11642 POST THIS CARD NE 'FR
ARONTOFBUILDING
- ' t PERMIT NUMBER "
CITY .OF CUPERTINO 11642
INSPECTION DIVISION'
JOB INSPECTION RECORD
t - .PERMIT E XP I RATION' .E
JOB'ADDRESS Io IID SID n gd11 �' - UNIT# LOT#
PERMIT EXPIRES,IF WORK
' OWNER 51 •'• ' "+ CONT FACTO R,e IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD_ •180 DAYS OF PERMIT ISSu-
" FOUNDATION" jJL d I,� (ANCE OR 180 DAYS,FROM'
• LAST CALLED INSPECTION.'
UFER -
PREGUNTE I w' ' �• - PERMIT.VALIDATION /
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED s- � -
'.UNDERGROUND.
/SLAB
PLUMBING. •.
ELECTRICAL - - - - - ^ . .. - �.
_ `ISSUNNC[DPTF:
MECHANICAL - B DI • FLECT.: PLG. MECR. '
/. sEl
DO NOT POUR FLOOR UNTILAB VE
HAS BEEN SIGNED
BUILDING PERMIT
.. - � 'INFORMATION
WOOD FLOOR IS
7AT'l, N $lFT.PLUMBING ;MECHANICAL -
RMIT TOELECTRICAL � - �
FRAMING .c- 4; '. I
INSULATION - 1 - STORIES .TYPE CONSTR.
I
'OCC GROUPRES..UNITS -
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - 1
- 1 50.F „FLOOR ARE/ TOTAL ACACAGE
ROOF •!Iry%j 1;., ' ;
DIAPHRAGM - - /t t -
' e USE
I
Rrs CON INo,• CON Pe OI ,,�
APPLYAO ROOFING UNTIL ABOVE HAS BEEN SIGNED ) El 11
nSSES50R5 PARCEL NO.
ROUGH;.
I `
PLUMBING,. + _ - +
GAS TEST TRACT NO, 1',PARCEL NO.
' MECHANICAL ^"
ACC.DATE ACC FILF.ND.�
ELECTRICAL i - FINALS DATE INSP: '
FRAMING -' SAN zoNlNc ENG.SITE No.
INSULATION - PLUMBING �_ EI
GAS _ ,
.`" FIRE SPRINK" ENERGY T Z
MECHANICAL 4
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING O N-❑ NN[]❑
3 _ FLOOD ZONE AL.U.O. '
' LATH—INTERIOR , •• ELECTRICAL
„Y.O NO. ,Y ,: NO 4
LATH—EXTERIOR FIRE DEPT
SHEETROCK GRADE' S FEE SUMMARY
SHEARiINTERIOR. - BUILDING'
SHEAR'*EXTERIOR TEMPORARY APPROVALS' 'BUILDING .-
FIREWALLS ELECTRIC + + ; ' PLAN CHECK ,.
i
GAS FEE' '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPAN CYrOFBUILDINGISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC
" F- ONE WORKING DA, Y BEFORE'REQUIRED INSPECTION aeuMewG;,
PLEASE GIVE'JOB ADDRESS WHEN.PHONING
Z I - MECHANICAL
'=SEE PERMIT FOR'EXPIRATION DATE.
CONST.TAX -
IMPORTANTI
PLEASE READIREVERSE$IDE BEFORE TOTAL, G
CALLING'FOR FINAL INSPECTION.
OFFICE COPY. , •..I• ', .r
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
•4
PERMIT NUMBER
BUILDING PROJECT IDENTI FICATION ._ APPLICATION SI PERMIT
BUILDING L 11642
aooREO� D QI ..y.�� ILDING - ELECTRICAL-PLUMBING-MECHANICAL -
OWNER'S ✓L �( v • . PLAN CHECK VALIDATION
CITY. ELECTRIC PERMIT FEE ] )) Z
a HONu�' J1 k-.i
NONnaAcroBsOUTLETS'-SWITCH
ES
NAME -RECEP 10.00/1.00
uc.No, LIGHTING FIXTURES 10.00/1.00 -
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 1
` ADDRESS,I.
? PHONE PANELS- 10.00 DATE OF APPLICATION
ARCHITECTPcNo.
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FBE . ,
Ofl
ENGINEER - -
�uc.No. SIGNS TRANS. 3.00
ARCH,OR ENG. SPECIAL CIRCUIT 5.00 PER MIT VALI DATION
ADDRESS -
ZIP ITEMP.METER OR POLE INS. 20.00 n
APPLICANT'SMOTORS SEE FEE SCH.
ADDRESS .. '•
SERVICE CHANGE 20.00 r, .
o o LICENSED CONTRACTORS DECLARATIONL - �� •�''(L
a u u I hereby am licensed that I alicensed'Imder provisions ol'Cliapter 9 ISSUANCE DATE
N G H (commencing with Scdion'7000)of Division 3 of the Business anti , BLO - ELECT. PLG. MECH,
H D z Professions Code,and my license is in full force and effect. - El "El El
o 03 - License Class Lia Number
.10 z Date Contractor
< x f BUILDING PERMIT
Ix w ef OWNER-BUILDER D17CLARATION ., INFORMATION
w ;°' m I hereby affirm that I am exempt from the Contractor's License MISC.- - REFER TO ORD
LL o ar Law for the following reason.(See.7031.5,Business and Professions VALUATION $/FT;
r - Code:Any city or county which requimsa permit reconstruct,alter, 'PERMIT ISSUANCE 10.00 y"'OQ0
SE a, I improve;demolish,or repair any structure,prior to its issuance,also SLED.CONTR., LIC.No. ELEC. /
s
D M requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
ell
La m he Is licensed pursuant to the with Sectio 7tile00 Contractor'svisLicense
rii Law(Chapter9(commencingwith Section 7000)a Business and Professions Code)or that he IS exempt therefrom and CITY. PLUMBING PERMIT FEE .
KI
H o the basis for the alleged exemption.Any violation ol'Seclion 7031.5 STORIES TYPE CONSTR.
au r? by any applicant.for a permit subjects the applicant toa civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred'dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GflouP RES.UNITS
their 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 ovenF,of -
property�whO builds Or improves Hiro on,and who docs such work - FIXTURES-PER TRAP 5.00 r > Sd F LO R AREA TOTAL ACREAGE
himself or through his own employees.Provided that such improve.
himself a through
intendeughhis or employees,ffered far pre.ovided
that such
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
bXprofessions
er will have the burden of proving that he did not build or im. BUILDING USE
pfor purpose of saleJ. ES IND CON PB Other
INDUSTRIAL WASTE INTER.. 30.00
-1,as owner of the property,:on exclusively contracting with _ ❑ ❑ - ❑ ❑
Iied contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 , , ASSESSORS PARCEL NO.
a Code:.The Contractors Lucow Law does not apply
1d an owner of properly who builds,or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft110.00
the Contractors License Law. TRACT NO. , PARCEL NO.
I oto exempt under Sea ,B.&I•.C,for this WATER HEATER W/VENT 6.00
reason
Owner Date j WATERS YSTEM 5.00 ACC.DATE ACC.FILE NO.
• WORKERS'COMPENSATION F.CLARA7'ION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure,
Or a certificate of Workers'Compensation Insurance,Or a certified ZONING ENG.SITE NO.
copy lhereof(Sec:3800,Lab.C.). - -
Policy No. • L Company
O ❑ Certified Copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z'Z ❑ Certified copy is filed with the city inspection division. MISC.- r REFER TO ORD.
Applicant ' - •FY E] NE] Y E] NE]y PERMIT ISSUANCE 10.00 FLOOOZONE A.L.U.C.
Lu > CIiRTIFICATF.OP EXEMPTION FROM WORKIiRS'
W _ CUMPIiNSATION'INSIJRANCIi PLG.CONTR. LIC.NO. PLG.
CL O I'I'111s section-need'net be completed if the Permit is fSr.one TOTAL Y❑ N❑ Y ❑ N❑
Z hundred dollars($10(nor less.)
.0 O 1 certify that in the performance of ten work for which this per. CITY. MECHANICAL PERMIT .FEE FEE SUMMARY
I F- mit is issued,I shall not employ any person in any manner so as to
U become subject 10 the Workers'Compensation Laws of California. -
J p BUILDING
D
0 i ale Applicant ALTER OR ADD TO MECH. 5.00 -
} W NO'fICII 'f0 APPLICANT: If,after.inaking this Certificate Of Ex-
H Z emption,you Should become subject Ib 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 revoked. AIR HANDLING UNIT(TO JOPMCF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE
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 fSee. MICROFILM'
3097,Cie,C.). t. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name"
Lenders AddrHEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
ess
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
nfirmunion is cornier. I agree to comply with all city and county PLUMBING >
ordinances and state laws relating to building.construction, and BOILER-OOMP,(3 H.P.of 100,000 B.T.U.) 6.00
�• hereby authorize rrepresentatives 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
may any, w accrue again said City in consequence of the PERMIT ISSUANCE 10,00
g Pf lei �j MECH.CONT. LIC.IO - MECH. / a.Q
TOTAL TOTAL .�
Signature of kala/Contractor IDat - I '
• - ,• - . OFFICE COPY