C 8328 (2) POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PERMIT NUMBER
INSPECTION DIVISION C 8328
JOB INSPECTION RECORD
PERMIT EXPIRATION I
JOB ADDRESS NI # LOT •
PERMIT EXPIRES IF WORK
OWNER JIM — geA40 CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATEINSPECTOR INSPECTION REC D 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
UFER
_f/-'v/0-3-2t
LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED R,C c C c T A t yr r 04 !t
UNDERGROUND /SLAB C[.cI 've— s -
PLUMBING i -r- Ben, CC / < / NG S-B-8Sk
ELECTRICAL YAN ATE
MECHANICAL F"/z In 4/.9 III. S N [ [T fz o CFc B DG. PLG. MECH.
� - za � g ❑ ❑
ING PERMIT
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED FORMATION
WOOD FLOOR S—�1'�� VALUATION $/FT,
PLUMBING
MECHANICAL PER
PEHMI O
ELECTRICAL -
FRAMING
STORIES TVP. S i.
INSULATION
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM BUILDING USE
RES IND CON PB ORF.'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ 1:1
ASSESSORS PARCEL NO,
ROUGH
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICA N•
ACC.DATE ACC.FILE N0.
ELECTRICAL FINALS DATE INSP.
FRAMING ,� SAN it ZONING ENc.SITE NO.
INSULATION PLUMBING
GAS
MECHANICAL
FIRE SPRINK ENERGY T.24
' v ❑ N❑ v ❑- N[] '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.u.c.
- ❑ N❑ ❑ N❑
LATH-EXTERIOR FIRE DEPT.
SHEETROC I GRADE - FEE SUMMARY
SHEAR INTE TOR BUILDING _ -2 -QS
BUILDING
SHEAR EXTERIOR T PPROVALS
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 FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F 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 BALL POINT PEN ONLY
QUILUING PROD CT IDENT (CATION PERMIT NUMBER
OIJILOING APPLICATION & PERMIT
°,4 Sy dmbu-E V W 8 3 2 8
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'5 PLAN CHECK VALIDATION
NAME
• V AL1-C-p 'AI.'. QTY. ELECTRIC PERMIT FEE I/6 ! 6-�
PHONE �� (f A^
CONTRACTOR'S Z
AME OUTLETS-SWITCHES-RECEP 10.00/1.00 4 -_
LIC.NO AS4��m LIGHTING FIXTURES 10.00/1.00
CONTRACTOR -� Ita> ggoV APPLIANCES-RESIDENTIAL 4.00
"414 ST PHOA),'� I(d_QII PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR ^ 1DR� F PANELS (OVER 200 AMP) 20.00
ENGINEA4 LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS �/�J SPECIAL CIRCUIT 5.00
`
t 0 Y I&u.'o Vf4-okopAmk z.P`p NoLf EMP.METER OR POLE INS. 20.00 WS APPLIDDACE rvr$ MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
wo O LICENSED CONTRACTORS DECLARATION TEMP.POLE 30,00
o I hereby affirm that I am licensed under pr.vi,mnsof Chapter 9 ISSUANCE DATE
1- Q (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r o z Professions Co biBd my license is in full fsttlr}II (L ❑ ❑
Z 0 - License lass v I Lia NumbCr�J J
Q w 2 w ale L_4'_C Contracm
¢ a a ¢ /OWNER-BUILDER DECLARATION ING PERMIT
rc w U FORMATION
w- 04. MISC.- REFER TO ORD
S a. w I hereby:((flan that 1 am exempt from the Contractor's License
LL 0¢ Law for the following reason(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 WA S/FT.
� - 0 Code:Anycity orcounly which requires a permit mCOnstnaLaltel. IRA
re a, < improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O ¢ requires the applicant for such permit to file a signed statement that TOTAL ,T TO
A w ma, he is licensed pursuant to the provisions of the Contractor's License yp
F z a
Law(Chapter 9(commencingwith Section 7000VI'Division 3 ofthe I Ar Vi FF M� s
E i 0 Business and Professions Code)or(hat he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ I-o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
La ;m by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.caauP RES.UNITS
(heir 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 build,Or Improve,thereon,and who docs and,work FIXTURES,PER TRAP 5,00 50,FT,FLOOR AREA TOTAL ACREAGE
• mems arc not intough ended
ownemployees,for side
I F,ed that however,
the
improve- GAS-EA.SYSTEM-I INC-4 OUTLETS 6.00
mems arc not intended w offered for sale.IL mpleveq the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or int- RES IND CON PB Other
1,as o
prove r of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ owner of the properly,am exclusively contracting with
licensed
as o
contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Law does not apply
to anowner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a contrtractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Iain 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 hereby Infirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'C. (,on Ins u nonce or a certified
copy thereof lSec.3S00,Lah.C.1.I Jr.yp� r
Policy N..--C....Pa
O ❑ Cen, ed co y 'hereby) FIRE SPRINK ENERGY T-24
Z� ❑ Ceni is filed will _ cit-'nspe'tion d' inn. MIS[.- REFER TO ORD.
O Applicant V❑ N❑ Y ❑ N❑
OC .ITRTIPICA' OIs IiXE P'I'ION OM WORKIi ' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UC.
LU - COM -.EX
INSU ANC(: PLG.CONTR. LIC.NO. PLG.
CL a (This see I oat be completed If the permit Is for one TOTAL Y❑ N❑ Y❑ N❑
Z hundred dollars(SIOD or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F not is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California. Q-p
W Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING /13
} W NOTICE 1'O APPLICANT: If,after making this Certificate of Ex- / ,
I. Z 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(evoked. AIR HANDLING UNIT(TO J0=C.F.M,) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE /O
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(See. 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
I certify that l have read this application a nd ,are that l he above VENTILATION FAN (SINGLE) 4,00
• information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 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, costs and expenses which CONST.TAX
da in a way c st said City in consequence of the PERMIT ISSUANCE 10.00
g, his per5 '` MECH.CONT. LIC.NO. MECH. /O
`{/Y� TOTAL TOTAL l9tS
Signature Ap ,cant/ tractor 41 Date
OFFICE COPY