13179 (2) POST THIS CARD NEAR FRONT,OF BUILDING
CITY ' OF CUPERTINO PFRMIT
{ INSPECTION DIVISION
13179
JOB INSPECTION RECORD
�k..
PERMIT EXPIRATION-
JOB ADDRESS 809 StendHal Lane UNIT# LOT#
_ PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION _gyp - ANCE OR 180 DAYS FROM
LIFER
LASTCALLEDINSPECTI ON.
- - � '
PREGUNITE - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED,
UNDERGROUND /SLAB p J1�
PLUMBING /
ELECTRICAL I �� •' ISSUANC. DATE
MECHANICAL
BLDG.� ,E \ PLG. MECH.
❑ ❑ ' .
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED —W—BUILDING PERMIT
- INFORMATION
WOOD'FLOOR' VALUATION $/FT.
PLUMBING
MECHANICAL
R
X
ELECTRICAL - PEIT TO
�N1� (iM�� lr '
FRAMING /V
STORIES 'TYPE CONSTR.
INSULATION
- OCCGROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - -
ROOF SO.FL FLOOfi AREA TOTALACREAGE
,
DIAPHRAGM BUILDING USE
' RES INO CON PB 00", .
APPLY NO ROOFING UNTIL ABOVE HAS-BEEN SIGNED 11 1:1 ❑ El ❑
ROUGH'
A55E SSORS PARCEL NO.
.. � � ,. -
PLUMBING -
GAS TEST. -
TRACT NO. PARCEL NO.
MECHANICAL
r ACC.DATE ACC,FILE NO.
ELECTRICAL . - -S'7 FINALS DATE INSP.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
' MECHANICAL HEATING FIRE SPRINK ENERGY T 24—_Nt`]
v � N�- r �
"COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED EL000 ZONE A L.u.c. \`
LATH-INTERIOR ELECTRICAL %z- -
LATH-EXTERIOR - FIRE DEPT.
Np Y ❑ N❑
SHEETROCK GRADE FEESUMMARY
SHEAR INTERIOR BUILDING PtO..lrt R.. O 'B'C BUILDING 7G,G 5
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIG NED BY,BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC '
oONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
RD,LUG APPLICATION Br PERMIT
} ADDRESSID. 5rQrn L lAt BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 13179
r OWNER'SPLAN CHECK VALIOATN
xAME (L/ ��y/ / 4 OCITV. ELECTRIC PERMIT FEE
,p6.E/ c�c•irp/w�PRDNE /.�YJ / 70
CONTRACTORS - OUTLETS-SWITCHES-RECEP 10.00/1.00
DY LED LIGHTING FIXTURES 10.00/1.00
CONTRACTOR's /fY a PPLIANCES-RESIDENTIAL 4.00
AGOR 6 �V/\ �V/"�
/ (Y) PRONEQ PANELS 10.00
GATE OF APPLICATION
ARCRITECT 1J PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE V.C.NO.
on J
ENGINEER
uc.NO, ISIGNS TRANS. 3.00
ADDRESS ExcSPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS. 20.00 PAI
APPLI MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE a 20.00 J� 1 p�u ��1
C o LICENSED CONTRACTORS DECLARATION r y b (x fpr+❑r1
a u U 1 hereby affirm that I am licensed under provisions of Chapter 9 q T•s r City IIfSl1�INCH GIATE
2< w (commencing with Section 7000)of Division 3 of the Business and
- Ut• /� ,� •� LOU. ELECT. PLG. MECH.
0 w i Professions Cod nit y license is in full force 1 t.a � ❑ ❑
z O w' License Cl ss Con Number lj.�-Gip-...L
I_ Date Contractor City Cupertino
a x E< C(tY of BUILDING PERMIT
S o a o OWNER-BUILDER DECLARATION INFORMATION
La ; LL I- 1 hereby affirm that I am exempt frum the Contractor's License MISC.- REFER TO OR
u o a Law far the following reason.(Sec 7031.5,Business and Professions
VALUATION $/FT.
H _ PERMIT ISSUANCE 10.00 _
m�
Code:Any demolish,
county pairany structure,
prior ttoconsuance,alter,
7
ac eQ p improve,demolish,Dr repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. '1 W
ea , G u requires the applicant for such permit to file a signed statement that TOTAL 0�! PERMIT TO
E:
ur he is licensed pursuant to the provisions of the Contractor's License
Fis
Law(Chapter 9(commencingwith Section 7000)ofDivision 3 ofthe 14177 A,:-�/KQOg[_a
< Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
w =$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a3 � by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EP.) 5.00
of not more than five hundred Aollars(SS001):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEV ICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,unit 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 SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended oroffered for sale.Il'.however,the build ing GAS-EA.SYSTEM-l1NC.40UTLETS 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 he did not build or int- BUILDING USE
RES IND CON PB Other
prove 1,aso nee of sale.).p INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ I,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 forsueh projectswith a contractorts)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dune WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DFCLARA'I'ION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a curlificate of consent to self-Inxure,
or a cerlificune of Workers'Compensation Insurance or a cert ilicd ZONING ENG.SITE NO.
Copy thereof(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is fled with the city inspection division.
O Applicant MISC.- REFER TO ORD. Y ❑ IN Y ❑ N❑
~ h PERMIT ISSUANCE - 10.00
UJ - CERTI PICCI'F:OP EXEMPTION FROM WORKERS' PERMIT ZONE A.L.UG.
W COMPIiNSAT'ION INSURANCE PLG.CONTR. LIC.N0. PLG.
C O CORS section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
D Z hundred dollars($100)or less,)
0 O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issoeJ,.l sha Pe crop] W,,,,onW,. manner so as to
0 w beco/mK^EsafYg/lrlJ R •Worke s orniu.Ume I licant ALTER OR ADD TO MECH. 5.00BUILDING} ti NO' ICANII II ehis etlif ate of Ex-
emption,you should become subjecrkers' mpensation 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 l0=C.F.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE d "
Thereby affirm that there is a conitruction 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 HEATI NG UNIT(OV ER 100,000 B.T.U.)9.50
Lenders Address ELECTRIC
1 certify that I have read this application and state that The above VENTILATION FAN (SINGLE). 4.00
fnfri n ition is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP love,100,000BTUI SEEFEE 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, costs and expenses which. PERMIT ISSUANCE 10.00 CONST.TAX
ma 'n y way accrue.against Said City in consequence of the
of f this ermiL MECH.CONT. LIC.NO. MECH.
2 -�' TOTAL TOTAL q
gna re ofA plic ntraclo
Date
OFFICE COPY
(IMPORTANT MESSAGE
FOR 10P/I-i—A
A.M. {
DATE TIME.r P.M.
M-
OF-OFPHONE
ATEA NUMBER EXTENSION
TELEPHONED , 17.EASE CALL db�f.
CAME TO SEEYOU �� WILL CALL AGAIN;. '-.`,
V^ ;WANTS T06EEYOU 9w�'ff RUSH' °` y;," del .
RETURNED YOUR CALL SPECIAL ATTENTION
r MESSAGE -,Ld �
01,4 4AA
l`I 0��
SIGNED _.
LITHO IN U. A.
TOPS FORM 3002P