11825 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO $�5
INSPECTION DIVISION.
JOB INSPECTION RECORD
16o,-2 Mki-Aa ke►� c PERMIT EXPIRATION
JOB ADDRESS UNIT#'' LOT#
- y PERMIT EXPIRES IF WORK -
• OWNER • .CONTRACTOR ,C�I'L�1• IS NOT STARTED WITHIN
INSPE ION DATE INSPECTOR INSP CTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM,
UFER - LAST CALLED INSPECTION.
PREGUNTE I' - PERMIT VALIDATION
I' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED / ^
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL i ISSUANCE DATE
'MECHANICAL BLDG. ELECT. I PLG, M H.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED %U ILDING PERMIT
.. INFORMATION
WOOD FLOOR VALUATION s/FT.
PLUMBING -
MECHANICAL -
ELECTRICAL PCMIT'To
FRAMING _b6fOb6i L
STORIES TYPE CONSTR.
INSULATION
OCC.CROUP RES.UNITS
:PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT.FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM
BUILDING USE
RES IND CON PB Ober
''APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El C_l 11 -❑ El
ASSESSORS PARCEL NO,
ROUGH
PLUMBING I TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL
ACC.GATE ACC.FILE NO.
ELECTRICAL Ij^ o-E` FINALS I DATE INSP. .
FRAMING f2__"-0 SAN * ZONING ENG,SITE NO.
INSULATION - ,fr{� PlLurAkika I I
GA
FIRE SPRINK ENERGY T$4
- E ANICAL v N� YE] N
MH �
,,:."COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HE TING '
LATH-INTERIOR EL CTRICALC
-
FLOOD ZONE A.LM0
LATH-EXTERIOR „ FIR DEPT. - YE] N� Y0N[]
SHEETROCK 1A_ & GRAD FEESUMMARY
SHEAR INTERIOR BUILDING - ,2,Z77P7 I W
-
SHEAR EXTERIOR TEMPORARY PPROVAL BUILDING
' FIREWALLS ELECTRICPLAN CHECK
GAS - 1. FEE
'NO TAPE OR PLASTER UNTIL ABOVE HASfBEEN SIGNED JOCCUPANCY1 , SEISMIC FEE
OCCUPANCY OF,BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING T
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX.
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.',
OFFICECOPY
_ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY,
BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS AI BUILDING -ELECTRICAL-PLUMBING-MECHANICAL c711825
OWNER'S PLAN CHECK VALIDATION
NAME 1 QTY. ELECTRIC PERMIT FEE
PHONE � rZ—IW0
NONrRAcroRs68b
NAME UTLETS-SWITCHES-RECEP 10,00/1.00 3d v=
(f o LIGHTING FIXTURES 10.00/1.00 V
ADORE.row's 1 2 g(d93S PPLIANCES-RESIDENTIAL 4.00
`�l
P/ ,�I/L OxE s.S PANELS 10.00 DATE OF APPLICATION
ARCHITECTPANELS (OVER 200 AMM 2000 PLAN CHECK FEE P.C.NO.
OR .
ENGINEER
LIC.NO. ISIGNS TRANS. 3.00
ADDDRESS ENG' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
• IIF EMP.METER OR POLE INS. 20.00
ADDRESS
A 7..2/8 /�(�}� V MOTORS SEE FEE SCH.
E(bDRESS�b� K(2k /
JfLf J 1 S SERVICE CHANGE
O O LICENSED CONTRACTORS DECLARATION C
A, u I hereby affirm that I um licensed under provisions of Chapter 9 J JL' ISSUANCE DATE
N<n (commencing with Section 7000)of Division 3 of the Business and BLDG.f GT P MECH.
H y i I''cl'assioms Cod' d ny licmtse is infur nd effd epL q t?
Z i N c License CP ss Lic. nalb L6 I y O uI sw L �Con[rlet EV
wat OWNER-BUILDIiR DARATION It O
MISC.- REFER TO ORD
E 0 r; 1 hereby affirm Ih at I am exempt front the Contractor's License VALUATION $/FT,
a,u o Q Law for the following reason.lSec.7031.5,Business and Professions PERMIT ISSUANCE - 10.00 a •—
Code:Any city or county which requires a permitio construct,alter,
sc2¢G improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. oLU V"
DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
P6 w m w he is licensed pursuant to the provisions of the Contractor's License
Hi> Law(Chapter9(commencingwithSection7000)ofDivision3ofthe �rLT X�trN/OJ�L. ,
0 Business and Professions Code)or that he is exempt therefrom and
QTY. PLUMBING PERMIT FEE
W 1=-$ the basis for Ilse alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n3 � by any applicant for a permit subjects the applicant toa Civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not 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,AREA,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 7j FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00
ments are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS•EA.SYSTEM•OVER 4(EA.) 2.00
builder will have Ilse burden of proving that he did not build or im- BUILDING USE
prove for purpose:of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB owe,
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ , ❑
licensed contractors to construct the project(Sec.7044,Business ILAWN SPRINKLERS•1 INC 6 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- (EA.) 1.00
contracts for such projects with a contractods)licensed pursuant to
the Contractor's License Law. SEWER—SANITARY—STORM EA.200ftI10.00
TRACT NO, PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATERWIVE "tl 6.00
reason
Owner - Dare WATER SYSTEM - 5.00
ACC.DATE ACC.FILE NO.
WORK I;RS'COMPENSATION DECLARATION WATER TREATIN • tV E Ifl 5.00
I hereby uffirm that I have n certificate of consent to sell'-insure, ZONING ENG.SITE NO.
or o certificate of Workers'Compensation Insurance,or u certified
copy therco(,(,ec.3811Q"1 1'.. )� l�,+C.��/`�/,
Policy IJI J7A'Ia' /'
Z ❑ er led Copy ish reby(with d. FIRESPRINK ENERGY T-24
Z Z ❑ Ce "e cop iz i •d with the it �pction division. MISC.- REFER TO ORD.
p Applicant I Y ❑ N❑ Y ❑ N❑
Hy PERMIT ISSUANCE 10.00 (i `�' FLOOD - A.L.u.c.
G.RTIFICA'1'Ii01'IixrMI'T FROM WORKERS'
LU — COMPENSATION INSURANCE PLG,CONTE. IJC,NO. PLG, �-9L
CL D (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
D Z hundred dollars IS 100)or less.)
U 0 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I. mit is issued,I shall not employ any person in any manner so as to
Q U became subject to the Workers'Compensalion Laws of California. BUILDING .�
y Dale Applicant ALTER OR ADD TO MECH. 5.00
} N NOTICE TO APPLICANT: If,after making this Certificate of
Ex-emption.you should become subject to the workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forlhwitlt comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVE .M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH 5.00
the performance of the work for which this permit is issued(Sec. - MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,Q 0 .Tj.Ut),,S!00
Lender's Name HEATI NG UNIT IOV ER fd0,0 B.T.U.)9.50 ELECTRIC z-
Lender's Address
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGE 1 uDP j{�610 rir-
�' information is correct. I agree to comply with all city.and County PLUMBING J
ordinances and state laws relating to building construction, and BOILER COMP I3H.P.or ,0 ie
6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEESCH. MECHANICAL o/ dU
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 16.06 CONST.TAX
in any way accrue against said City in consequence of the V
gm O this n it. C MECH.CONT, LIC.NO. MECH.
_ TOTAL �q TOTAL a33
Si 1 of p tic. t o racto Date
OFFICE COPY