11721 (2) POST THIS CARD NEAR FRONT OF BUILDING
Q.. - PERMIT NUM1'16ER
-• CITY- OF CUPERTINO
INSPECTION DIVISION 11721
OwPERMIT
JOB INSPECTION RECORD
11 I ' /� EXPIRATION
JOB ADDRESS 0(ei ( �AA-A- L al— LUNIT;Ak—LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED"WITHIN
INSPECTION DATE I INSPECTOR INSP ION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION _ ,Ti Er ANCE OR 180 DAYS FROM
UFER — wd4 +CDP LASTCALLED INSPECTION.
' PREGUNITE �-_ r? SrN� '�-PYC 0A �p
11g S(q PERN,Ir vALIonTION
7-'27-$2 v 'ce I _ . ..d
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 2-rc5$ .r 61-1 u P.7 r ,o - -�`
UNDERGROUND /SLAB aX«I T eorrec{,oN ' ba E1� aG
PLUMBING 'Z.-'D- C
ELECTRICAL ISSUANCE DATE
MECHANICAL eLDG. ELECT. PLc. MEC'.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMI
INFORMATION
PLUMBING ATIO
WOOD FLOOR VALUN SIFT,
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING ,
STORI S TYPE CONSTR.
INSULATION
EXPIRED . - OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF _ SO FT.FLOOR AREA TOTAL ACFEACE
All
w f(
DIAPHRAGM 9UILDINUSE
RES IND CON
Pe GO—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
PLUMBING ROUGH 3•?4v - 17—o -71
1RACT NO, PARCEL NO.
GAS TEST
MECHANICAL - -
-
ELECTRICAL - FINALS DATE INSP. ACC.DATEACG FILE NO.� -
FRAMING . $g SAN # ZONING. ENG.SITE NO.
INSULATION PLUMBING '
GAS
FIRE SPRINK ENERGY T@0
MECHANICAL - r ❑ N❑ r E] N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING PLDDD ZONE A.L.U.c.
LATH-INTERIOR IELECTRICAL
LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Yo N❑
SHEETROCK GRADE FEE SUMMARY
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
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC ' e
U, 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 ALJ.-,POINT PEN ONLY
BUI LD1 NG PROJECT I DENTI FICATI ON PERMIT NUMBER
B1yILDI"° 061( i LVC-1 APPLICATION & PERMIT
/wo°RESSP
9 BUILDING-ELECTRICAL=PLUMBING-MECHANICAL 117 2�1
OWNER'S7Z 5Z /7 /N PLAN CHEC VALIDATION
1 NAMEELECTRIC PERMIT v 73 S_ry�8�(6w OTY. FEE / ,� p
PHONF 33
LONTRgCT R'S
rvamE OOUTLETS-SWITCHES-flECEP 10.00/1.00 --�Q'-
b Ic.No 5 LIGHTING FIXTURES 10.00/1.00 U'
CDNTRACTOR's 4fiS APPLIANCES-RESIDENTIAL 4.00
�,- ADDRESS-Sd [/�I/� Qu 7-
pgg
O / Lft- W�� PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECTon PLAN(OVER 200 AMPY 20.00 PLAN CHECK FEE P.C.N0.
ENGINEER l L� - -
` uc.no. SIGNS TRANS. 3.00
ADDRESS E"G SPECIALCIRCUIT ' 6.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20,00
APPLICANTS MOTORS - SEE FEE SCH.
ADDRESS r
• SERVICE CHANGE 20.00
Woo LICENSED CONTRACTORS DECLARATION
FU w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
< (commencing with Section 7000)of Division 3 df the Business and BLDG. ELECT. PLG. ME
H O i Professions Code,and my license is in full lir�,e a��nd��of��ccL
z O y= License Class $1 Lic,Number.Z,�_x'1_I_b
4 m Dale f
a x f �OyA7A�y� BUILDING PERMIT
¢ ¢ a OWNER.BUILDER DECLARATION
¢i v INFORMATION
w ; a., 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO OR
r
S.
o J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
w Code:Anycity orcounty which requires a permit to construct,alter, 'O :!� �
'SE R Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.
Ix DLL requires the applicant for such permit to file v signed statement that TOTAL PERMIT TO
w $ he is licensed pursuant to the provisions of the Contractors License
Hzi
Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe -ddi7-�e�
Q Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢i-c the basis for llte'alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
!d ;m by any applicant for a permit subjects the applicant toacivil Penalty ALTER-DRAIN (EA.) 5.00
of not more than five hundred dollars(5500).) _ S ,
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
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 thereon,and who does such work FIXTURES-PER TRAP 5.00 d-_ 9D.FT.FLDOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- 3 ice,
mems arc not intended or offered for sal,It,however,the building GAS-GAS -11NC.40UTLETS 6,00
x , or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM.OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or in, BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ 1,as owner of the property,am
exclusively contracting with E] L] ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS FARCE L NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who build or improves thereon,and who LAWN SPR I N KLERS-OV ER 5(EA.) 1,00 a 17-07/
contracts lou such projects with a contractons)licensed pursuant to SEW ER-SAN V-STORM EA.200ft/10,00
the Contractors License Low. - TRACT NO. PARCEL NO.
❑ I um exempt under Sec.-,B.&P,C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
1 herehy affirrn that I have a certificate of consent to scl0.insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or o certified
copy thereof(Sec.3800,Lah.C.).
Policy Nn. Company -
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
zAp Applicant
copy is filed with the city inspection division. MISC- REFER TO ORD. y NV N
❑ [0:], ❑ ❑
�+ PERMIT ISSUANCE 10.00 O ^
CC CERTIFICATE OF EXEMPTION FROM WORKERS' FLOOD ZONEA.L.U.C.
W COMPI!NSATION INSURANCE PLG.CONTR. LIC.NO. PLG. fLir-"U` y❑ N❑ V ❑ N❑
CL O (This action need not be completed if the permit is for one TOTAL YC`O� '-
D 2 hundred dollars(S100)or less.)
U O I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mil is issued, I shall not employ any person in any mannerro as to
O beco st bje�ct sp ho Workers�('om pensalkm I ass f Celifi
U a Date-1.��Z b•sLApplicant Sk-4lih.C2+J' ALTER OR ADD TO MECH. 5.00 //I' BUILDING 7 00
} to NOT ICIi TO APPLICANT' If a ler making this Certifi ele of Ex-
F ? 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=r-F.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a 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,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Natne HEATING UNIT(OVER 100,000 B.T.U.19.50 e,
Lender's Address ELECTRIC
1 I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 tN
information is correct. 1 agree to comply with all city and county PLUMBING /14o
(� ordinances and state laws relating to building construction, and BOILER 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL �1-w
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
Ing of this permit - MECH.CONT. LIC.NO. MECH.
TOTAL /I� TOTAL 37436
v ✓
�- Si are of Applicant/ hector Date
OFFICE COPY