Loading...
9120 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO ' p INSPECTION DIVISION I ,7 120 JOB INSPECTION RECORD ' ,t ' PERMIT EXPIRATION. 4r e!'�tYlp�. '\ JOB ADDRESS �' UNIT# :LOT# c 11 /1__ PERMIT EXPIRES IF WORK OWNER) 1'(Q�pNTRACTOR ���, IS,NOT STARTED WITHIN INSPECTION- DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-' FOUNDATION - - ANCE OR 180 DAYS FROM LIFER LASTCALLEDINSPECTION. " PREGUNITE _ • PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB / 4- PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL - - BLDG: ELECT. PLG. MECH. ❑ ❑. ❑ ❑ DO NOT POUR FLOOR UNTILABOVE HAS BEEN SIGNED f BUILDING PERMIT ' WOOD FLOOR - INFORMATION PLUMBING VALUATION., $/FT. MECHANICAL ELECTRICAL - '; " PERMITTO ' FRAMING - INSULATION STORIES TYPE CONSTR. - � a OCCI GROUP,/ " RES.UNITS' - LIS r.T,. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ,L "1 'i1.l�Iy ,ROOF SOITLOOR AREA TOTAL ACREAGE f DIAPHRAGM - ' Jl BUILDING USE. � FES IND . CON PB OIFer APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 El - 0� 0 ROUGH ASSESSOR. AR CEL NO PLUMBING TRACT NO. PARCEL NO. GAS TEST-- ' MECHANICAL . ' ' - ELECTRICAL FINALS �_ DATE INSP. ACC.DATE 'ACG.1 FILE NO.. FRAMING SAN # INSULATION PLUMBING ZONING .ENG.SITE NO, GAS. - FIRE SPRINK ENERGYT24 MECHANICAL '� N� T ❑ N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L.U.C. ' LATH—INTERIOR' � ELECTRICAL LATH—EXTERIOR 'FIRE DEPT. Y ❑ NQ,' SHEETROCK GRADNG E - FEE SUMMARY SHEAR INTERIOR- BUILDI SHEAR EXTERIOR TEMPORARY APPROVALS 'BUILDING FIREWALLS ELECTRIC • PLAN CHECK . GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - ..7 SEISMIC FEE OCCUPANCY OF BUILDING ISNOT PERMITTED UNTILBUILDING FINALISSIGNED By BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o.� ONE WORKING DAY BEFORE REQUIRED INSPECTION. ' PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. Y - SEE PERMIT FOR .EXPI RATION,DATE =• MECHANICAL IMPORTANT!'. CONST.TAX' . 'PLEASE READ REVERSE SIDE.BEFORE -L TOTAL CALLING FOYi FINAL INSPECTION.' Lii OFFICE COPY /•"^c APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT 1 DENTS FICATION PERMIT NUMBER BUILDING /�f BUILDING APPLICATION & PERMIT 9120 11 n O -ELECTRICAL-PLUMBING-MECHANICAL o NE 's PLAN CHECK VALIDATION mE OTY. ELECTRIC PERMIT FEE ON gCTORS NAmE OUTLETS-SWITCHES-RECEP 10.00!1.00 vu 6ZCTIC.NO. /}4?IS�j2 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ADDRESS � APPLILASNCES-RESIDENTIAL 4.00 ^F0VHONE-72-7-4 ANE 10.00 DATE OF APPLICATION ARCHITECTPLAN CHECK FEE .C.NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER OSS lN4A.+a LIc.No. SIGNS TRANS. 3.00 ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 ,/ / r o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 JUL CE A a v 1 hereby affirm that I am licensed under provisions of Chapter 9 ISS ANCE DA w a m (Commencing with Section 7000)of Division 3 Of the Business andBL I 55Rq{EEEy��C77T PPLO. MECH. H y,m Professions Code, C-1 d my license is in full for4a Ff"2 r ,IJ ert§ Z icons lass Lie.Number- Z. �T LJ LC f w' Date Contractor a ae s BUILDING PERMIT X w u OWNER-BUILDER DECLARATION INFORMATION woA I - MISC.- REFER TO ORD ; N I hereby affirm that 1 am exempt from the Contractor's License F u O J Law for the following reason.(Sec.703 L5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT, Zw0i Code:Any city orcounty which requiresa permit to construct,alter, C 2 Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. n -0 u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w m he is licensed pursuant to the provisions of the Contractors License r z a Law Chapter 9(commencing with Section 7000)of Division 3of the 4 O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE re r $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. n ; _ by any applicant lora permit dollatsthe$500).livunt toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 ln'� of no[more than flue hundred dollars(my cm): ❑ 1,as owner of the property,a or employees with wagesot BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.G O RES.UNITS intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONES. 5.00 Code:The Contractor's License Law does not apply to an owner of property who buildsor improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.PT.FLOOR AREA -TOTAL ACREAGE menta re not hrough own employees. Sale.If,however, ever,hat the improve= GAS-EA.SYSTEM-1 6.00 menta are not intended or offered for sale.If,however,she building or improvement is sold within one year of hacompletion,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 PB OMe. prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 O d as owner of the property,he exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors ors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 gSSE550 PARCEL NO. and Professions Code:The Contractor's License Law does not apply to anowner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts(Ursa ewithacontrectorts)licensed pursuant License L the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-,BAP.C.for this WATER HEATER W/VT 6.00 reason Owner Date WATER SYSTEM 5,00 ACC.DATE ACC.FILE NO. WORKERS'COMPF-NSATION DECLARATION WATER TREATIN UIP. .T 5.00 1 hereby affirm that 1 have a certificate of consent to self-insure, ZONING ENG.SITE N0. or a certificate of Workers'Comp' ,or nsation Insurancea certified copy thereof(Sec.3800,Iab.C.).x Policy No. Company- eity of Q ❑ Certified cop hereby fu hed. FIRE SPRINK ENERGY T-24 ❑ Certi(ie Is Sled 'th the uy ins " 'on' MISC.- REFER TO ORD. 0 Applicant - Y ❑ N❑ Y ❑ N❑ d' - CER CATE OF f: E ION FROM WORKERS' •PERMIT ISSUANCE FLOODZONE A.L.U.C. UJ > COMPBNS ON INSURANCE PLG.CONTR. sec.NO. PLG. CLO (This section need not he completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ 0 Z hundred dollars(S IOU)or less.) U O I certify that in the performance of the work for which this per QTY, MECHANICAL PERMIT FEE FEE SUMMARY LL F mil is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. - y Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING } N NOTICE TO APPLICANT` If,after making this Certificate of Ex- F ? empsion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most 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 UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE I hereby affirm that there is a Construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the 3097 performance ante of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name H EATS NG U N IT(OV ER 100,000 B.T.U.)9.50 _ Lender's Address ELECTRIC / \• I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 ordininformatn is costarrect 1 agree to comply with all city and county PLUMBING ancesioand le 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 the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. ��--/ (We) agree to aavc, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which' CONST.TAX may in a way ace against said City in consequence of the PERMIT ISSUANCE 10.00 grant tis permit - MECH.CONT. LIC.NO. MECH. TOTAL TOTAL ign sere of Applicant ontmc or Uate OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER BUILDING APPLICATION & PERMIT ADDRESE /. 1 BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 9120 O E '/ / PLAN CH ECK VA LI DATION NAME CITY. ELECTRIC PERMIT FEE /0 4 V1 / _14 in H NOME AcroRs UTLETS-SWITCHES-RECEP 10.00/1.00 0161 Duu Z IC No. A421Scaz LIGHTING FIXTURES 10.00/1.00 CONTRACTOR 5 APPLIANCES-RESIDENTIAL 4.00 ADDRESS -''j2_741 �/� PHONE /{�I' 1 (JI� PANELS IO.OD DATE OF APPLICATION ARCH i CT PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMPI 20.00 ENGINEER Lic.No. SIGNS TRANS. 3.00 ADDRESS END, CIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 i APPLICANT'S MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 a v I hereby affirm that 1 am licensed ander provisions of Chapter n IbbUANC€DATE vHi G aa, (commencing with Section 7000)of Division 3 ofthe Business and BLOC. ELECT. PLG. MECH. H y z Professions Code, 1d my litense is in full fore and effec z o w License Class Lic.Number �� _ I 1:1 E ❑ 9 v,r w Dale—I Contractor a m s BUILDING PERMIT Ix ¢ w ¢ OWNER-BUILDER DECLARATION' a0 a ° MISC.— REFER TO ORD INFORMATION o 1 hereby affirm that I am exempt from the Contractor's License VA WATIOry /FT. I- 0 uoj Law for the following reason. 7031.5.Businessland Professions pERMIT ISSUANCE 10.00 E W Code:Anycityorcounly which requires a permit to construct,after. ac m Q 2O improve,demolish,or repair any structure,prior to its issuance,also ELEC,CONTR. LIC.NO. ELEC. na - DLL requires the applicant for such permit In file a signed statement that TOTAL 1 11T TO a w m m he is licensed pursuant to the provisions of the Contractor's License a, t. Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE VO V K F o the basis for the alleged exemption.Any violation of Seclion7031.5 STORIES T C NSTR. by any applicant lot a permit subjeetithe applicant ot civil penalty ALTER-DRAIN (EA.) 5.00 of not more than five hundred dollars(5500).1: '> ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 400 DCC GR 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 docs not apply to an owner of property who builds or improves thereon.and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE • himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have file burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND PB • Other LI . . I,as owner of the property,am exclusively contracting with El0❑ Q ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSO ARCELNO. and Professions Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 , emvrocts Ibr such projects with a contractons)licensed pursumtl to the Contractor's License law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,H.&P.C.for this WATER HEATER W/VENT 6.00 Rasan Owner Date WATER SYSTEM 5.00 ACC.DATE ACE.FILE NO, WORKERS'COMPENSAT ION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, (77a ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance.or a certified copy thereof(Sec.3800,Lab.C. , Q^ Policy No. Company ). K v O ❑ Certified copy Is hereby ff I i FIRE SPRINK ENERGY T-24 Z d ❑ Certified^cop is filed ith the Ily ins d ion division. MISC.- REFER TO ORD. Applicant Y❑ N❑ Y ❑ N❑ ~ PERMIT ISSUANCE "TJc. C1i R rII ICATE OF EXlih TIONPROMWORKIiR$' IA.DD FL00o ZONE A.L.U.C. LU COMPI>NS N INSURANCE PLG.CONT R. LIC.NO. PLO. �p�. ❑ CL Z( T' hls Section need not be completed if the pe nn Y❑ N C] Y El N it is for one TOTAL !/V hond,,U dollars IS 100)or less U O 1 certify that in the performance of the work for which this Per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued, I shall not employ any person in any manner so as to O become subject to the Workers'Compensulion Laws ol'California, UJ Dam--- Applicant ALTER OR ADD TO MECH. 5.00 BUILDING ` } w NO'f ICES TO AI'I'LICANT: IC after making this Cenificam of fix- _ ? emption,you should become subject to the Workers'Compensulion APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U sucll provisions or this permit shall be deemed revoked: AIR HANDLING UNIT(TO 10)000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCYt AIR HANDLING UNIT(OVER 10,ODDC.EM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 theperformance of the work for which this permit is issued(Sec. MICROFILM HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC I certify that I have read this application andstate that the above VENTILATION FAN (SINGLE) 4.00 information is correct, I agree to comply with all city and county PLUMBING QI(j ordinances and state laws relating to huilding construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby amhorve representatives of this city to enter upon the BOILER-COMP(Over100,000BTUISEE FEESCH. MECHANICAL �- above mentioned properly 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 Amy in any way accrue against said City in consequence of the gnuung f this penni MECH.CONT. LIC.NO. MECH. TOTAL TOTAL ; Sign t e o A icon Contr to Date INSPECTOR COPY