12730 (2) POST THIS CARD NEAR FRONT OF BUILDING O ^ PFRMIrNMRER
-.-CITY OF CUPERTINO 1q� i4 , '. 12730
INSPECTION DIVISION Ce(, kyl
JOB INSPECTION RECORD /
V vVf PERMIT EXPIflATION1 ,plJOBADDR UNI LOT#
('
PERMIT EXPIRES IF WORK
OWNERcTOR IS NOT'STARTED WITHIN
IN PECTI N 11 1 DATE I INSPECTOR INSP CTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - Dyp ���` �� ANCE OR 180 DAYS FROM
UFER0O ( LAST CALLED INSPECTION.
N i e/ o
PREGUNITE /f/�/� /N�'nJ.I �j�[L 'X71#44 - PERMILVALIDATION
MR16W 'z
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED / M✓` CPF �� ` ��
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL 'ter �• v /G L � A CE DATE
MECHANICAL . LECT. PLG. MECH.
00 NOT FLOOR.UNTIL ABOVE HAS BEEN SIGNED UILDI NG PERMIT
- INFORMATION
WOOD FLOOR "• vnwnION . �, SIFT.
PLUMBING
MECHANICAL
ELECTRICAL lr PERM TO
FRAMING ^/V — •�('
INSULATION S�ORIETYPE CONSTR. '
e
OCC GR P RE ITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
O SO,FT.FLOOR AREA TOTAL ACREAGE
• �,—C'� tr'
DIAPHRAGM BUILDING USE
r/
OD /ISA/G ^- L r RES IND CON PS 00'e'
APPLY NO`ROOFIN NTIL ABOVE HAS 8 IGNED ' ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
Roue y-3�- w
PLUMBING - IC• TRACT No. PARCELN
GAS TEST i71I 'm
MECHANICAL
ELECTRICAL.. - 9FINALS DATE;'.' .n INSP,.�;. A "DATE Acc.P
FRAMING SAN 0
- INSULATION �21,Y7 � PLUMBING Z ING G. TE N0.
GAS
MECHANICAL FIRE SPRINk I fJ ENERGY T"24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ IN Y ❑ N❑
LATH—INTERIOR ELECTRICAL I,
}001)ZGIIE A,L.U.C.
LATH—EXTERIOR FIRE DEPT.
No Y ❑ No
SHEETROCK GRADE fFEESUMMARY
SHEAR INTERIOR' I._ BUILDING
SHEAR EXTERIOR TEMPORARY APP OVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS _Z241
FEE
NO TAPE OR:PL'ASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
i
ARRANGE FOR.INSPECTION BY PHONING 252-4505, ELECTRIC
-400o� PLEASE
WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z E GIVE JOB ADDRESS WHEN PHONING. .
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANTI CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL '
CALLING FOR FINAL INSPECTION.
OFFICE COPY
NT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
I
LE PROJECT I DENTI FICATION PERMIT NUMBER
- APPLICATION & PERMIT 12730
r i Tiler, Ail
J //! BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
.. PLAN CHECK VALIDATION
8APnsr 014U�(.xN .C.
a 7111QTY. ELECTRIC PERMIT. FEE9PHONE 1 !!OUTLETS-SWITCHES-RECEP 10.00/1.00"
_ -4 I LIGHTING FIXTURES 10,00/1,00
r, TOR's PPLIANCES-RESIDENTIAL 4.00 �� O
AOOP
PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR
NGINEER O ^ 4rre OIQ nn �x PANELS (OVER 200 AMP) 20.00
LIC.NO.y N SIGNS TRANS. 3.00
ARCH,OR ENG. ;ANCEDATE
VALIDATION
ADDRESS 5(p4 725se James A SPECIALCIRCUIT 5.00
k �O n T zIP $ EMP. METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH,
ADDRESS SERVICE CHANGE 20.00OO LICENSED CONTRACTORS DECLARATIONa to Phereby affirm that 1 am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business and - BL ELECT. PLG. MECH.
i Professions Co and my license is in full for
z 0License Class5 Lic.Number V
9 2 4 w Dan,- '10^ Contractor
Q y 3 J BUILDING PERMIT
¢ ¢w a OWNER-BUILDER DECLARATION INFORMATION
A o D MISC.- REFER TO OR
X ;e I hereby affirm that I am exempt from the Contractor's License VALUATION
v.ort Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 /n� / S/FT.
L- W0 � Code;Anycity orcounty which rcquiresa permit to constom.1ter, (/)D O..
2 ¢ ¢ improve,demolish,or repair any structure,prioi to its issuance,also ELEC.CO R. LIQ N0. ELEC.
i F O u requires the applicant for such permit to file a signed statement that
TOTAL PERMIT T
w m he is licensed pursuant to the provisions of the Contractor's License
F i
Law(Chapter9(eomme ncing wit t Section 7000)of Division 3 ol'the O
a Business and Profession,Code)or Oct he tseomi therefrom and CITY. - 'PLUMBING PERMIT _ FEE
M r$ the basis for the alleged exemption.Any violation ofSection7031.5 STORIES, TYPE DN$TR.
by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(SS00).):
O 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 occ.GROUP REB,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,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
,y s properly who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 b0.FT,FLOOR AREA TOTAL ACREAGE
7 himself or through his own employees,provided that such improve.
meats are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-111NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner.
�ry*•�'" builder will have the burden of proving that he did not build or in,. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). E IND CON PB Other
C1 1.as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 0 El 1:1 Cl
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL No. '
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 contracturts)'licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor s License La TRACT NO. PARCEL NO.
❑ as funder c. ,B.&P.C.for this WATER HEATER W/VENT 6.00
Ow Dat WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSAIION DFCLA RATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent m self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy there-((Sec.3800,Lab.C.).
Policy No. Company
0 ❑ C tifled copy is hem by furnished. FIRE SPRINK ENERGY T44
Z Z e 'ed copy is filed with the city inspection division. MISC.- REFER TO ORD.
O pplicant V F1 N[] V � N�
~
us ( PERMIT ISSUANCE 10.00
2 - 61FIFICATE OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 1
n' O (This section need not be completed if the permit is for one TOTAL Y❑ NY F] No
Z hundred dollars(SI00)or les.)
U O I certify that in the performance of the work for which this per- 'UTV. MECHANICAL PERMIT FEE FEE SUMMARY
F
IL mit is issued.I shall not employ any person in any manner so as to
O e subject to the Workers Compensation Laws of California.
0 Wa Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} *21
N GTO APPLICANT: If,after making[his Certificate of Ex-
F Z emp[ion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of.the Labor Code, you most forthwith comply with FEE
U 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 10,000C.EM.) 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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name HEATING UN IT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
- I certify that I have read[his application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county PLUMBING
ordinances and slate laws relating to building construction, and BOILER-CONPI3H.P,Or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
`:,;r)• above-mentioned property for inspection purposes. BOLEER
(Over 100,0008TUI BEE 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 CONST.TAX
ma in any aceta st sai ity in consequence of the PERMIT ISSUANCE 10.00
nil lg of Is mi MECH.CONT.. LIC.NO. MECH.
TOTAL . TOTAL
Si aur ofA pbcan onlractorI D
OFFICE COPY