13842 POSTTHISCARD NEAR FRONTOF BUILDING
PFRMIT NUMBER
CITY' OF CUPERTINO 13842
INSPECTION DIVISION
'JOB INSPECTION RECORD
.. 1 PERMIT EXPIRATION
JOB ADDRESSS�✓L2J_/�� ,c— UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER fy��(-OQ Q� G „CONTRACTOR t'y� v"oLAA IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPE ION RECO D 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION LASTCALUD INSPECTION.
LIFER
PREGUNITEPERMIT VALIDATION
�
w
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB - 'a�• ��'
PLUMBING
POP
` •y:�� �.
ELECTRICAL ISSUANCE DATE
MECHANICAL ELECT. PLG. MECH.
Ngo ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED UILDING PERMIT
INFORMATION
WOOD FLOOR - VALUATION siRr.
PLUMBING
,,VALUATION
MECHANICAL pui
ELECTRICAL PEapu7r
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
5(I.FT.FIOOH AREA TOTALACREAGE
ROOF
.� DIAPHRAGM em LOINOUSE
RES IND CON PB 00F,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST - TRACT NO. PARCEL NO.
MECHANICAL
.
ELECTRICAL FINALS DATE INSP. ACC.DATE ACCFILE NO.
FRAMING SAN S
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
MECHANICAL FIRE SPRINK ENERGY T-24
o
1 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y "o Y ❑ NO
FLOOD20NE A.L.U.C.
LATH—INTERIOR ELECTRICAL v� N� v �] n❑
LATH—EXTERIOR FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY 1
SHEAR INTERIOR BUILDING —/f•' S ��
SHEAR EXTERIOR TEMPORARY APPROVAL BUILDING
FIREWALLS ELECTRIC PLAN CHECK .l
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM v
w, ARRANGE FOR INSPECTION BY PHONING-252-4505, ELECTRIC ,
0- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY .1
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
,.BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
II Sc APPLICATION & PERMIT
C.REA ^
ApOREss BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I G
OWNER'S PLAN CHECK VALIDATION
Nome .�/iS CITY. ELECTRIC PERMIT FEE
�1I 24;t3'va G.¢av� prvE S�?S 2!
j CONTRACTOR'S UTLETS-SWITCHES-RECEP 10.00/1.00 S'O
NAME " ��',,,,
� XC- L7gCy(/r/i✓L LIC.NO. LIGHTING FIXTURES 10.00/1.00 '
CONTRACTORS- PPLIANCES-RESIDENTIAL '4.00
A TQec.A9/
p�jp ^9� PANELS 1D.QQ DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMPI 20.00 PLAN CHECK p FEE .C.NO.
oR f-3
ry / /
_ C.F-iUN sec.NO. SIGNS TRANS. 3.00 / � i'
ARCH OR Enc. SPECIAL CIRCUIT S.QQ PERMIT VALIDATION
AME GUC�
5(� Zz66 EMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
Foo LICENSED CONTRACTORS DECLARATION v
¢ v I hereby affirm that 1 am licensed under provisions of Chapter 9 CE DATE
¢ z w (commencing with Section 7000)of Division 3 of the Business and VIL
i Professions Cod nd y license is in tial tor' ff c - PLG. MECH.
z o 2- Licenu Lic.Number ❑ ❑ ❑ ❑
0 m=w Dote Contractor
a y f BUILDING PERMIT
or ¢ w OW Ii R-BUILDER DECLARATION INFORMATION
w0
a 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
a__ a- Law for the following reason.(Sec.7031.5,Businumand Professions PERMIT ISSUANCE 0 VALUATION S/FT.
L Code:Any city or county which requireso permit toconstrucl,altcq
rt ¢ Q FO improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR, LIC.NO' ELEC,
DLL requires the applicant for such permit to File a signed statement that TOTAL PERMIT TO
y ' w he is licensed pursuant to the provisions of the Contractors License
Hzi
Law(Chapter 9(commencing with Section 7000)ol'Divisiou 3 ofthe
s i < Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
o
¢ H $ the basis for the alleged exemption.Any violation of Section]031.5 STORIES /TYPE CONSTR..
a; 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(E500)J:
❑ I,as owner of the property,or my employees with wages as tBACK FLOW PROTECT.DEVICE
then-sole compensation,will do the work,and•the structure is not OCC.GROUP RES.UNITS
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 docs such work FIXTURES-PER TRAP 5.00 Sa FT.FLOOR AREA TOTAL ACREAGE
A ants are not
hde own employees,provided ever,at the
improve-
A-9
mprove- GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
rims are not intended oroffered
on for sale.(completion[hc builder-
ouider improvement is sold within one year of completion,o t 0m 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 1,apurposes owner of Odle.). INDUSTRIAL WASTE INTER. , - 30.00 ' RES IND CON PB ocher
C ❑ d as owner of the property,he project
, 7044onng with - ❑ ❑ ❑ ❑ ❑
an it Professions
contractors to construct the project(Sec. does Rosiness LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
nod Professions Code:The Contractor's License Law does not apply
t to anfrowner ofproperty who builds r reproves thereon,and who LAWN SPR IN KLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractoAs)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL No.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner - Date WATER SYSTEM -6:00 a - ACC.DATE ACO.FILE NO.
}Gyofp��o;c/Crp,�fy`y,p7LG/pTION/p�I LARATION WATER TREATING EQUIP. 5.00
I byalTrrAfthat7ISvc3fer6ficsTe consent tou6insure. ZONING
ora certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
cup,them.((Sec.3800,LaNC.>�G/Fi E'
1 Policy No, Company
0 ❑ Certified ropy is hereby furnished. FIRE SPRINK ENERGY T-24
Z 2��.{ ❑ Ceffif y is fdcd with yt ty 'n ectl islon.
O , Applicant C &(-'aG y MISC.- REFER TO ORD, y ❑ N❑ Y ❑ N❑
~ w PERMIT ISSUANCE 10100 FLOOD ZONE A.LU.C.
� CERT(FICCOMPE COMPENSATION
ION PROM WORKERS'
IL COMPENSATION INSURANCE PLG.CONTR. LIC.ND. PLG. YE] N❑ Y ❑ N❑
1 O (Chis dollars need not be completed if the permit is for one r TOTAL (O
� Z hundred dollars IS 100)or IevJ
L) O I certify that In the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mil is issued,I shall not employ any person in any manner so as to
0,Of become subject to the Workers'Compensation Laws of California. BUILDING SJ
C_ Date-Applicant ALTER OR ADD TO MECH. 5.00 -�
} W NOTICE TO APPLICANT: If,after making this Certificate of F.x-
F-. ? emption,you should become subject to the Workers'Camper satum 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 revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNMOVER 10=C.F.M.) 6.00 SEISMIC FEE Oen
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the 3097,Civ.0 Ince of the work for which this permit is issued(Sec. MICROFILM
HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
- 1 certify that I have read this application and state that the aboveVENTILATION FAN (SINGLE) 4.00 0-p
'+ `nformallon is correct. 1 agree to comply with all city and countPLUMBING
ilinances 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
lho
above-mentioned Property for inspection Purposes
. BOILERCOMP (Over 1010,000 STU)SEE FEE SCH. MECHANICAL
L"'f
(We) agree to save, indemnify and keep harml¢ss the City of MISC. REFER TO ORD.
Cu no against [abilities,judgments, costs and expenses which PERMITISSUANCE 10.00 CONST.TAX -
( may in way acme u rust said Ci N corse minc of the
grand [. MECH.CONT. LIC.NO, MECH.
TOTAL TOTAL
. Si roof Applicant/Con[mclor Da
OFFICE COPY
1