11649 POST THIS CARD NEAR FRONT OF BUILDING
' - PER MIT NUMBER
CITY OF .CUPERTINO 1169
INSPECTION DIVISION
//�
JOB
INSPECTION RECORD
JOB ADDRESS!20 :!M ' 417kl A UNIT# LOT# - PERMIT EXPIRATION
IF ON
C,, /n1,^� 1' � PERMIT EXPIRES IF WORK
OWNER l �J, �"( I.VaO. CONTRACTOR rL oYA2S IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
LIFER - o
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -'
PLUMBING
UNDERGROUND /SLAB
gll. ol(J
ELECTRICAL ' ISSUANCE DATE
BLDG. ELECT. PLG. MECH.
MECHANICAL ❑ Ll
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR vA LunnoN SIFT.
PLUMBING
MECHANICAL '
ELECTRICALPERMIT To
sHow�n i.✓srrt�c-,:
FRAMING
STORIES TYPE CONSTR.
INSULATION- -
OCL".GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
FT.FIOOH AREP TOTAL-ACREAGE
ROOF
DIAPHRAGM
BUILDING USE
HES ' IND CON PD Otlon
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑
Cl
ASSESSON5 PARCEL NO.
ROUGH .
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL r,�,g`.. -
ACC.GATE ACC FILE N0.
ELECTRICAL FINALS DATE INSP.
FRAMING IL-2 V SAN # I
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY L7a
MECHANICAL YN� Y ❑ No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.L.U.C.
LATH-INTERIOR - ELECTRICAL
LATH-EXTERIOR - FIRE DEPT. Y❑ No Y I]� N[]
SHEETROCK i GRADE FEE SUMMARY
SHEAR INTERIOR 71W BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING ,
FIREWALLS ELECTRIC PLAN CHECK
I GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE -J
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT'FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST,TAX
PLEASE READ REVERSE SIDE BEFORE _ g : TOTAL S
CALLING FOR FINAL INSPECTION.
- OFFICE COPY '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
UILOING
�Q
wAPPLICATION & PERMIT
ADDRESS
;3O BUILDING-ELECTRICAL-PLUMBING-MECHANICAL. 11649
ONNER'a PLAN CHECK VALIDATION
NAME / OTY. ELECTRIC PERMIT FEE
don
CONTRACTOR'S D p ' (,
NAE � DJ L (, UTLETS-SWITCHES-RECEP 10.00/1.00
p LIGHTING FIXTURES 10.00/1.00
\ CONT AcroR's / PPLIANCES-RESIDENTIAL 4.00
xAOD Ess_ A_ ^IGiHP O�'�jL�1�/ >� II
S YA" I� • PHONZ r /-L{pl b PANELS 11).00 DATE OF APPLICATION
ARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINE LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADORE
ZW TEMP.METER OR POLE INS. 20.00
ADDRESS is MOTORS SEE FEE SCH. /1 _ rA_A-
ADDRE99 /' / 1..N1,v
S'Sl Ldp. L-1 SERVICE CHANGE 20.00 VOL , p
0 o LICENSED CONERACTORS D CIARATION `' �GOs�SJ 0
Q v w 1 hereby affirm that I am licensed under provisions of Chapter 9
�
u C DAT
w< (commencing with Section 7000)of Division 3 of the Business and LOQ E ECT. P G- MECH.
F m i Professions Code,a ny license is in full f0 ce d e P a � ❑
Z 0�, - License ClassLic.Numb /
ax Dalem-/Contractor
¢w OWNER-BUILDER DECLARA ION LDIRM PERMIT
re a MISC.- REFER TO ORD INFORMATION
woI hereby el
;u affirm that I em exempt from the Contractor's License
u_ovs Law forthe following reason.(Sec.7031.5,Bummisaand Professions PERMIT ISSUANCE 1000 VALUATION 5/FT.
L0 Code:Any city or county which requires a Permit to Continuer,elle,
Qw Q p improve,demolish.Or repair any structure,prior to its 6wanCe.also ELEC.CONTR. LIC.NO. ELEC.
- o¢ requires the applicant for ouch permit to file a sigrsed statement that TOTAL PERMIT TO
whe is licensed pursuant to the provisions of the Contractor's License
Law(Chapter9(commencingwith Section 7000)ofDivision 3 ofthe J'fie.nae /NJ7f1�.�.
< Business and Professions Code)or that hi is exempt therefrom and CITY. PLUMBING PERMIT FEE
Q r the basis for The alleged exemption.Anv violation of Section 7031.5
STORIES TYPE CONSTR.
a by any applicant permit subjects the applicant to a civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00 s-
of not more than five hundred dollars($500).):
❑ E as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure n not
intended or offeted for sale (Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors 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 ouch improve
ments are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 RVILDIrvG USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Omer
prove for pirPow of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner ol'the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Busim"ss 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-
contracts for such projects with a conlrectons)licensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STD MEA.200ft110.00 TRACT NO. PARCEL NO.
❑ I ars exempt under Sec.-,B,&P,C,for this WATER HEATER W/VENT, ,, {+ 6.00
reason
Owner Date WATER SYSTEM ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. `p 5.00
I hetuby affirm t or I have a certificate of ranee.m sa Certified ZONING ENG.SITE NO.
r or a certificate u(Worker'Compensation Inwmncc,or a certified
copy thereof lSeC. Lab.
Policy Company f.yA 1/ _ CW
S
Q ❑ Ci,nified
Copy whereby famished. FIRE SPO INK ENERGY T 24
Z
Fe Certi copy is fiIc rich, cit ins a ion division.
Z-) Applicant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
~ mPERMIT ISSUANCE 10.00 U - FLOOD ZONE A.L.u.c.
CC CFRTIF) ATI:OF EXEMPTION FROM WORKERS'
L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. oZd K Y N Y N
d (This section need not be completed if the Permit is for one TOTAL ❑ ❑ ❑ ❑
Z hundred T1.1ho(5100)or less.) .
U O 1 certify that in the performance of the work for which this Per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ personman
any in any ner so as to
become subject to the Workers'Compensation Laws of Califumia. �fp
u Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING .2 `-
} N NOl'ICE 1'0 APPLICANT: It,alter making this Certificate of Ex-
F. ? emotion,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
PT visions of the Labor Code, you must forthwith comply with FEE
m
U such provisions or this penult shall be deemed revoked. AIR HANDLING UNIT(TO 109COC.F.M) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.EM) 6.00 SEISMIC FEE t`rD
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(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 0�0 O'O
Lenders 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 roue ly PLUMBING
ordinances and slate laws relating to building construction, and BOILER-COfaP 13 H.P.or 100,000 B.T.U.)' 6.00
hereby anthoHze represcmatives of this city to enter upon the BOILER-COMP (Oxer 100,0008TU)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 again( liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue egei said Cityin con uence of the PERMIT ISSUANCE 10.00
gn this permit. _n ECH.CONT. LIC.NO. MECH.
(t/// OTAL TOTAL SLS?
�( Si tune of ppbcant/Contactor Date
OFFICE COPY