14065 (2) POST THIS.CARD NEAR FRONT OF BUILDING
CITY 0'F CUPERTINO PF.RMIT NUMBER
INSPECTION DIVISION •
14065
j JOB INSPECTION RECORD
PERMIT EXPIRATION
7521 KINGSBURY
JOB ADDRESS UNIT# . LOT# , PERMIT EXPIRES IF,WORK
OWNER VYT0 CICEN �CONTRACTOR IS NOT STARTED WITHIN -
INSPECTION DATE INSPECTOR. INSPECTION RECORD 180 DAYS OF PERMIT ISSU• '
FOUNDATION - -` I ANCE.OR 180"DAYS'FROM
LASTCALLE DINSPECTION.
UFER'
- PREGUNITE - - PERMITyALIOATION
POUR NO CONCRETEUNDERGROUND / BEEN SIGNED
SLAg
PLUMBING - f ,/-
ELECTRICAL CITY iE u�NB Po
MECHANICAL' BLDG, ELECT. •-PL .• MECH.�
100 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING vERMIT
WOOD FLOOR INFORMATION
VALUATION. $/FT.
PLUMBING T
MECHANICAL - f `
ELECTRICAL
PERMIT TO _
� � � -
FRAMING
INSULATION STORIES- TYPE CONSTR.
OCC-GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I SD FT.FLDURARRA , TOTAL ACREAGE
ROOF '
DIAPHRAGM c r
11 N[5 INP CON PB OiM1ci
APPLY-NO ROOFING UNTIL ABOVE HAS BEEN SIG 0 w.tl' 5-c-",IV("el d V\ El . 1:1 ❑ ❑
- ASSESSORS PARCEL NO.
ROUGH
PLUMBING
TRACT NO.. PARCEL NO.
GAS TEST
MECHANICAL '
ELECTRICAL
FINALS, DATE INSP
' . ACC.DATE ACC.FILE NO.
- �
FRAMING SAN AE,
INSULATIONPLUMBING ZONING ENG.SITE NO.� - � ,
GAS I• - _
FIRE� SPRINK� Z ENERGY T'9
COVER NO WORK UNTIL ABOVE HAS BEEN SIG D HEATING;, ` ❑ ❑' N[]
` -
" ELECTRICAL FLOOD ZONE A.L.U,C:
LATH-INTERIOR
LATH—EXTERIOR FIRE DEPT. y ',N❑_ Y❑ N❑
SHEETROCK - - G DE - - FEE SUMMARY
SHEAR INTERIOR BUILDI
SHEAR EXTERIOR -
TEM ORARY APPROVALS BUILDING
FIREWALLS - ELECTRIC PLAN CHECK' �,+
GAS FEE f��,f
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
y OCCUPANCY-OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL+S SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING:252.4505, ELECTRIC
H QNE'WORKING DAY-BEFORE REQUIRED INSPECTION PLUMBING
z PLEASE'GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! coNsr.rnx
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL IN
OFF
�-
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION - PERMIT NUMBER
SDILnIN^ APPLICATION & PERMIT
AOGAEs� /fBUILDING
- 5
kk% Duh Cr BUILDING-ELECTRICAL-PLUMBING-MECHANICAL J
/ DINNER - - PLAN CHECK VALIDATION
1( NAME 1/� QTY. ELECTRIC PERMIT FEE
V c.ev.1 -PHONE
CON FRACTOR'S OUTLETS'-SWITCHES-R ECEP' 10.00/1.00
NA
LIC.No. LIGHTING FIXTURES 10.00/1.00
ADDRESS
� - PPLIANCES-RESIDENTIAL 4.00
A ONTRAC
PHONE PANELS 10,00 .DATE OF APPLICATION ,
ARCHITECT - PANELS (OVER ZOO AMP) - 20.00 - 'PLAN CHECK FEE P.C.NO.
OR
ENGINEEfl
uc.No. SIGNS TRANS. 3.00 tv7ar. rat.,,
ARCH,ORENO 'PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. .20.00 (1
- APPLICANTS MOTORS •SEE FEE SCH.
ADDRESS.
•, SERVICE CHANGE 20.00 ,lit,
•r-1
woo LICENSED CONTRACTORS DECLARATION
¢U U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
yaA
z a (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH.
r H i Professions Code,and my license is in full force and effect ❑ ❑ ❑
ElaClan Number
Dudc contractor
BUILDING PERMIT
¢ ¢w a OWNER-BUILDER DECLARATION INFORMATION
D r' MISC.- REFER TO ORD
R
; H I hereby affirm that I am exempt from the Contractor's License
a.oa Law forte following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 -VALUATION $/FT.
r - to Code:Any city orcounty which requires a permit to construct,alter, ✓//� '
¢ ¢ ¢ C Improve,demolish m repair any structure,poor IO its Issuance,also ELEC.CONTR. LIC.N0. ELEC. /a/-
wm LL requires the applicant for such permit to file a signed statement that - TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe' -
i O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT - FEE
¢ t-$ the basis for the alleged exemption.Any 4iolation of Section 7031.5 STORIES TYPECCINSTR.
byanyapplicanl for a permit subjects the applicant to a Civil penalty ALTER-DRAIN -WATER (EA.) 5.00,
of nol more than five hundred dollars($500).):
❑ I,as owner of 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 is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are nol intedded or offered for sale.If,however,the building •GAS-EA.SYSTEM-1 INC.4 OUTLETS 61.100
or improventent is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA) 200
builder will have the burden of proving that b . . .
e did not build or am. - BUILDING USE
prove for purpose of sale.). INDUSTRIALWASTE INTER. • 30.00 RES' IND CON PB Other
IJ 1,as owner of the properly,am exclusively.contracting with • ❑ 0 ❑ ❑ ` ❑
licensed contractors to construct the project(Sec:7144,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does riot apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EAt) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SAN EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCELING.
❑. l am exempnmder Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason_ s
Owner � iet- Date f 1 WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
of a certificate of Workers'Compensation Insurance,or a certified _
copy thereof(Sec.3800,Lab.C.I - -
Policy No. COIIIPWlY
O ❑ Certfledcmpyisllerebyfurnished. FIRESPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. -MISC. _ REFER TO ORM O Applicant - Y F NF YE]' N[:]
~ rn . ' PERMIT ISSUANCE 10.00
CC CF.RTIPICA'1'Ii NIAX-MPPIFROMWORKf:RS' FLOOD ZONE A.L.U.C.
W � COMPEENSATION INSURANCE PLG;CONTR. - LIC.NO. PLG.
Z ('This Section'meed not be.compleled if the permit is for One TOTAL Y❑ NEI V 0 NE]
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
- LL H alit is issued, I shall.not employ any person in any manner ser as to
O W become subject to the Workers'Compensation Laws of California.
d Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ W NOTICE TO APPLICANT: If,after making this Certificate of Ex- -
2 camption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with 77
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10.000C.F.M.) 4.00 FEE' .,70
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.)6.00 SEISMIC FEE 0
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
-*e 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
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 agree to comply with all city and county gOILER•COMP 13 H.P:Dr 100,000 B.T.U.) 8.00 PLUMBING
ordinances and state laws totaling to building construction, and
hercby 'authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE'SCH. MECHANICAL
above-mentioned property for inspection purposes.
(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
may in any way accrue against Said City in consequence of the
grantinthis pe MECH.CONT. LIC,NO. MECH.
TOTAL TOTAL
Signature of Applicant/Contractor Uak
OFFICE COPY