13013 (2) POST THIS CARD NEAR FRONT OF BUILDING
- PERMIT NUMBER
CITY OF ,CUPERTINO 13013
INSPECTION DIVISION
JOB INSPECTION RECORD
) l •� PERMIT EXPIRATION
• JOB ADDRESS // rI) ell-h ' )S hIJ 0//Z—'UNIT#
L T PERMIT EXPIRES IF WORK
OWNER ` CONTRACTOR 1^ZO A-I //��j� IS'NOT STARTED WITHIN
IN PEC ION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION , '
ANCE OR 180 DAYS FROM
UFER LASTCALLED INSPECTION.
•
PREGUNITE PERMIT VAUOATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING f"%
ELECTRICAL ISSUANCE ogTE
MECHANICAL" BLDG. ELECT. PLG. MECH.
rv-vPcv w D ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR
PLUMBING VALUATION
MECHANICAL '
ELECTRICAL - ` PERMIT TO
\f{
FRAMING
INSULATION STORIES U TYPE CONSTR.
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF $O FT,FLOOR AREA TOTAL ACREAGE
. DIAPHRAGM PAIT5 '
i BUILDING USE
REB IND CON PB 0l1e1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED MAY n (I El ❑
ROUGH PgRD
ASSESSORS EL NO.
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
, -
MECHANICAL
.
ELECTRICAL FINALS �: DATE INSP. ,ACCDATE ACG FILE NO.
FRAMING SAN #
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS
-F IRE SPRINK .ENERGY T�24
- MECHANICAL Y ❑ .NE] Y [D NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
,FLOOD ZONE -' A.L,U,C.'
LATH-INTERIOR ELECTRICAL,
LATH-EXTERIORFIRE DEPT. Y❑ NE] Y ❑ N❑
SHEETROCK GRADE FEESUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY- SEISMIC FEE
OCCUPANCYOF 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. ,M
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 -"
gooREssdq BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 13013
OWNER'S PLAN CHECK VALIDATION
• NAM
.!I CITY. ELECTRIC PERMIT FEE
Q ((//� {�� rok PRONE
CONTRACTOR
NAME NAME � t�p OUTLETS-SWITCHES•RECEP 10.00/1.00
/`/?O LIC.N1, T)/O LIGHTING FIXTURES 10.00/1.00
aooessT°RsePPLIANCES-RESIDENTIAL 4.00
PIONCO 0 .-SLI PHON pQ
PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.N0.
OR PANELS (OVER 200 AMP) 20.00 -
ENGINEER
LIC.No ISIGNS TRANS. 3,00
ARCH.
DDDRESS ENG' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 PAID
ADDRESS T s MOTORS
SEE FEE SCH.
SERVICE CHANGE 20.00 MAY 2 01987
w o O LICENSED CONTRACTORS DECLARATION yp��1�
< z w 1 hereby affirm -IS9tl
that 1 am licensed under provisions of Chapter 9 ANCEUM'E-q
w ¢e (commencing with Section 7000)of Division 3 of the Business and
r w 2 PPofes..ons Code,a license is in full force�gd a BLDG. ELECT. PLG. MECH.
z O m- License Class Lie.Number_S,S
0 m -D Date Contractor
IF YE J
IF IF w¢' OWNER-BUILDER DECLARATION BUILDING PERMIT
wDAD INFORMATION
3: H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
U_ O¢ Law for the following reason.(Sec.7031 S,Busimessand Professions VALUATION $/FT.
L - PERMIT ISSUANCE 10.00
w i
Code:Any city or county which requires a permit m construct,altar,
Q ¢ ¢6O improve,demolish,or repair any structure,prior 1°its issuance,also ELEC.CONTR. LIC.NO. ELEC.
A. m LL requires the applicant for such permit to file a signed statement that TOTAL
whe is licensed pursuant to the provisions of lite Contractor's License RMIT TO
rz> Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
i o Business and Professions Code)or[],at he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢r the basis for the alleged exemption.Any violation of Section7031.5
a 3 by any applicant for a permit subjects the applicant to a civil penalty STORIES TYPE CONSTR.
of not more than five hundred dollars(S500).): ALTER-DRAIN III VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 400
their sole compensation,will do the work,and the structure is not . .
OCC.GROUP RES.UNITS
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[hereon,and who does suchch work
himself or through his own employees,provided that suchorimprove-
F IXTUR ES-PER TRAP 5.00 D 50.FT,FLOOR AREA TOTAL ACREAGE
ments are not intended or offered for sale.I L however,the building GAS-EA.SYSTEM-11INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner A 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.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Ome.
❑ I,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 Pummnt to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 Q TRACT NO. PARCEL NO.
❑ Iwo exempt under Sec. ,e.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner - Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREAT%kMIP. 5.00
I hereby affirm that I have acertifica[eofemnsenl tosel Gin sure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy Ihereof(Sec.3800,La b.CJ. ��JJ //�� /J O
Policy No. Conspany�) Ad& &ag '12f�
O .❑,r Certified copy is hereby furnished. FIRE SPRINK ENERGYTZ4
Z Z pC Certified co y is f e th le city inspection division.
O Applicant C.
MISC.- I y Of CU QI FER TO ORD. y N v IN
W CERTIFICATE.OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00
OQ FLOOD ZONE A.L.U.C.
W COMPENSATION INSURANCE PLG.CONTR. LIC.Na. PLG.
a o This section need not he completed if the permit is for one TOTAL Y N V N0
Z hundred dollars($100)or less.)
U O I 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 fo
become subject to the Workers'Compensation Laws of California.
i Date Applicant ALTER OR ADD TO MECH. 5,00 BUILDING
>• N NOTICE TO APPLICANT: If,afterBackingthis Certificate 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 U FEE such provisions or this permit strait be deemed revoked. AIR HANDLING UNIT(TO 1OA00 C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 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 BOILER H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and �-
hereby above-mentioned
authorize representatives foriins of this city to enter upon the BOILER-COMP Me.,100.000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property tativspecrion purposes.
(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
may 1n any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
grunting of this permit. MECH.CONT, LIC.NO. MECH,
TOTAL TOTAL
Signature of Appllcan t/Contractor Date -
OFFICE COPY