6714 (2) I
POST THIS CARD NEAR FRONT OF BUILDING
PF HN1I T NUN113 FH
CITY OF CUPERTINO• 6714 INSPECTION DIVISION
JOB INSPECTION RECORD
• PERMIT EXPIRATION
JOB ADDRESS �}r-' <� - �f�� '%"r "L'- L"-V/ UN,I# LOT#
PERMIT EXPIRES IF WORK
OWNER r ri�.1.:! — CONTRACTOR - I „<l- , 9acc. `/-d,r1 n- IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR - CORREC- ION N ICES 180.DAYS OF PERMIT ISSU-
FOUNDATION NOTE: A REINSP. FEE WIL BE ASSESS. UNDER ANCE OR 180 DAYS FROM
PROVISIONS OF SEC.305(9) LASTCALLED INSPECTION.
PREGUNITE
DATE INITIAL INSPECTION PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
CONCRETE SLAB FLOOR
GAS PIPING (Groundwork) ^ �Q'•.� '• "-
PLUMBING (Groundwork)
ELECTRICAL(Groundwork) ", ' '` Is NCE DATE
t�` "•\ BLDG PLG. MECH,
FILL& REINFORCEMENT 1"1•' I^
v'r
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �•,C El 1-1
WOOD FLOOR BUILDING PERMIT ..
GAS PIPING (Groundwork) INFORMATION
vA LUATION SIFT.{
PLUMBING (Groundwork)
HEATING (Under Floor)
ELECTRICAL(Groundwork) PERMIT TO
INSULATION �,�'�-�T-0'G
UNDERPINNING(Bldg.Inspector) STORIES TYPE CONSTR.
. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED occ.GROUP RES.UNITS
ROOF
Sf1 FL FLOON RHEA TOTALACREAGE
- ELECTRICAL -.
(.' DIAPHRAGM NAILING - - '
I' B W LO USE
� HES IND CON
PB 00-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH GAS PIPING ASSESSORS PARCEL NO.
ROUGH PLUMBING
ROUGH HEATING TRACT NO. PARCEL No.
ROUGH ELECTRICAL
INSULATION .ACC.GATE ACC,FILE No,
FRAMING INSPECTOR'S NOTES
ZONING ENG,SITE NO,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
LATH FIRE SPRINK ENERGY T 24
SHEETROCK NAILING Y ❑ N❑ Y ❑ N❑
EXTERIOR LATH FLOOD zorvE A.L.0 c.
YO N❑ Y ❑ No
FIRE DEPT.ACCEPTANCE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED „<qr};pEE SUMMA. 'C '
FINALS DATE INSP.
APPROVALS PLUMBING TEMPORARY APPROIy-
I BUILDING e._.?;•_
HEATING GAS ❑ DATE INSP. pL'AfJ CHECK
ELECTRICAL ELECTRIC ❑ DATE INSP. FEE'
BUILDING
I FINAL OCCUPANCY❑ DATE INSP. SEI SMIC FEE
OCCUPANCYOF BUILDING I9NOTP`EFfMITTEbUNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
t PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL ,
- SEE PERMIT FOR EXPIRATION DATE -
! IMPORTANT! CONST.TAX '
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
APPL ICANTS POSTING COPY '
APPLICANT TO FI'L'L IN INFORMATION WITHIN RED..LINES - USE BALL POINT PEN ONLY
BUI LDI NG PROJECT 1 DENTI FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESSgo?8 9 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 6 714
OwNER'S I - PLAN CHECK VALIDATION
DTV.€T
ELECTRIC PERMIT •tiy,FEE,�'aNy
PHONE
CONTRACTOR ff,, UTLETS-SWITCHES-RECEP 5.00/100
uc.No. 6 06 LIGHTING FIXTURES . .5.00/1.00
CONTRACTORS 1 1PPLIANCES-RESIDENTIAL 4.00
gsc �
1dCH
/OJJ a17U PHONtJO 9-3= PANELS 5.00 DATE OF APPLICATION
ORD
ITEGT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDRESS cmc, - SPECIAL CIRCUIT '5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00 -
ADDRESSrs - - MOTORS SEE FEE SCH. n
SERVICE CHANGE 10.00
. Hoo LICENSED CONTRACTORS DECLARATION '
a u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w a N (commencing with.Section]000)of Division 3 of the Business and Bl,p� ELECT, PLG. MECH.
H.2 Professions Cml anshlyy license is in full fore glkeJ:/_ /��) ❑ ❑ ❑
2
' 0.; Lieensy,C{ey)�-yT_�-Lie.Numbs 6
4 N' w ' Date l/
Ha m � ppUILDING PERMIT
¢ ¢ OWNER-BUILUCR,DECLARATION nn "fT -L-A
K o'c-u MISC.- REFER TO ORD (aC `FINFO'RMIIJ 7N
w g LL N 1 hereby affirm that I am exempt from the Contractor's License
:. O¢ Law for the following reason. Sec.]031.5,Business and Professions `7 1niT E/FT.
H - g ( ' PERMIT ISSUANCE 6.00_ jKK//fVVxII'11TT D
Code:Anycity orcounty which requiresu permit to Construct,alter, 1 Q�
¢¢ improve,demolish,or repair any structure;prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. 0
O¢ relpuoce the applicant for such permit to file a signed statement that TOTAL
a w m w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
H z> Law(Chapter 9(commencing with Section 7000)of Division 3 of the •py ., •^
4 o Business and Professions Code)or that he is exempt therefrom and DTT �v+�. � '4.'�-. PLUMBING PERMIT FEE%,-
¢s-m the Luis'for the alleged exemption.Any violation of Section 7031.5 ' v ' °'� " STORIES VPE CONSTR.
d ; - by unyapplicaut fora peamitsubjects theapplicant toa civil penalty ALTER-DRAIN&VENT-WATER IEA.14.00
of not more than five hundred dollars(S5001.):
Cl I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00
their-sole compensation,will Jo the work,and the structure is not OCG.CROUP RES.UNITS
intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Cole:The Contractor's License Law docs not apply loan owner of
Ipruperty who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- _
.cuts are not intended or offered formic.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS 4.00
or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or im GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE
prove for purpose of sale.). PESe IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑
licensed contractors to Construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARC E L NO.
and Professions Code:'I'he Contractor's License,Law hoes not apply
to I..owner of ptoperty who builds or improves thereon.and who, LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a eon raitor(s)licensed pursuant to
the Contractor's License Law. SEWEWSANITARY-STORM EA.200ft/B4O0 TRACT NO. PARCELNO.
❑ lam exempt under Sec. ,R&P.C.for this WATER HEATER W/VENT 4.00
reason
Owner Date WATER SYSTEM - 4.00 ACC.DATE ACO.FILE NO.
WORKERS'COMPENSAT ION DECLARATION WATER TREATING EQUIP. 4.00
I herchy aH'irm that I have a certificate of consent to sell'-insure. ZONING ENG.SITE NO.
ora certificate of Workers'Comperes tit n Insurance;or a cert iris.)
copy HIT Eq fLS��yy X�00,Lab.C.L
Policy No.Y�-'P.f4loCompany__1
CI Cetlilicd copy is hereby lurnisheQ. FIRE SPRINK ENERGY T 24
_Z Z �$Ceriifi coy fl d _'D a city speer ion division. MISC.- REFER TO ORD.
O pp scant - Y ❑ N❑ Y❑ N❑
~ va PERMIT ISSUANCE 6.00
CC CERTIPICATCO I?XIiMI'I'ION I'kOM WORKERS' FLOOD ZONE A.L.U.C.
Lu > COMPHNSAT'ION INSURANCE. PLG.CONTR. LIC.NO. PLG.
D• O 1 (This section need not he completed if the.permit is for one TOTAL Y❑ IN Y❑ N❑
V O hundred,dollars IS 100)or less.) - -
1 certifythat in the crforma ce of the work for which this er. S, " '' * ' & 's ten`s•d
p p DTY7a. 'a ." MECHANICAL'PERMIT s<wFEE-, 'FEE�SUMMA�`R,�V
LL U mit Is issued,I shall not employ any person in any manner so as to ..
OW become subject to the Workers'Compensation Laws of Calilbnua. ` v �1
ED Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING �" V`V
�}ED 'NO'I'ICh TO APPLICANT: If,after making this Certificate o1'Ex-
F ?- eruption,you should become subject to the Workers'Compensation APPLIANCE 4.00 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 10,000QF.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMICFEE
I hereby affirm that there is a Construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the wink for which therpennit is issued(Sea MICROFILM
3097,Civ.C.): HEATING UNIT(TO 100,000 B.T.U.)- 4.00
Lender's Name HEATI NG UN IT ER 100,000 B.T.U.)7.50
Lenders Address ELECTRIC
I certify that I have read this application and State that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating to huilding,eonstruction, and
herchy authorize representatives of this city to enter upon the BOILER-COMP IDVBr l00,o008TU15EE FEE ECH. MECHANICAL
above-mentioned property for inspection purposes.
(We-) agree to Save, indemnify and keep harracm the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments,costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue against said City in consequence of the
gmntingofthis permit. MECH.CONT. LIC.NO. MECH,
TOTAL TOTAL"' S�'OV
Signature ol'Applican[/Contractor Dute
.OFFICE COPY