11098 POST THI RD NEAR FRONT OF BUILDING FP�ERMIT
R
Ci OF CUPERTINO QQ
INSPECTION DIVISION V V
I ✓ JO INSPECTION RECORD
1 TION
JOB ADD ESS
LIE LOT#
PERMIT'EXPIRES IF WORK
. OWNER .6e TRACTOR IS NOT STARTED WITHIN
IN P CTI
DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMITISSU-
FOUNDAT ON - _ ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
LIFER
PREGUNITE . - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
BLOQ EL PLG. MECR.
MECHANICAL ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED e BU DING PERMIT
1 FORMATION
WOOD FLOOR _ vALunnoN s(FT.
PLUMBING ui •+
MECHANICAL �" '� -�•'l"'��
PO TO
ELECTRICAL r
FRAMING
STORI S TYPE CO
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- SQ LL FLOOR AREF TOTALACREAGE
ROOF
DIAPHRAGM
BUILDING USE
' RES IND CO PB Olner
0 0 El 11
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ASSESSORS ARCEL NO,
ROUGH
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL .
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILENO.
FRAMING SAN # ZONING ENG.SITE NO,
INSULATION PLUMBING
GAS
FIRE SPRINK r ENERGY T 20
MECHANICAL YE] N[:] Y (] N]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD
LATH—INTERIOR ELECTRICAL -
jzoNB aL.u.c.
Y
LATH—EXTERIOR FIRE DEPT. N] Y NC]
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING _ 7
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING tr
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
I
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
. o� 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 INF�MATION WITHIN RED LINES - USE ALL POINT PEN ONLY
fi`'�UILDINGPROJECTIDENTIFIC ON PERMIT NUMBER
BUILDING APPLICATION & P AIT
Aooplys !Z � �Q ^ zu IpIU 1 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 11098
't OWNER'S /- Y� G1 PLAN CHECK VALIDATION
OTY. ELECTRIC PERMIT FEE 39 c,L'COxTRKDpsU O
NAME // �� 15 _c UTLETS-SWITCHES-RECEP 10.00/1.00 y o 8
64 LC171-✓It1.�-✓ti'1-� LIC.w 46 LIGHTING FIXTURES 10.00/1.00 /✓
CONTRACTORS PPLIANCES-RESIDENTIAL
ADDRESS
( V 5T PANELS 10.00 DATE OF APPLICATION
ACHITECT PANELS (OVER 200 AMP) 20.09 PLAN CHECK fEE P.C.NO.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00 -
n DRESS E"G' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 lGv
PLICANS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION
a i W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and D ELECT. PLG. MECH.
Professions Cod my license is in full fu4"'4"11
a tq� 1
o z C License Class Con Number T ❑ ❑ ❑
Dal6 Contractor
Q L ^� J BUILDING PERMIT
fC a w ¢ OW LR-BUILDER DECLARATION INFORMATION
Ko A D MISC.- REFER TO ORD
LL N 1 hereby affirm that I am exempt from the Contractor's License VALUATION SIFT.
w IL o j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
r -0 Code:Any cityorcounly which requires a permit to construct,
alter,
ac a ¢ O improve,demolish,or repair any stnmlure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
- o Be requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License
rii Law.(Chapter 9(commencing with Section 7000)of Division 3 ofthe
¢o Business and Professions Code)or that he is exempt therefrom and QTY, PLUMBING PERMIT FEE
si
aro the basis for the alleged exemption.Any violation of Section 7031.5 ST S TYPE CON R.
by any applicant for a permit subjects the applicant to a civil 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
their sole compensation,will do the work,and the structure is not OCG GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and professions DRAINS-FLOOR,ROOF,AR EA,COND. Elm
Code:The Contractor's License Law docs 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 imlrrove-
mentsmean,intended oroffered for,sBle.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4(EA.) 2.00 6011-DING USE
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.). RES IND PB Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 4-t o ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 LJ ASSESB S PARCEL NO.
and Professions Code:The Contractor's License Law dues not apply
to an owner of property who builds or improves 0mreon,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.
❑ lam exempt under Sec.-.B&PC.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACGDATE ACC,FILE NO.
WORK ERS'COMPI:NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent 1.self-insure.. ZONING ENG.SITE NO.
or a certificate of Workers Compensation Insura e,or a certified
copy thereof(See.3800,Lab.C,l.ti .CUA
Pol�icyy No. Company O
0 IS Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is Filed with the city inspection divi ion. MISC.- REFER TO ORD. Y N Y N
I"'
p Applicant ❑ ❑ ❑ ❑
y
D: CERTIFICATE EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
UJ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y[3 N❑ Y C] N❑
CL O (This section need not be completed if the permit is for one TOTAL
U 0 hundred
cert dollars(51 the pe less.)
U O 1 certify that h the performance of the wink for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
kk0H mit is issued,1 shall not employ any person in any manner so o
U become subject to the Workers Com ensation Laws of California..a ^
O w Dam I A licant p BUILDING
a pp ALTER OR ADD TO MECH. 5.00 UU
} m NOTICE you
APPLICANT: If,after muting this Certificate of Ex
f- ? emptio n you should become subject to must
forthwith
Ccomply with APPLIANCE 5.00 PLAN CHECK
provisions io the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 GF.M.1 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.EM.) 6.00 SEISMIC FEE 70
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
Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
. I certify that l 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 county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMM H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 100,000BTU)SEE FEE SCH, MECHANICAL
above-mentioned property for inspection furrows.
(we) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,jud mems, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue ag d City in consequence of t
o thio arm' L 'MECH.CONT. LIC.N0. MECH.
Y TOTAL TOTAL ,O
Signa um of Applican o trac n Ua1e 0 �,
.Lr
OFFICE COPY -,
APPLICANT TO FILL IN INFQ&MATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFIC N PERMIT NUMBER
BUILDING yu• APPLICATION & P 11T 11132
ADDRESS
OSo�S E /� 1 �Y /AW BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OwNER'S �-n 11 PLAN CHECK VALIDATION
♦u NAMME�( OTY. ELECTRIC PERMIT FEE
\/ coNrRAcroR's UTLETS-SWITCHES-RECEP 10.00/1.00 J
Is N MEQQ �//�� j`
• fOldGa+O,.l CLIC.NOM/ T'V Q ILIGHTING FIXTURES 10.00/1.00
f,ONTRACTORS
PPPLILASNCES-RESIDENTIAL 4.00
qp9 414-/ y • HO ]C1} 7VAANE
10.00 DATE OF APPLICATION
RCHrtECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.G.NO.
O
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH,OR ENG. SPECIAL CIRCUIT 5.00 5-00 PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS PDDRESS FEE SCH.
APPLICA
Sf7MMi L r-TI 1ry4,,, SERVICE CHANGE pf1 _2p.00 ./�
w o o LICENSED CONTRACTORS DECLARATION M S
a u I herehy affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
vHi Q w (commencing with Section 7000)of Division 3 of the Business and .� O BLDG. ELECT. PLG. MECH.
y Z, 'rofessions Code and my license is in full foL4,L a ❑ ❑ ❑
o m- 'cense Class �.rQ_Lic.Numberi{� ` f•
H E w Dote r'1 1'{1f. Contractor pl
a ae s BUILDING PERMIT
¢ ¢w OWNER-BUILDER DECLARATION INFORMATION
X
;LL w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
'^ VALUATION $/FT.
uoa Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 V '
yi-
v, Code:Any city or county which requires permit to construct,alter,
¢Q. Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELED, pp��
a O u requires the applicant for such permit to fle a signed statement that TOTAL C- PERMIT TO
La he is licensed pursuant to the provisions of the Contractor's License yy
r z i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the �L�Lq.
a: Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢f m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a-; � by any applicant forupermitsubjects the applicant Ina penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(8500).):
❑ I,as owner of the Property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 Dec.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is art
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
himmilro
'or through his own employees,pvided that such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00
meats are not intended or offered for sale.If,however,the budding
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- RES IND CON PB Ons,
prove for purpose of sale.). INDUST8IAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ 1:1 1:1 El
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 I LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the contractors License Law. TRACT NO. PARCEL NO.
O 1 am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACL.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent to self-insure, ZONING
or a certificate of Workers Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3900,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby famished. FIRE SPRINK -ENERGY T-24
Z
Z ❑ Certified copy 6 filed with the city inspection division. MISC.- REFER TO ORD.
Q Applicant Y ❑ N❑ Y ❑ N❑
CC CERTIFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL
O (This section need not be completed if the permit is for one TOTAL Y F] N❑ Y C] N❑
Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
ll. U mil is issued,I shall not employ any pperson in any manner so as to
becomp�ul. tr the Workers' un aio ws of California. BUILDING
i Date
\-lApplicant �r44 ALTER OR ADD TO MECH. 5.00
} to NOTICE T APPLICANT: If,after making this Certificate of Ex-
Z emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
'G7 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10000CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.FM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency I'or EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,CN.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 100
Lender's Address
• 1 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 county BOILER-170MP13 H.P,or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH.11 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
�,..�,n-g,e
anyway accme against sail Cily in consequence of the
ft pert MECH.CONT. LIC.NO. MECH,
TOTAL TOTAL
uof pplicanl/C mtracto#1Date /
OFFICE COPY /