10139 POST THIS CARD NEAR FRONT-OF•BUILID ING
- F `+° • • PFRMITNUMReR .
R CITT.01 CUPERTINO
INSPECTION DIVISION;_ ,
JOB INSPECTION RECORD =
• n n/J / [,,� �^ /�},y]J ` - PERMIT EXPIRATION
J,O&ADDRESS [.Cl�`�1 /Il�iil .�J ��-%«�� UNIT# --L-OT# ' '
•'/ PERMIT EXPIRES IF WORK
OWNER CONTRACTOR`, '•'IS` NOT STARTED WITHIN
'�^',:' .
INSPECTION - DATE I INSPECTOR . INSPECTION RECORD, 18064YSOFPERMITIssu,.
4 FOUNDATION s1 i6 AlcfS(y.(-'r 1vv{{�� ',`5 ANCE OR 760 DAYS FROM r
UFER` - f_y *ry�:�yd '-l- &,,E,(C (S 4TB D:__ [r LAST CALLED INSPECTION. y +
' PREGUNITE emPERMIT VALIDATION
' Lout � i
• S t`
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED a-7-5� "
UNDERGROUND /SLAB
PLUMBING - ".?-T- �,.
° ELECTRICAL ' •a - s E '
MECHANICAL a + .2..Io-f{(j.���.:�/r [ELECT PLG._ MEC
51 1
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED" -,pb „e ,. BUILDING PERMIT .
WOOD FLOOR r INFORMATION' -
�' VALUATION $/FT.
PLUMBING � R � �� -��„���`�q } R�m,� 1
MECHANICAL .�.aT �'a' 7 . l.onw...KpA.o `jam d�tl OOV.
ELECTRICAL• . PERMITTO `
` Sar•' - EY !r h
FRAMING.- . ,R..~
:INSULATION a ""' RI S• TYPE c NSTR.
I i
i OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
f - 50.FC FLOOR AREA iOTNL ACREAfiE
ROOF
® DIAPHRAGM a '
.BUILIJ,
R2 HES IND CON PB 'Other
-APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED �l .''C]'• E] •❑ ❑
ROUGH z:
ASSESSORS PARCEL NO.
^//- t !J�^
PLUMBING'
GAS TEST r - . TRACT NO, " PARCEL NO.
MECHANICAL
ELECTRICAL -
FINALS - DATE INSP. ACC.DATE ACC.FILE NO�
•.j .o ` � , " _
FRAMING, ^" SAN.#
,. .INSULATION• PLUMBING - zoNINO- ENE,SITE NO.
,.
A f.
-------------------
y, c _ FIRE,SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS'BEEN'SIGNED HEATING : ' "❑ '' v ❑ •""❑ .
LATH-INTERIOR' ELECTRICAL ., ,y Y�_ FLOOD ZONE >• AL.U.C.
LATH-EXTERIOR FIRE DEPT. a Y❑� "❑` "'y'Y ❑ N❑'
SHEETROCK i - GRADE - --
FEE SUMMARY r.
SHEAR,INTERIOR" - BUILDING -
' ' SHEAR EXTERIOR TEMPORARY APPROVALS '�BUII.DING •,
FIREWALLS - ,'} - - I ELECTRIC"' - PLAN CHECK '
` I GAS, FEE N
.NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANcv SEISMIC FEE
- OCCUPANCY OF BUILDING.IS NOTPERMITTED UNTIL BUILDING FINAL
SSIGN ED BV BUILDING INSPECTOR: -
MICROFILM
LU ARRANGE FOR.INSPECTION BY PHONING 252;4505,'
ELECTRIC, r
F-� ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING d ,
lZ ', -PLEASE-'GIVE JOB'ADDRESSWHEN`P,HONING :,
Z _ . . a � �MECHANICA
=•,SEE PERMIT FOR EXPIRATION DATE
s
IMPORTANT! t CONST.Tnx
're• PLEASE READIREVERSE SIDE BEFORE, . . ,TOTAL Fl "
CALLING"FOR FINAL-INSPECTION.
'•,OFFICE
APPLICANT TO FILL IN INFORMATION:WITHIN REDLINES - USE BALL POINT PEN ONLY
�. BUI LDI NG PROJECT I DENTI FICATION - PERMIT NUMBED '
9UI DING _ APPLICATION & PERMIT ,
ADDRESS I
;��►�s dna G BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 10139
.9wNER'S ^ ^ S9a( I ^�y PLAN CHECK VALIDATION
-/1/1�/� OTY. ELECTRICPERMIT FEE 11411
�{/�
® D PHONE GLC/ ( // �
NOME Acrces UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. !j((//f/ LIGHTING FIXTURES 10.00/1.00
f-ONTRA T R'S
ADORERS # /�•.g� ��--'f2 - APPLIANCES-RESIDENTIAL 4.00
O r V" PNONE �j PANELS - 10.00 DATE OF APPLICATION
ARCHITECT , PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20,00
ENGINEER �,
LI➢.NO. SIGNS TRANS. 3.00
ARCH.Ess ENG. „ ..' SPECIAL CIRCUIT '., 5.00 PERMIT VALIDATION
2Iv
APPLICANT'S EMP.METER OR POLE INS. •-20.00 //Q//���
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
_ -
F o o LICENSIiD CON'I'RAC'I'ORS DIeCLARA'I'ION- TEMP.POLE - 30.00 -
a cull b I hereby affirm that I am licensed under provisions of Clmpter 9 ( _ 159UANCE GATE
a rt u (cnmmencing with Section 7000)of Division 3 of the Business and LDG. ELECT. PLG. MECH.
o Poofessimse o hrrom license is in full-for - 'na"
Licens L• y Lic.Numb �� _ V 0 ❑
E m I- w Dutc CDntmctor�rXma
M a w a OWNER-BUILDER DECLARATION 1 'BUILDING PERMIT
wo A ° -f INFORMATION
; LL _ I hereby affirm that I am exempt from the Contractor's License MISC.- - - REFER TO ORD
LLOto Law for the following reason.(Sec.7031.5,Buslnessand Professions VALUATION S/FT.
L- - - PERMIT ISSUANCE - 10;00
any
Code:Any city or county which requiresa permit loconstnu:Colter, "r
QQ 4 0 Improve,demolish,Or repair any structure,prior to its Issuance,also ELEC.CONTR. - LIC.NO.
_ ELEC.
requires the applicant for such permit to file a signed statement limy '
n n.
w m,�he is licensed pursuant to the provisions of lite Contractor's License TOTAL PERMIT TO
rzQ
Law(Chapter 9(commencing with Section 7000)ofl)ivision 3 ofthe �iti�ni'/ �A`Y�n✓Bs
4 O Business and Professions Code)or that he is exempt therefrom and QTY. 'PLUMBING PERMIT FEE /
R the hasis for the alleged exemption.Any violation of Section 7031.5 -
STORIES TYPE CONSTR.
by not
that fire permit dollatsthe$500).liwmtoacivil penalty. - ALTER-DRAINSt VENT-WATER IEA.) .5.00
of not marc than five hundred dollars(5500).):
❑, I,as owner 01 the property,or my employees with wages as BACK FLOW-PROTECT.ECT.DEV ICE - 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP ,RES.UNITS
" intended or offered for sale(Sec. 7044, Business and n owner of DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The who or License Law docs not apply toss owner of
himspropelf
Whn hal h or Iltn me"employees,
[hereau,vided th does m Work FIXTURES-PER TRAP, 5,00 ' SO.FT.FLOOR AREA TOTAL ACREAGE
himself ments re throughante his own employees provided that such improve. .
or
intended or within
red one y sale.If.
compleveq ihe the owner. GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is sold within one year of completion,.the owner- ' GAS-EA.SYSTEM-'OVER 4 (EA.) 2,00
builder will have tile burden of proving thus h ,
e did not build or im- BUILDING USE
prove for 1,aso neeose of solea. INDUSTRIAL WASTE INTER.- 30.00 REB t-1 D PB ocher
❑licensed as owner of the property,am exclusively c 7044, ing with11
and El
Pro colons Cod :The Contractor's
projectns(Soo 7044,Business LAWN SPRINKLERS-1INC5V.B. •6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply '
to an owner of property wlm builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for sunt,Dowels with to c,)alractods)licensed pursuant to '
tm Commctar's License Law. 11 SEWER-SANITARY-STORM EA.200ft/10,00 TRACT No. PARCEL No. -
❑ lam exempt under Sec. ,0.&I'.C.for this
on WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM .. 5.00
ACC.OATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5,00
I hereby oRinn Ilett I have a certificate of consent to sc1&insure,
or a certificate of Workers'Compensation Insurance,or a certified - ZONING ENG.SITE N0.-
copy thereof(Sec.3800,Lab.CJyuQr`
Policy No, Compi n . �J Rf-
CJ ❑ t7 op t mbyf it, ed FIRE SPRINK ENERGY T�20
Z 2 Certifi i d 1 e kv
tion division. ..i
F O plicont MISC.- - REFER TO ORD.
Y N V N
CCN L?:RTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR.- . . LIC.NO. PLG.
d'O
This section need not be completed it the permit is I'or one TOTAL ` Y O N V IN
Z hundred dollars(SI00)or less)
U O I certify that in the performance of the work for which this per, CITY MECHANICAL FEE SUMMARY
LL U - mit is issued,I shall not employ tiny person in any normcr so as to PERMIT FEE '
become subject to the Workers:Compensation Laws of California. '
Do Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING [N
} GO NOTICE TO APPLICANT: If,after making this Certificate of Ex- _
(.-Z emption,you should become subject to the Workers'Compmtsatiou APPLIANCE 5.00 PLAN CHECK
U
Pool
isions of the Labor Code,.you must forthwith comply with FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10SMCF.M.) 4.00
CONS'fRUCI']ON LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE-
1 hereby affirm'that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
tie performance of tho work.ron 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 UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC ,
I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) '4.00
information n correct, I agree to comply with all city and county PLUMBING
ordinances and erre laws relating to is building construction, and BOILER-OOMPI3 H.P.or.100,0008.T.U.) 6.00
hereby authorize representatives dives ec this city es enter upon the - BOILER-COMP (Over 100,000 BTU)SEE FEE SCH.
otiose-mentioned property for inspection purposes. MECHANICAL
agree to Arise, indemnify and keep harmless the City of MISC.- REFER-TO ORD.
Cuporh o against liabilities,judgments, costs and expenses which . CONST.TAX
may in ny ve accru ay" s( said City in eonsequen of the. PER ISSUANCE 10.00
gmn[in pf Iljs t h[ MECH.CONT,- LIC.NO. " TOTAL
/ 2 TOTAL
s mature of Applicant/Contractor Date
OFFICE COPY - - - -