11390 ` POST THIS CARD NEAR FRONT OF BUILDING
PF R1 NUMBER
CITY OF CUPERTINO 11390
INSPECTION DIVISION
JOB INSPECTION RECORD
jhodo N 00A Rd PERMIT EXPIRATION
IF ON
JOB ADDRESS / UNIT#1 LOT# PERMIT EXPIRES IF WORK
OWNER I � Q Qr✓• CONTRACTOR / f SfYVI(�'Q-_ IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
LIFER
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND'7t&n 5-
PLUMBING
ELECTRICAL E /�p .Vr ISSUANCE DATE
BLDG. ELECT. PLG, MECN.
MECHANICAL ./ ,Iy-/- E] [:]
./ WL FJ�s�UL I�O
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED leaZ--w..- BUILDING PERMIT
INFORMATION
WOOD FLOOR « r( q E ->7- aALunn DN gIPT.
PLUMBING TE .L Y ry hl 9- -gb
MECHANICAL PERMIT To
ELECTRICAL
FRAMING
STORIES TYPE CONSTR.
INSULATION-
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$O.FT.FLOOR PREA TOTALACREAGE
. ROOF
DIAPHRAGM
BUILDING USE
NES IND CON PB O,m•,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
g55ESS0N5 VgRCEL NO.
ROUGH
PLUMBING
TRACT NO. PARCEL NO,
GAS TEST
MECHANICAL
Acc.Dq_rE ACC.FILE No.
ELECTRICAL FINALS DATE INSP. -
FRAMING SAN # ZONING END.SITE NO.
INSULATION PLUMBING'
GAS
FIRE SPRINK ENERGY TZ<
MECHANICAL Y [3 No Y ❑ N[j
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.L.U.c.
LATH-INTERIOR ELECTRICAL
LATH-EXTERIOR FIRE DEPT. v N� v L-] N�
SHEETROCK - GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
F
GAS EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFICM--.-
UJ i
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
•� � ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
GPLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE
CONST.TAX
IMPORTANT!
` PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
' OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY o261y
BUILDING PROJECT IDENTIFICATION. PERMIT NUMBER
BUILDING - APPLICATION & PERMIT 11390
noon FSB
BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
O
OWNILH PLAN CHECK VALIDATION
NAM/E/J/_�� QTY. ELECTRIC PERMIT FEE
/(•"I-(�/C' �/%e/\ PHONE
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1,00
NAME /
�1��17Z19 p��jP(✓.(' .No.��/•f37 LIGHTING FIXTURES 10.00/1.00
r,ONTRACTOF, APPLIANCES-RESIDENTIAL 4.00
ADDRESSll� 61 /J ,/� C
`�V 'elk5 ✓' PHOrvE 90��/�/�ri PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER��.. /�C ,/ LIa No. - ,f/O SIGNS TRANS. 3.00
ARCH
.On ENG. �C� // S.00 PERMIT VALIDATION
ADDRESS AA SPECIALCI
CIRCUIT
(f �iG L;- 9..wlwo zIP AZZ EMP.METER OR POLE INS. 20.00 q
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS n n I
sG' �9/zICs >f �, 7�/ SERVICE CHANGE 20.00 _-7
0 o o LICENSED CONTRACTORS DECLARA• ON
a u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
uHi< w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, PLG. MECH.
H w z Professions Cody,and my license ism full force a d eff L� ❑ ❑ El. z o m - License Class = Lic.Number
o r w Date---q- Contractor
a x f BUILDING PERMIT
¢ ¢w u OWNER-BUILDER DECLARATION INFORMATION
w 3 LL N 1 hereby (firm that I am ex t from the Conlranor's License MISC.- REFER TO ORD
y a p VALUATION $/FT.
FLoj Law l'ot the followingmasoo.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
e ¢Q�o improve,demolish,or repair any structure,prior to jurssuance,also ELEC.CONTR. LIGNO. ELEC.
- 0 u requires the applicant for such permit to file a signed statement that TAL PERMIT TO
n w m he is tic used pursuant to the provisions of the Contractor's License
Hit Law(Ch ter9(CommencingwithSection7000)ofDivision3"The SEWG�,
a Business� d Professions Code)or that he is exempt thercGom and OTY. PLUMBING PERMIT FEE
at i O
at s-$ the basis to the alleged exemption.Any violation of Section]031.5 1 STORIES TYPE CONSTR.
u; _ byanyappll nl for a permit subjects the applicant-to a civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not mom t n five hundred dollars(SSOU)J:
❑ I,as ow r of the property,or my employees with wages asBACKF LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole comp cation,will-do the work,and the structure Is not
intended or offe d for Sale (Sce. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contra or's,License Law does not apply to an owner of
property who build i improves thereon,and who does such work F IXTUR ES:PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through In own employees.provided that such improve- GAS-EA.SVSTEM-l INC.4 OUTLETS 6.00
mems are or inteddc r offered for sale If,however,the building
or improvemenVis sold 'thin one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will h e the bur n of proving that he did not build or im- RES IND CON PB Omer
prove for pu os,of saleJ. INDUSTRIAL WASTE INTER. 30.00
❑ I,as caner of the pro try,am exclusively contracting with
licensed nuractors to constr 't the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
o ssions Code:The Contr or's License Law does not apply
to an net of property who build9.Lrr improves thereon,and who
and PrLAWN SPRINKLERS-OVER 5(EA.) 1.00
conn is for such projects with a commeror(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the C niractor's License Law.
❑ 1 am exempt under Sec. .B.&P.C.for this WATER HEATER W/VE 6.00
Tessinn
Owncr Date WATER SYSTEM , y,5.00Acc.OnrE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATERTREATING IP, n 5.00
1 hereby ufl'irm (hut 1 have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of workers'Compensation Insurance,or a certified
copy there IS 3 00,Lab.C.).
y eF ..�.
Policy Not 5 ompany O/11F Ano/ LIf S
C) ❑ Certified Copy is hereby furnished. FIRE$PRINK ENERGY T-14
Z Z -�Certil icdj�Y is ed it the ilY ins tion,Qjyjsipn' Y NE] Y ❑ No
f- O oCpplicanl�l� �51tJA � APL- MISC.- REFER TO ORD.
0: W CF-RTI FICA'1'1:OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 daJ FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. /�,5 YD N� YE] N[
CL O This section need not be completed if the permit is for one TOTAL _x 14 f/a
D Z hundred dollars(S 100)or less,)
V O I certify chat in It performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
ly H mil is issued,1 shall t employ any person m any manner so as to
O W become subject to the kers'CompeasaI o California. BUILDING
Dale ADph nt ALTER OR ADD TO MECH. 5.00
} tail NOTICE. 'IO APPLICANT: r making this Certificate of lix-
F Z ennFlinn,you should been ' cr to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor ode, yo must forthwith comply with FEE
U such provisions or this comic shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE
1 herebyafF,,m4,yhat there a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the perfornwnce ol'Th work Rsvdh h.,hie" serf it 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
Lenders Address
I certify that lhaveread ,,I,application and slate tlmlrheabove VENTILATION FAN (SINGLE) 4.00 44
information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING 6(�
ordinances and stale laws relating to building construction, and
hereby authorize representatives of this city to enter upon he gO1LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection put 0s Is.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,jUdgme s, costs andexpenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against Id City in W sequence of the
granting oft permit. MECH.CONT. LIG NO. MECH.
,0 TOTAL TOTAL
Ignalu a of APPI¢ant/Contractor Date
OFFICE COPY