13122 (2) POST THIS CARD NEAR FRONT OF BUILDING '
PF RNIIT NUMBER
'CITY OF CUPERTINO- - 13122
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 847 September Drive UNIT# LOT#
PERMIT EXPIRES IF WORK
1 OWNER Cheng CONTRACTOR Ba Shore IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTIONRECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION
ANCE OR 180 DAYS FROM
UFER LASTCALLEDINSPECTION. ,
PREGUNITE - - PERMIT VALIDATION
• r
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED —
UNDERGROUND /SLAB PAl Df
PLUMBING - w
ELECTRICAL UN ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLG. ME j
City Gf, Dein p• ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - ONFORMATION
VALUATION - $TET.
PLUMBING -
MECHANICAL
ELECTRICAL - PERMrt TO
FRAMING _5....
INSULATION STORIES TYPE CONSTR.
- OCC.GROUP, RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
�. ROOF 50,FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
' - NES IND CON PB Omn
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED _3 ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST THACT NO. PARCEL No
MECHANICAL
ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS', DATE INSP.
FRAMING SAN #
ZONING - ENG.SITE NO.
INSULATION � PLUMBING '
GAS '
MECHANICAL FIRE SPRINT( ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N[:] Y ❑ N❑
LATH-INTERIOR ELECTRICALFLOOD ZONE A.L,U.C.
O
LATH—EXTERIOR .. FIRE DEPT. Y❑ NEI ° ❑ NEI
SHEETROCK - GRADE FEESUMMARY
SHEAR INTERIOR - BUILDING,, BUILDING
SHEAR EXTERIOR TEMPORARY'APPROVALS
FIREWALLS ELECTRIC PLAN CHECK '
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT 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
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE
CONST.TAX
IMPORTANT!
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
NU
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT 13122
u..OINc �� NUMBER
AOREss '� AlC'-I BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
OwNER'S - PLAN CHECK VALIDATION
"AME /7 ./�, I OTY. ELECTRIC PERMIT FEE
N PHONE
caNTRAc,r1ORs p OUTLETS-SWITCHES-RECEP 10.00/1.00
NAM /" ✓`• �•� LIC.NO. LIGHTING FIXTURES 10.00/1.00
rorv/TRKJacrons ['D APPLIANCES-RESIDENTIAL 4.00
700 aooREss �.//�/� 77TH W *7 PNONE O / PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER 52! L LIC.NO. SIGNS TRANS. 3.00
ADDRESS ENO SPECIALCIRCUIT 5.0Q PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT'S
ADDRESS MOTORS SEE FEE SCH.
lL0 Ur'""
SERVICE CHANGE 00 / (/
w
02 LICENSED CONTRACTORS DECLARATION �/
v I hereby affirm that 1 am licensed under provisions of Chapter 9 �' ISSUAN/E DATE
Z, w (commencing with Section 7000)of Division 3 orthou Business and
Q y .;LOU. ELECT. PLG. MECH.
r o z Professions Code,u d y license ie in full force13y1�ffjyy>� '
O z=W License Olins Lic.Number -Ti El El LD
P: LDate-fL� Contractor- CI�Y of Caper,mo
m BUILDING PERMIT
C a u OWNER-BUILDER DECLARATION INFORMATION
K ; u I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
w g Business and Professions VALUATION $/FT.
F LL w a Law for the following reason.(Sec.7031.5, PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
Q ¢Q20 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
d LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w$w he is licensed pursuant to the provisions of the Contractor's License
F z a Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe EL�Z7
4 er Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE /
¢ H � the basis for the alleged exemption.Any violation ofSection 7031.5 STORIES TYPE CONSTR.
. a by any applicant fora permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500).1:
❑ 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 0se 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 5.00 SQ.FT.FLOOR AREA TOTAL ACREAGE
himselfor through his own employees,provided that such improve
-
mentsarenot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
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 Ise did not build or im- BUILDING USE
prove for purpose ofsaleJ. INDUSTRIAL WASTE INTER3000 RES IND CON PB Omer
❑ 1,as owner of the property,am exclusively contracting with . .
❑ ❑ 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 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 SEWER-SAN V-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ tum exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
ason
Owner Dune WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0.
WORK BRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insunmce,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company rRaMV's(I./
O Certified copy is hereby furnished. FIRE SPRINK ENERGYT-24
Z 2 Certi(ie co is filed i s the ity ins n division.
H O mount _ MISC.- REFER TO ORD. Y❑ N❑ v ❑ NE]
� N CERTIFICATE OF EXEMPTIONP R KERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C,
LU >_ COMPENSATION INSUR CE PLG.CONTE. LIC.NO, PLG.
D' O his section need not be completed if the permit is for one TOTAL Y[:) NC] Y �' NE
D 2 Imndocddollars(S100)Orlcss.)
U O 1 certify that in the performance of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mit is issued,I shut)not employ any person in any manner so as to
OWbecoriesubject tothe Workers'Compensulion Laws of California.
W Dam Applicant BUILDING
Q.>_ W NOTICE'f0 APPLICANT: If,after making this Certificate of nix- ALTER OR ADD TO MECH. 5.00
F Z maption,you should become subject In the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must I..thwilh Imnsply'with FEE
C.1 Such provisions or this permit slsall be downed revoked, AIR HANDLING UNIT(TO 10,000CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm tont 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 UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC W
I certify Ilial 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 PLUMBING
ordinances and slate laws relating to building construction, and BOILER-ODMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
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, casts and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
8.11h of this permit MECH.CONT. LIC.NO. MECH.
�. 71 TOTAL TOTAL
IS arc o pp ant/ onlracto119 Date
OFFICE COPY