CALLED INSPECTION.
PREGUNITE
y_ PERMIT VALIDATION
- -
4_ OQ 'b
OUR NO CONCRETE UNTIL ABOVE HAS BERN&GNED _-
UNDERGROUND /SLAB
PLUMBING ' �p( Li T6 otvo %—f ` ^Z -SS- — i '• "
ELECTRICAL ISSUANCE OATS
MECHANICAL eLOG. ELECT. PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR B INFORMATION
PLUMBING
ALITAt ION $/FT.
� .
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING
6 L
INSULATION . - —STORIES TYPE CONSTR, -
OCC.GROUP RES.UNITS
.,
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
� � ROOF -SO.FT.FLOOR AREA TOTAL ACREAGE
•, DIAPHRAGM '
8UILOING USE
.L RES IND CON PB 00n"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
"ROUGH ASSESSORS PARCEL NO.
PLUMBING '
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL . FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN # 1i
INSULATION PLUMBING ZONING ENG.SITE,NO.
GAS'
MECHANICAL FIRE SPRINK ENERGY T2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
LATH—INTERIOR ELECTRICAL -i FLOOOZONE 'A.L.U.C. .
LATH—EXTERIOR FIRE DEPT. Y❑ N❑ Y N❑
SHEETROCK GRADE
SHEAR INTERIOR FEE SUMMARY
BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC "PLAN CHECK
GAS 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
loF� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
tZ PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! coNsr.TAX
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
ADILpING APPLICATION & PERMIT g 189
ADO E BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
S' uk rS oh10-
OWNER'S - PLAN CHECK VALIDATION
^ - TY. ELECTRIC PERMIT FEE
I'` O PXONE��/ JV
CONTRACT R'S
N ME (( f ^�a -� �5 ''ry1 OUTLETS-SWITCHES-RECEP 10.00/1.00
1 e*l VNe �Oo�S uc Noaa0 2a _ LIGHTING FIXTURES 10.00/1.00
coNTRACT Rs I APPLIANCES-RESIDENTIAL 4,00
oREss JJ�� I p�
0 &n 1�1n�jhlv►GtRorvE `i Iq 7Q� PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
oR a e Nn�Kh
EPANELS (OVER 200 AMP( 20.00
NGINEER uS
IT No. SIGNS TRANS. 3.00
ooaess Ervc' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zIP EMP.METER OR POLE I 20.00 ,f
APPLICANT'S
A REA C (y� p A MOTORS SEE FEE SCH.
D Jai^ I� Ohto 1� I SERVICE CHANGEJUL i (� " 0
o ¢ zQ
F, o O LICENSED CONTRACTORS DECLARA ION TEMP.POLE 3000
¢u u 1 hereby affirm that 1 am licensed under Provisions of Chapter 9
Q 2 w ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and f
wi Professions Cod' Y license R in full(arc cep ef0. 0 LLE�7 e- d o�. BLDG. ELECT. PLG. MECH.
z o w - License Crlass��Lie Number LL O ❑ ❑ 0
9 w r w Datc_Ip.l! Contractor
IF ¢ w < OWNER-BUILDER DECLARATION
°a U
X 1 hereby affirm that 1 ora exempt from the Contractor's License
MISC.- REFER TO ORD INFORMATION
g u m
uoj Law fertile following reason, 7031.5,Business and Professions .-10,00 VAg4ATION1 '7 g3
E - PERMIT ISSUANCE �1 OJ'f�
u,y Code:Any molish wurepair which regwtesup prior ttacansuance.lter,
or 0
improve, or repair any shuc[u[e.prior to its issuance. E EC. T LIC.NO' ELEC.
o ¢ requires the applicant for such permit to file a signed statement that ° Q TOTALp2� E I
w . v
u w m" he is licensed pursuant to the provisions of the ContemiRT'S License
H z a Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ I- o the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR.
i ;m by any applicant for a Permit subjects the applicant to a civil penalty /�7� �
of not more than five hundred dollars(8500).)'. ALTER-DRAIN -WATER (EA.) 5.00 CST/Nf7e-
❑ I,as owner of the property,or my employees with'wages as BACKFLOW 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
Code:The Contractors License Law docs 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 TOTALACREAGE
him.If or through [his own employees,provided that such in.prove=
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 ( .00 BU LDING USE
prove 1,aso neeose of sale.). INDUSTRIAL WASTE INTER- 30.00 ❑ f❑ ❑N ❑ o❑ _
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors Io ronstruct the project(Sec. 7044,Business LAWN SPRINKLERS-1 IN V.B !OQ'Fj
and Professions Code:The Contractor's License Low does not apply �/ ASSESSORS PARCEL NO. '
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OV IEA.) 1.00
L
ontracts for such projects with a eontructor(s)licensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STORM 0 0 TRACT NO, PARCEL NO.
❑ 1 am exempt under Sec eason WATER HEATER W/VENT,B&P.C.for this 6.00
r
Owner Date WATER SYSTEM 5.00
ACC.OATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or o certified ZONING ENG.SITE NO.
-6 copy thereof(Sec 3800,Lab,C.).,
Policy No. GOhllPany d/L- (� '
0 ❑ Cert tied op) Is herebY(umisI
Z Z �Certified oy -s Bkd h pool ran. FIRESPRINK ENERGY T-24
AppllZant cA -��";11.P� . MISC.- REFER TO ORD. v� NE] Y ❑ NE]
~ PERMIT ISSUANCE
LU W CBRTIV C F:XF,MPTION FROM WURKIiRS' _I�0 FLOOD ZONE A,L,U.C.
W COMPENSATION INSURANCE P .cP IC.NO qq
(This dollarrn need not ss wmpleted if the permit is for one TOTAL oCV, Y N� Y� N�
� Q hundred dollars is 100)or Icss-) .
I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to NI
become subject to the Workers'Compensation Laws of California,
- a NOT Date-AppliAPPLICANT
g ALTER OR ADD TO MECH. BUILDING O
Z NOTICE TO APPLICANT'. If,after..king[his Certificate of fix- 5.00
F _ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, You must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO .M.) 4.00 FEE
CONSTRUCTION LENDING AGENCYAIRHANDLINGUNIT( 10p0pC.F.M.)t6.00 SEISMIC FEE ( 'K
I hereby affirm that there is o construction lending agency for EXHAUST HOOD( -D Clf) iJ "5.00
the performance of the gq�fof_wInch this permit is issued(Sec,
MICROFILM
3097,Civ.CJ. NN //�LVVIIIC. HEATING UNIT(TO 100,000 B.T.0 1. 8.00
Lender's Nome
Lender's Address HEATING UNIT(OV 0 .50 ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information . PLUMBING cornetI agree to comply with all city and county C
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 8.00 �b
hereby authorize representatives ec this city to enter upon the
above-mentioned propertyy for inspection purposes. BOILER-COMP (Over t00,000BTU)SEE FEE SCH. MECHANICAL
(We agrce to save, indemnify -�
and keep harmless the City of MISC.- REFER TO ORD.
Cup m against liabilities,judgments, Costs and expenses f the
mwhich CONST.TAX
ay in Any
way accrue a onst said City in conseq once PERMIT ISSUANCE 10.00 .Q
gran of this peumilr^ MECH.CO T. LIC.N0. MECH.
-'I nt �� , ,��35�, TOTAL `�� TOTAL 0 .?
Sig ature ol'Applicant/Contractor to V1�
OFFICE COPY
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