10115 DST THIS RDNEAR ,FRONTOFBUILDING
PERMIT NUMBER
1
f CI,T*F CUPERTINO : 11 t-
1 M,
1
' • n 4 '
INSPECTION DIVISION
f� JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS ' D UNIT# 'LOT#. ' PERMIT,EXPIRES'IF WORK
OWNER CONTRACTOR IS NOT 'STARTED WITHIN
IN PECTION DATE INSPECTOR INSPECTIO RECORD 180'DAYS OF PERMIT.ISSU.
FOUNDATI N ANCE OR 180 DAYS FROM
-�^
UFER LAST CALLED INSPECTION.
' O((U
PREGUNITE ;PER ` ^41 r10.N
POUR NO CONCRETE UNTIL ABOVE HAS BE SIGNED ,`�aN.��..�tiI
UNDERGROUND./SLAB �. i' t ,
PLUMBING 1 ��IY.•Gf,cuPe ?0
_ ELECTRICAL ISSUANC unTW
MECHANICAL' - BLDG . ECr '.P MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION $/FT. "
��
MECHANICAL- - -
ELECTRICAL PERMIT TO
/
FRAMING - '
INSULATION - STORIES TYPE CONSTR.
- OCC GROUP RES,UNITS
1
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF 't SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM ` '
BUILDING USE
Poor- fi G , RES IND CON PB Other
APPLY NO ROOFING UNTIL ABOVE HAS BE IGNED ❑ ❑ ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO
7/ 1��frx J+c svl�- + A Tog-
17
PLUMBING
GAS TEST - rRAcr No. PARCEL NO.
MECHANICAL
.
ELECTRICAL FINALS DATE INSP.
ACCDATE ACC,FILE NO.
FRAMING . `— SAN #
ZONING ENG,SITE NO.
INSULATION _ - PLUMBING �•J —� -
G S
CH NICA , dd d p� - FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SI NED EATI G
LATH—INTERIOR - _ Q1, EVECTRICAf FLOOD ZONE
LATH—EXTERIOR '—S/j FIRE DEPY. Y❑ N❑ Y ❑ No
SHEETROCK _� - , GRA FEE SUMMARY
SHEAR INTERIOR - f,, BUILDING _
SHEAR EXTERIOR, TEMPORARY APPROVALS
- BUILDING
4-
FIREWALLS ELECTRIC PLANCHECK
• - - GAS FEE '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I SEISMIC FEE
OCCUPANCY,OF BUI LDI NG IS NOT PERM ITTED UNTI L BU I LDING F INAL IS SIGN ED BY BUI LDI NG'INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION, p�uMewG
�• Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE -. MECHANICAL
CONST.TAX
' ` IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. i
- OFFICE COPY aw-
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICA (�^
PERMIT NUMBER
Bmto,Na APPLICATION & PER*
�^ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PL ALIDATION
NAME QTY. ELECTRIC PERMIT FEE�P� Kuea�+�-I Co DNEGrd-66�K 'JAN 22 1986
CONTRACTOR'S
�NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
CO uc.No. LIGHTING FIXTURES 10,00/1.00 Clty Of CU
ADOTRAcroRs PPLIANCES-RESIDENTIAL 4.00 U2IfIO0
ADDRESS � �j` / ('�
SaW a-WONE (.)(( -44&1 PANELS 10.00 DATE OF APPLICATION
ORRCHITEGT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO,
ENGINEER
LIC.NO, SIGNS TRANS. 3.00
ADD ESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 20.00
AMOTORS SEE FEE SCH.
ADDDRESSDRESS
SERVICE CHANGE 20.00
. 02 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
a v U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
v,G w (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH.
H y z Professions Code, Wpdxy license is in full force and effect. ❑ ❑ ❑
Z z w W License Class Lie.Lie.Number
m Date Contractor
¢ ¢w ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
a O MISC:- REFER TO OR INFORMATION
x ; m I hereby affirm that I am exempt from the Contractor's�License
a_ 1.Lawforthe following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE
1000 �VALUATION $/FT.
Fwif Cade:Any city or county which requiresapermit toconstn,cLalter,
¢ ¢ Q O improve,demolish,or repair any structure,prior to its issuance,also ELEO CONTR. LIC.NO. ELEC. / /
ac O LL requires the applicant for such permit to file a signed statement liar TOTAL T TO
E
$ he is licensed pursuant to the provisions of the Contractor's License ��
F z r
Law(Chapter 9(commencing with Section 7000)OC Divlsion3 oCthe DP
¢ o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMITFEE"
the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ I,as owner the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES'UNI S
their sole compensation,will 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 owner of /
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SG. r.FLOOR AREA TOTAL ACREAGE
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-I INC.4 OUTLETS 6.00 a
or improvement is sold within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4 IEA.1 2.00
builder will have the burden of proving that he did not build Or ITT- AS NG USE
prove for purpose of sale.).. INDUSTRIAL WASTE INTER3000 RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with . .
0 ❑ 0 ❑
licensed contractors to construct he project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 g55E55oRSP RCEC rvO.
and Professions Code:The Contractor's License Law does nut apply _
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pennant 10
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/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILENO.
W&.R,OCOMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I her yave acertificate ofcdnsem to self-insure, ZONINGcer e apen In era c ,or a cer' ieENG.SITE NO.
I ). ��o. p
❑ C tific c py ish yfur h d. FIRE SPRINK ENERGY T-24
Z 2 p(,Certified led t ra city inspection division.
� O Applicant misc.- REFER TO ORD. Y� IN Y ❑ NC]
CCT CERTI .ATF-OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.V.C.
ANC
w ' (This section need not becompleted lit heFpermit is for one PLG.CONTR. LIC.NO. TOTAL Y C] NE] Y(2 NE3
CL O
=) 2 hundred dollars f$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 1- mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
Date Applicant BUILDING f'�6
>_ as 'NOTICE TO APPLICANT: IL after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 ..r
I'- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of he 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 UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE 3
I hereby affirm that here is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ,C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize hrepresentatives of this city to enter upon the
above-mentioned property tfor inspectionpurposes.
BOILER-COMP(over 100,000 BTU)SEE FEE SCH. MECHANICAL
(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 ez
may in any way accru against said City in c sequence of the
grand g of this perm' �r}_^ ,/ MECH.CONT. LIC.NO. - MECH.
�lI'f,7kt - TOTAL TOTAL OI
Sign are o Applicant/Contractor /// Date
OFFICE COPY
f