12801 (2) POST THIS CARD NEAR FRONT OF BUILDING
µPERMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
s PERMIT-EXPIRATION,`I
JOB ADD E S — NIT LOT# PERMIT EXPIRES IF WORK
OWNER CONTRA r R L)uwIS NOT STARTED WITHIN
I S CTION DATE INSPECTOR SPE TI N RD 0 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER LASTCALLED INSPECTION.
PREGUNITE - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED —
UNDERGROUND /SLAB
PLUMBING r � 7
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG, ELECT, PLO. MECH.
ElEl ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL AMIA nnn fin _
ELECTRICAL
FRAMING
STORIES• TYPE CONSTR.
INSULATION
OCC,GHOUP RES UNITS
1' r
/ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• _ ROOF sn,FT.r1.DOH nRPA IornL ACRear,e
J DIAPHRAGM BUILDING USE
HES IND COry PB Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED .❑ ❑ :
ASSESSOHS PARCEL NO,
ROUGH
PLUMBING
TRACT NO, PARCEL NO
GAS TEST
MECHANICAL _MITT
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE N0.
FRAMING SAN dt
zorvlNc Enc.SITE No.
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY L
MECHANICAL N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� Y �
FLOOD ZONE A,L.U.C.
LATH-INTERIOR - ELECTRICAL � d=
LATH-EXTERIOR FIRE DEPT. v❑ N� v ❑ N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING �1.D
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING 1
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE-HAS SIGNED occuPANcv SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, , ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0PLEASE GIVE JOB ADDRESS WHEN PHONING.
I 40 z
— SEE PERMIT FOR'EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY /'�
1 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
1 BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADoREse, 19447 1.aruneridge Avenu12801
uildin 4 e BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S , PLAN CHECK VALIDATION
NAME HEWLETT-PACKARD
PNONE (415) DTV. ELECTRIC PERMIT FEE 3
FS
CONTRACTORS 725-8111 ext. OUTLETS•SWITCHES-RECEP 10.00/1.00 ft_„p C[r
NAME r/ U
THE JACK DYMOND CO.LIC,No, 164319 LIGHTING FIXTURES 10,00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS P. 0. Box 7430 (415) 968-5
CA 94029-741-90
PANELS 10.00 DATE OF APPLICATION
aR cT PANELS (OVER 200 AMP) 20.00 PLANCHECK FEE P.C.NO.
ENGINEER HET.rT a!T T-P A CCA RD
YYYY LL L,1111 CLfI LIC.No. ISIGNS TRANS. 3.00
ADD Ess ENG' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
IIP TEMP.METER OR POLE INS. 20.00
ADDRESSSS 9447 Pruneridge Avenue MOTORS SEE FEE SCH.
Cupertino' CA ()517114 SERVICE CHANGE 20.00 �U
w
,09 LIC13NSh:U CONTRACTORS DECLARATION A
W I hereby affirm Thal I am licensed under provisions of Chapter 9 1 U DATE
w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH,
H =MZe. Professions Code f�)a.nd m license is in full force ec
• 0
20 Lcen1 ,
O o Dar7 - D 0.
e, x f .�, BUILD N PE IT
M Be w OWNER-BUILDER DECLARATION ffC�n1
WO e I hereby affirm that I am exam t from the Contractor's License MISC.- REFER TO ORD
3 D.t y p VALUATION $/FT.
LL o ¢ Law for the following reason.(Sec.7031.5,Businessand Professions
Code:Any cityor County which requires a permit to construct,alter, PERMIT ISSUANCE 10.00
am �
¢ ¢ Fo improve,demolish,or repair any structure,Puerto its issuance,also ELEL.CONTR. LIC.NO, ELEC. On
G LL requires the applicant for such permit to file a Signed statement that TOTAL T TO
a w m
in he is licensed pursuant to the provisions ol'the Contractor's License �Nl/�/IOi✓/L{'��V�,e-
H z Q
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ��
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r r� the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant ION civil penalty ALTER-DRAIN -WATER IEA.) 5,00
of not more than five hundred dollars(55000.):
❑ 1,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 FIXTURES-PER TRAP 5.60
SOL FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-I1NC.4 OUTLETS 6,00
of improvement is sold within one year of completion,the ownery GAS-EA.SYSTEM•OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of Sale.). RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 0 ® ❑ 0 ❑
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 docs not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsuch projectswithe conlractods)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ tem exempt under Sec. ,B.&P.C.far this reason WATER HEATER W/VENT 6.00
0
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC,FILE NO.
WORKS RS'COM PENSATION DG LARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a cert icatc a L-onsen to self-insu
or a serlifcale of Workers Campe tion I suranc , a cerlif• ZONING ENG.SITE NO.
copy thereof(Sec.3800,L'b.0.).
Policy No. _
0 ❑ Cur' o ishereby dished. FIRESPRINK ENERGY T-24
Z Z ert ifie py is filed with the city spec' n div' on.
O pBgp REFER TO ORD. v N❑ v ❑ N�
~ 5 PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
'Cr CERTIF CATE OF EXIIMPTION h M WO KERS'
LU COMPENSATION INSUANCE PLG.CONTR. - LIC.NO. PLO, YE] N� v� NE]
Z on( This sectineed not be completed if the permv
it is for one TOTAL _
hundred dollars(5100)or less.)
L) 0 1 certify that in the performance of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workcn'Compensation Laws of Czdfarniu.
Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Cerlificalc of Ex-
�-Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 .PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=QF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE 8Z
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
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 stale that the above VENTILATION FAN (SINGLE) 4.00
information is s
etl agree to comply with all city and county PLUMBING
ordinances and stateate l laws relating to building construction, and BOILER-COMP I3H.P.or100,0008.T,U.1 6.00 '
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,00OBTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against Gabililies,judgments, co sand ex enses which CONST.TAX
may in any,way accrue,against said C' in s uence of the PERMIT ISSUANCE 10.00
gmnling this mil.., MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Signature of pp icant/Con r Date
OFFICE COPY