12900 POST THIS CARD NEAR FRONT OF BUILDING'
•PFRMIT NUMBER
CITY OF •CUPERTINO 12900
INSPECTION DIVISION
••, ., JOB INSPECTION CORD,. '
/.I. .. PERMIT EXPIRATION
JOB ADDR PERMIT EXPIRES IF WORK Y'
OWNER CONTRACTOR IS NOT STARTED WITHIN
.INSPE TION DATE INSPECTOR INSPECTIONRECORD 180DAYSOF PERMIT ISSU-
ANCEFOUNDATION /�^ c✓q 1 A �. OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER ..
PREGUNITE - PERMIT VALIDATION 11,
• - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - •1 `1
UNDERGROUND /SLAB
` PLUMBING 1Y/'
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG. ELECT, PLG. MECH.
❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ s LDING PERMIT
INFORMATION
WOOD FLOOR- - VALUATION $/FT.
PLUMBING -
MECHANICAL -
PEH
ELECTRICAL
FRAMING. V -
STORIESL TYPE CONBTH.•
INSULATION -
OCC.GROUP RES.UNITS.
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
4y ROOF SQFT,FLOORAREA TOTAL ACREAGE
JDIAPHRAGM BUILDING USE
HES IND CON PB. Olne
� • ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ ❑
ASSESSORS PARCEL NO,
ROUGH
PLUMBING `f - -
TNACI NO. PARCEL NO.
GAS TEST -
MECHANICAL Acc.DATE Acc.EILE NO.
ELECTRICAL FINALS DATE INSP. ,
FRAMING SAN # ' - ZONING ENG.SITE NO.
INSULATION PLUMBING ' •j'.),,
GAS-
IRE 7`1 K ENERGY h94
MECHANICAL 11
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y N❑ Y [:] NE]
LATH—INTERIOR ELECTRICAL '
LATH—EXTERIOR FIRE DEPT. v LONE A.L.U.C,
N❑ Y ❑. N❑
SHEETROCK ' GRADE FEE SUMMARY
SHEAR,INTERIOR BUILDING
SHEAR EXTERI OR TEMPORARY P O - BUILDING �j
FIREWALLS, ELECTRIC FEEN CHECK �•
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - I SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FI NALISSIGNEDBYBUILDINGINSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ala F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
- SEE PERMIT FOR EXPIRATIONDATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL %.
CALLING FOR FINAL INSPECTION.
OFFICECOPV
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEMONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
,E
ADDRESS �. ' 1 '''��,��
L L a 1 o ma- BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 12900
owNENR •J PLAN CHECK VALIDATION
') NAME 1S1 I,� �C� Z Q OTY. ELECTRIC PERMIT FEE
111•I �I� 1/
�yy PHONE
c N Ac o s
NAME OUTLETS=SWITCHES-RECEP 10.00/1.00 /
�nj
. I C uc.No. LIGHTING FIXTURES 10.00/1.00 O
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
ADDRES
PHONE PANELS 10.00/0- DATE OF APPLICATION
ARc ITECrPANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
on
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.oR ENG. SPECIAL CIRCUIT S.QQ PERMIT VALIDATION
ADDRESS ✓
ZIP EMP.METER OR POL S. 1
00 f� ,d,ry•
APPLICANT-$ MOTORS rifts, SEE FEE SCH. P
ADDRESS (�J Q �/J
PCL d')1^GL U SERVICE CHANGE 20.00 q 1y „„ /� l /
o o LICENSED CONTRACTORS DF.CLA•ATION (J ( 1
a v v I hereby affirm that I am licensed under provisions of Chapter 9 N E DATE
yaw (commencing with Section 7000)of Division 3 of the Business and t,la
QePLG. MECH.
H m z Professions Code,and my license is in full force and effect. Y ❑ LJz D w - License Class Lie Number
Z, z r o Date Contractor -
a y f BUIL NG PERMIT
¢ w u OWNER-BUILDER DECLARATION INFORMATION
E
e w I herebyaffirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
P VALUATION $/FT.
' r- 0< Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 _ O�
Code:Any city or county which requires a permit to construct,alter, [;
BE Be Q O Improve,demolish,or repair any structure,prior to Its Issuance,also ELEC.CONTR. LIC.NO. �J
ELEC.
o, requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO ,^
n w m he is licensed pursuant to the provisions of the Contractor's License /" .f(/�/.,"7.
Hzi L..(Chapter 9(cmmencingwlth Section 7000)ofDivision 3 ofthe / /�/762-'/ae O,4
4 Business and Professions Code)or that he is exempt therefrom andDTV. PLUMBING PERMIT FEE
BE r o the basis for the alleged exemption.Any violation of Section 7031.5
STORIES TYPE CONSTR.
u ; !' by any applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of n more than five hundred dollars($Soot):
L as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 oce.GROUP RES.UNITSt it sole compensation,will do the work,and the structure is not
mended 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 EO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
metals are not 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(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
' � prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RE5 IND CON PB Diner
❑ I,as owner of the property,am 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(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. .
❑ Ianlexemptlmder .Sec. __,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
RKERS'COMPENSATION DECLARATION WATER TREATING EQUIP: 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.). -
Policy No. Company
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T 24
Z_ Z'O' ❑ Certified copy is fled with the city inspection division. MISC.- REFER TO ORD.
Applicant V E] N❑ v C] NE]
Fy PERMIT ISSUANCE 10.00 FLOOOZONE A.L.u.c.
CC CERTIFICATEOF EXEMPTION I7ROM WORKERS'
DJ _ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. YE] N❑ YE] NE]CL O this section need not be Completed if the permit is for one TOTAL
0 Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE, FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
w Date Applicant BUILDING
a - ALTER OR ADD TO MECH. 5.00
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-.
H Z_ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK Sa
provisions of the Labor Code, you must forthwith comply with FEE L-
CJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,ODOC.F.M,) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE 5�
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
tire 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 HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC �� 0-0
Lender's Address
I certify that 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 manly BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and stale lawo
s relating to building constructin, and
.� hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU1 SEE FEESCH. MECHANICAL
�- above-mentioned property for inspection purposes
' (We) agree to save, indemnify and keep haniess the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX
in st said City in consequence of the PERMIT ISSUANCE 10.00
olio h'v:pe il. ///>(\ MECH.CONT. LIC.NO. MECH.
/✓/K - � L g TOTAL TOTAL 0 die
i nature of App ican/Contractor Date
OFFICE COPY
Peal' I HIS LAr1U IVEAK PHOIV I OF bUILDING
PFLAMIT NUMBER
CITY OF CUPERTINO X900
INSPECTION DIVISION
• JOB INSPECTION RECORD
/ ` PERMIT EXPIRATION
JOB ADDRESS /� O 7 S� L.r'! J,/1 Ly,-y,9- UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER CONTHACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD ,180 DAYS OF PERMIT ISSU
FOUNDATION LCL )may // A4 o V� I IV,)1, /G(�.•'?t ANCE OR 180 DAYS FROM
D� "/ LAST CALLED INSPECTION.
LIFER i
PREGUNITE PERmEi VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB ^`^
PLUMBING
ELECTRICAL ` ISSU TE
MECHANICAL Bwc,. 1{Ee a vLc. meo.
,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED PERMIT
ORMATION
WOOD FLOOR YA LUALUN sIF T.
PLUMBING
MECHANICAL
ELECTRICAL vulmrt TO
FRAMING
INSULATION STOOLS TYPE CONSli,
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
O.FT FLOOR AHLA TOTAL CtlE GE
ROOF
DIAPHRAGM
BUILDING USE
RES IND CON PB 1.,l.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST TRACT NO, PARCLL NO
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY T 2
MECHANICAL Y ❑ N❑ Y ❑ No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD zome A.L.U.c.
LATH-INTERIOR ELECTRICAL 16-
LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ No
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR T PORARY APPROVALSBUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOEEUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, pp'4Y'' ELECTRIC
1W� ONE WORKING DAY BEFORE REQUIRED INSPECTION. p , ; PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOIL FINAL INSTOTALPECTION. �I
._. ......... ... .._'.i;.,-::Wit ,