10113 POST THIS CARD NEAR FRONT OF BUILDING '
f I y.PFRVIT NUMBER
CITY 01 CUPERTINO 1
13
INSPECTION'DIVISION
JOB INSPECTION RECORD
''AUDI
/11I PERMIT EXPIRATION
� JOB ADDR ESS 1L�UNIT40LOT#
PERMIT EXPIRES IF WORK
OWNER JA
ad. CONTRACTOR IS NOT STARTED WITHIN
INSPEC ON I DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - - ANCE R'180 DAYS FROM ,
UFER AST CALLED INSPECTION.
PREGUNITE - PER _ ION
s s a 1,10:2
r POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - 19fj
UNDERGROUND,/SLAB
PLUMBING CI`y �fCUpQ• �o^
ELECTRICAL
- ISSUANC DATE
- MECHANICAL - BLDG. ECT. PLG. MECR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING VALUATION $/FT.
MECHANICAL
ELECTRICAL - -,:p
jPERM T TO I
FRAMING ' I ✓♦' K�►•••�'
INSULATION 'sroRles Tvae CONSTR. -
t
59.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' I
ROOF SO FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM BUILDING USE
)?Oslo .✓ Tj '1m 'k I RES IND ' CON PB Oleo,
APPLY NO ROOFIN UNTIL ABOVE HAS BEEA SIGNED - -
'ASSESSORSPARCECNO.
ROUGH /
PLUMBING - 'ri--(� /'y/ /:�.:%��•.
GAS TEST
TRACT NO. PARCEL NO.
" � _ C � -
MECHANICAL
ELECTRICAL ,ACC.DATE ACC.FILE NO. _
/ FINALS DATE INSP.'
FRAMING g' - SAN
,
INSULATION - _1e-�l PLUM ING• - ' - � kE
ZONING ,ENGSITE NO.
• GAS
FIRE SPRINK ENERGY T 24
MECHANICAL 6 - v Q N� Y [] Nn
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH-INTERIOR
ELECTRICAL FLOOD ZONE L.U.C.A.
LATH—EXTERIORFIRE DEPT. - v N❑E v "❑
SHEETROCKGRAD FEE SUMMARY
SHEARINTERI OR UILDING -
TEMPORARY. APPROVALS
BUILDING
SHEAR EXTERIOR, _ '
FIREWALLS, ELECTRIC > PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC.FEE
UCCUPANCV OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
,ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
z�
ONE WORKING DAY BEFORE REQUIRED'INSPECTION'. ' (PLUMBING
PLEASE GIVE JOB ADDRESS WHEN.PHONING:
SEE PERMIT FOR EXPIRATION DATE ' MECHANICAL
IMPORTANTI. coNsr.Tnx'.
PLEASE READ REVERSE SIDE BEFORE TOTAL.
CALLING FOR FINAL INSPECTION. f ';
OFFICE COPY - -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
• BIH LDING PROJECT IDENTIFICATION - APPLICATION SI PERMIT
Bu@DING
,ADpRFss L0,,._3 BUILDING PLAN
1
C kj! ws PLAN CHECK VAL ATION
OWNER'
RAME a CoQTY. ELECTRIC PERMIT FEE J,�� 2 2
• Rdw" Co PHONE 1986
CONTRACTOR'S UTLETS-SW ITCHES-RECEP 10.00/1.00
NAME II ''
R11t(7T j LIC,NO, LIGHTING FIXTURES 10.00/1.00 /� of Cupertino
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
k� fp,x,J WBNONE (�T� ��O PANELS10.00 DATE OFAPPLICATION
ARCHITECT PANEL,(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER SIGNS TRANS. 3.00
LIC.NO. PERMIT VALIDATION
ARCH.CR ENG. SPECIAL CIRCUIT 5.00
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00 � V
APPLICANT'S - MOTORS SEE FEE SCH. ' n wEJi
ADDRESS
SERVICE CHANGE - 20.00
woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
F IS ANCE DATE
I hereby affirm that I n licensed under pr3 of
a of Chapter 9
w< H (commencing with Section]0001 of Division 3 of the Business anJ BLDG. LE T. PLG. MECH.
r N zProfessions Coa m
de, y license ism full force and effect. ❑ El0
z O m - LicensC Class_ Lic.Number-
2 ,, ,
umber ,
9 DW Date Contractor
BUILDING PERMIT-- ' _
IS a,w 4 OWNIiR-BUILDER DECLARATION q INFORMATION
M ISC.-' REFER TO ORD
E:
a- w 1 hereby alfnm that I am exempt from the Contractor's License VALUATION $/FT.
u o a Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 '
wCade:Any city or county which requires permit to construct.alter,
QQ ¢ 0 Improve,demolish,Or repair any Structure,prior tO its Issuance,else ELEB.CONTR. LIC.NO. ELEC.
iLO¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
wes LL he is licensed pursuant to the provisions of the Contractor's License
F z t
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
4 Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢_0 the basis for the alleged exemption.Any violation of Section 7031.5 BTO 11 S VPE CONSTR.
dg _ by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC,GROUP RES.UNITS
their sole compensation,will do ilia work,and the structure is not rf-�
intended or offered for sale(Sec, 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractors 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
ultra are not hrough
ownemployees,for
Sit.If,edlhatsuch improve- GAS-EA.SYSTEM-I 6.00 3103
hems ore not intended or offered for sole.If,ed that s 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 iia- RE IND CON PB Due,
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 (�(f El El
❑ I,as owner of the property,am exclusively contracting with r-+
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS: 1 IN_C.5 V.B. 6.00 ASSESSORS PA CEL NO.,
and Professions Code:The Contractor's License s thereon,
does not apply
to an owner of property who builds 's improves thereon,and who LAWNSPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
ilia Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under See. _ ,B.&P.C.I'or this WATER HEATER W/VENT 6.00
reason
Owner Dam WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
OR S' .OMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
here afl'i hI�a cetlificale o rconsent lu selhin sur a. ZONING ENG.SITE NO.
c
o t at yqo rke o pensa' n nsumnc•,ora certified
fMrcc /�J_(/([�
VAI
❑ C itiCd copy lsh chyf fished. FIRE SPRINK ENERGY Tw20
Z Z 'ST C tified file h thwcity inspecl ion division. MISC.- REFERTOORD. V [] N� V � N❑
I- NA pllcont
PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
Lu - CIiRTIh COI OP EXEMPTION PROM WORKERS'
U.I > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. y N Y C] N
CL 0 (This section decd not be completed if the permit is for one TOTAL
D Z hundred dollars(1100)or less) -
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
U. H- mit is issued,I shall not employ any person in any manner so as to
OIV becohCsubject to the Workers'C'ompensation Laws of California. BUILDING
Date Applicant ALTER OR ADD TO MECH. 5.00
} ED NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
s 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 10,000C.F.M.) 4.00 /
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.EM.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of ilia work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lapeer's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify lhatl haveread this applicat inn and state Dmt the above VENTILATION AN (SINGLE) 4.00
information is correct.I agree to comply with nil city and county. PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,0008.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. 6
Cupertino against liabilities,judgments, costs laid expenses which CONST.TAX
may in any way accrue ams t said City in consequence Of the PERMIT ISSUANCE 10.00
gmntin of th� eru1. (7J MECH.CONT. LIC.NO, MECH.
�,�, C ► I1'LI 1(� TOTAL TOTAL QI
Sign rC of pplieant/Contractor Data 1
OFFICE COPY