13392 (2) POST THIS CARD NEAR FRONT OF BUILDING
- PERMIT NUMBER
CITY OF CUPERTINO 13392
n INSPECTION DIVISION
JOB INSPECTION RECORD
19976 PORTAL PLAZA PERMIT EXPIRATION
JOB ADDRESS UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER STOUGH CONTRACTOR FRED SMITH TERMI HS ''NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMITISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
LASTCALLED INSPECTION.
`
-PR EGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB 1p
PLUMBING
ELECTRICAL T.t 'IISS ANCEDATE
MECHANICAL YC c. I ELECT. I PLG, MECR,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION S/FT.
' PLUMBING � - - '
' MECHANICAL �` 4
ELECTRICAL - PERMIT TO
FRAMING "';�• I '•
STORIES TYPE CONSTR.
INSULATION 'S
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF 50,FT.FLOOR AREA. TOTAL ACREAGE
. DIAPHRAGM
BUILDING USE
RES IND CON PB O,he
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ El
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST - _ TRACT NO. PARCEL NO.
MECHANICAL
ACC.DATE ACC.FILE N0.
ELECTRICAL FINALS DATE INSP.
FRAMING - SAN a -1. zoNlNc ENO.SITE No.
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY T-24
MECHANICAL v ❑ N[] v [:] N[]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A1.U.C.
LATH—INTERIOR � (A/G� ELECTRICAL
LATH—EXTERIOR. FIRE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCK - GRADE FEE SUMMARY
SHEAR INTERIOR - BUILDING Vyyt►- I e,2—
SHEAR EXTERIOR TEMPORARY APPROVAL BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGN ED BY BUILDING INSPECTOR. MICROFILM
it `
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE'REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.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
BUILDING APPLICATION & PERMIT
ADOR "7b D4LlvL PLA-LA
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 13392
XOWNER'5 T Y PLAN CHECK VALIDATION
NAME
PHONE DTV. ELECTRIC PERMIT FEE
if
NAME OUTLETS
OUTLETS-SWITCHES-RECEP 10.00/1.00
$ LIC.NO. -57 3 LIGHTING FIXTURES 10.00/1.00
LTOR's
ADDRES5 PPLIANCES-RESIDENTIAL 4.00
OORE5n- r��r e
a.` y ro !Gp PHo-37)-?1'87 PANELS 10.00 DATE OF APPLICATION
OR
ROHITEcr PANELS (OVER 200 AMP) 20.00 PLAN LMECK FEE P.C.N0.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDRESS END' SPECIAL CIRCUIT 5.00 Ap PERMIT VALIDATION
ZIP_ EMP.METER OR POLE INS. 20.00 Yvl
ADDRESS Ts MOTORS - SEE FEE SCH,
SERVICE CHANGE 20,00 I��
w o o LICENSED CONTRACTORS DECLARATION ,,� e�-7/?7
a 0 w I hereby affirm that I am licensed under provisions of Chapter 9 Ci 01 Cupe11SS ANCE DATE
(commencing with Section 7000)of Division 3 of the Business and
C4¢ P- BLDG. ELECT. PLG. ME❑LH.
H D i Professions Code Id my license is in full forjtand..etfecl.
i o`�- License lass Lic.Number �7 S.S
o o ate f Lic.N mbar s41E0_ .If}a
117-1
N j
4MIna BUILDING PERMIT
rc a i u OWNER-BUILDER DECLARATION INFORMATION
R: LL 1 hereby affirm that I am exempt from the Contractors License MISC.- REFER TO ORD
Ci VALUATION $/FT.
w u.o ¢ Law for the following reason,(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 (�-•�+
Code:Any city orcounty which requires a permit to construct,alter, J
a ¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
iO LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT T
E
8 N he is licensed pursuant to the provisions of the Contractor's License
Law.(Chapter 9(commencing with Section 7000).(Division 3 of the
F2 ¢o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ H $ thebasis for the alleged exemption.Any violation ofScc(icm703l.5 STORIES TYPECONSTR.
by any applicant fora permit subjectslhe applicant 10 a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not mare than five hundred dollars(5500).):
❑ 1,as owner of the properly,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 ProfessionsDRAINS-FLOOR,ROOF,AREA, 5.00
Code:The Contractor's License Law does not apply to an owner of
Property who builds.r improves thereon,and who does such work FIXTURES,PER TRAP 5.00 SD.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
Dentsarenotinteddedor offered far sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
.r improvement is said within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build Or im-
prove for purpose of sale,). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
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 contractor(s)licensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10,00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,B&P.C.far this
reasoWATER HEATER W/VENT 6.00
n
Owner Date WATER SYSTEM 5.00 ALC.DATE ACL.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate.fconsenl t.self-insure, ZONING ENG.SITE N0.
or a certificate of Workeri sa
Compention Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
Q ❑ Certified copy is hereby furnished. FIRESPRINK ENERGY T-24
Z Z lIo-Car di it is is filed with the city inspection division.
� p ApplicuntkKF./±JL1.f1)I-'(ERr91.'� ee✓O2a L- MISC.- REFER TOORD. v❑ N❑ v ❑ N❑
CC- CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
(L 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ V❑ N❑
D Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
1L I- mit is issued,1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
Date Applicant BUILDING �7gg
} y NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
w
� ? emplion,you should become subject to the Workers'Comperoalion APPLIANCE 5.00PLAN CHECK
V provisions of the Labor Code, you must forthwith comply with FEE
such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10AWC.F.M.) 4.00
lCONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE Z„5�
I hereby affirm that there is u construction lending agency I'or EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). t HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
. I certify that I have read this aVENTILATION FAN and state that the above AN (SINGLE) 4.00
information n correct.I agree to comply with all city and county BOILER•CAMPO H,P.or 100,000 B.T.U.) 6.00 PLUMBING
hereby u and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the
above-mentioned properly for inspection purposes. BOI LER-COMP (Over 100,000 BTU)SEE 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
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX
gra ling of this permit MECH.CONT. LIC.NO. MECH.
afe... C O TOTAL TOTAL
Signature of Applicant/Contractor �-
FFICff COPY