10721 (2) POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PFRMIrN NUMBER
I � INSPECTION DIVISION
10721
JOB INSPECTION RECORD J �,
PERMIT EXPIRATION '
JOB ADDRESS �E�"� r I �I d�`+ v��NIT# LOT#
^ PERMIT EXPIRES IF WORK
OWNER loL CONTRACTOR (J IS NOT STARTED WITHIN
INSPECTION DATE INS ECTOR INSPECTION RECO 180 DAYS OF PERMIT ISSU.
FOUNDATION . j,�(�6 ANCE OR 180 DAYS FROM
UFER �--,;If_?-(- )C- � ' CALLED,INSPECTION.
PERMIT VALIDATION
PREGUNITE 'a^� y'}� PAfo
POUR NO CONCRETE UNTIL ABOVE HAS BEE SIGNED j_��_�6 �� Py3L FEB G
UNDERGROUND /SLAB �QQQ
PLUMBING F f
ELECTRICAL �„yh, A-= L. Is AcE06A ertinli
MECHANICAL BLDG. .LEcr. G. MECR.
❑ ❑
_CO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING _ VALUATION $/FT.
MECHANICAL 1
ELECTRICAL - ORM rro
FRAMING
INSULATION - s rus TYPE CON R.
C. NOUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF Q,FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
w BUILDING USE
NES ,BIND CON PB Other
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED �' 0 1:1 ❑ 0
ROUGH ASSESSORS PARCEL NO.
PLUMBING
GAS TEST TRACT No. PARCEL NO.
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN # '
INSULATION PLUMBING ZONING ENG.SITE NO,
GAS
FIR] [:]INK - ENERGYT 24
MECHANICAL NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NE wY
FLOOD ZONE NICU G.
LATH—INTERIOR � ELECTRICAL "-'V
LATH—EXTERIOR FIRE DEPT. Y[] NQS'-- Y.�],�FN�`;'.
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING O ec, ?--Fl BUILDING
SHEAR EXTERIOR 3 TEMPORARY APPROVALS V
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY .- SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUILD ING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM
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
CALLING FOR FINAL INSPECTION. TOTAL.
III
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI L-Dl NG PROJECT I DENTI FICATION PERMIT NUMBER
%.L.EN APPLICATION & PERMIT
A�ORESe BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 10721
10,31q
OWNER'5 , PLAN CHECK VALIDA ION
NAME, OTY. ELECTRIC PERMIT FEE
�ry\
3 i l r r r l �/I d PNONE
/ CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
r Cofn LIC.NO. LIGHTING FIXTURES 10.0011.00
DDRs
ADDRESS
11-13_ - Oq Sonny lxLe PPLIANCES-RESIDENTIAL 4.00
RE55 ('kC
J� -`.3 PHONE q4& PANELS 10.00 - DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER �_11�yy
�!s '4 I�7J . No. SIGNS TRANS. 3.00
ARCH,OR ENG. - PERMIT VALIDATION
MSPECIAL CIRCUIT 5.00
C�(Ahlal4QLIIStn rrEMP.METER OR POLE INS. 20.00
APPucarvrs MOTORS SEE FEE SCH.
AGO�R1Ess (� PMU
_!! QO,&I /S lbA'e � SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION FEB 6 1986
a i W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE TE
(commencing with Section 7000)of Division 3 of the Business and
n 1� BLDG. -ECT. PLG. M GH.
0 y i Professions Code, 1 my license is in full fore-' CIA) fs rse a
z O m- Licca c a Lic.N�mbcr I1A7
O z H Uate i/� 4 Contractor /�
sc x f - BUILDING PERMIT
M Be w OWNER-BUILDER DECLARATION INFORMATION
aa: 0 n I- 1 hereby affirm that 1 am exempt from the Comate lor's License MISC.- REFER TO ORD
3 u y VALUATION $/FT.
LL0 < Law for the following rcasoo.(Sec.7031.5,Birmnessand Professions PERMIT ISSUANCE 10.00
L w Code:Any city or county which requiresa permit to construct,alter,
We
2 Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.GDNTR, LIC.NO. ELEC. v
0 u requires the applicant for such permit to file a signed statement that TOTAL / PERMIT T
wm he is licensed pursuant to the provisions of the Contractor's License
rzr Law(Chapter 9(commencing with Section 70000af Division 3 oftbe
i o Business and Professions Code)or that he is exempt Olerufrom and QTY. PLUMBING PERMIT FEE
M r $ the basis for the alleged exemption.Any violation ol'Section 7031.5 TO IES TYPE CO TR.
n ; _ by any applicant Our a permit subjects the applicant toucivil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).1: -
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 --Dcr.FGHOUP F I R NITS
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 docs such work FIXTURES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenot intended or offered for Sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not huild or int- BUILDING USE
Pit
for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 - REs IND coN PB Other
❑ 1,as owner of the property,um 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 IEA.) 1,00
contracts for such projects with a contractolts)licensed pursuant to SEWER-SANITARY-STORM EA.200f1/10.00
Ilse Contractors License Law. TRACT NO. PARCEL NO.
❑ tum exempt under See.-,IL&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORKERS'COMPENSAI'[ON DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm tilt I have a certificate o(comucut to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insuru lle,or u certified _
copy thereof(Sec.3800,1 b.CJ.'1 ''
Policy No. Compuny��
OLl�cant Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z pQ Cerlifi d c y is fled with the oily inspection division.
AppliMISC.- V N Y REFER TO ORD. ❑ ❑ ❑ N❑
K CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOO ZONE A.L.U.C.
IU ? COMPENSATION INSURANCE PLO.CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the permit is for one TOTAL V❑ N❑ V❑ N❑
Z hundred dollars(S100)or less.)
U O 1 certify that in the performance of the work For Which this per- OTY. MECHANICAL PERMIT - FEE FEE SUMMARY,
LLH nt it is issued,1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
ow
Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING �
} m NOTICE:TO APPLICANT: If,after making this Certificate 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
V such provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT(TO 10=11F.M,) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 600 SEISMIC FEE /
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
tile jerrforCance of amissu
le work for which this pe is ed MICROFILM
(Sea HEATING UNIT(TO 100,000 B.T.U.) 8.00
309
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC 'S
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
n(ormitwo is Correct.I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-GOMP(3 H.P.or 100,000 B.T.U.) 6.00
f hereby authoriae representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE$CH. MECHANICAL
(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 in any way accrue against said City in consequence of the PERMIT ISSUANCE 10,00
R
fthis ermil 1 - MECH.CONT. LIC.NO. MECH.
N(o TOTAL TOTAL
Signature ofA pb of/Con tactor Date
OFFICE COPY