12624 POST.THIS CARD NEAR FRONT,OF BUILDING-.
M � PERMIT NUMBER
CITY: OF CUPERTINO12624
INSPECTION DIVISION .
JOB INSPECTION RECORD'
� PERMIT EXPIRATION
7
" JOB ADDRESS '�p ±UNIT# 1 LOT 4f -- '
- PERMIT EXPIRES IF WORK
OWNER ON RACTOH. - ISNOT STARTED WITHIN
INSPECTION DATE IN9KCM INSPECTIONS RECORD 180 DAYS OF PERMIT ISSO-
'ANCE OR 180 DAYS FROM
FOUNDATION - + LASTCALLED INSPECTION.
LIFER i..,.
PREGONITE PERMIT VALIDATION
- � � •- '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING ' - }
ELECTRICAL �, �; ISSUANCE DATE
MECHANICAL I -. ELECT PLG. MECH.
I ❑ ❑ ❑ '
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDmc PEaMIT
INFORMATION
-WOOD FLOOR i , VALUATION - $/FT.
PLUMBING i) '
MECHANICAL -
ELECTRICAL - PERMyr To
FRAMING
INSULATION, I STORIES. ' TYPE CONSTR. f'
OCC.GROUP RES.UNITS
PLACE NO SUB FLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF •I - SO.FT.FLOOR AREA TOTAL ACREAGE '
DIAPHRAGM ` �/ y
I-._..._�.�
-q-1-7 �_ MVV , IND.ILDCON
ING USEPC GO,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED V� µ r� El � - 1:1
I
VLL L G A SSESSON,PARCECNOPLU . J
ROUGH Al 0 'wt f4 T ce rS
GAS^TESTG TRACT No PARCEL NO i
MECHANICAL
ACC.DATE ACC FILE NO.
ELECTRICAL- - ` 'FINALS, DATE'' INSP.
FRAMING * 9.SAN #. -...--- - '
INSULATION 'PLUMBING ,` - - + ZONING ENG,SITE NO.
GAS "._..- �_.-i.� a�
MECHANICAL FIRE SPRINK ENERGY T 20
COVER'NO WORK UNTIL ABOVE HAS BEEWSIGNEO,L^j HEATING »_ ., a_ w0 " NE]-'r- •- ,E FLOOD ZONE A.L.U.C.
LATH-INTERIOR " ' ELECTRICAL77
YEl .NQ Y - N❑
LATH—EXTERIOR FIRE DEPT. - � �
SHEETROCK , GRADE � � I r' � , �' xFEE SUMMARY I
SHEAR INTERIOR - BUILDING. BUILDING
SHEAR EXTERIOR %' TEMPORARY'APPRuv'ALS
FIREWALLS + ELECTRIC' " PLAN CHECK j
- GAS .FEE ,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE . S
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ,
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC {
0� ONE WORKING DAYIBEFORE REQUIRED INSPECTION', ' ' PLUMBING
PLEASE.GIVE JOB ADDRESS WHEN PHONING
we Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE
CONST.TAX'
IMPORTANT!•`
,PLEASE'READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION
P -•` - ' OFFICE COPY •-
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Y a
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINkS.- USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BULDING APPLICATION & PERMIT
ADDRESS
UILDING-ELECTRICAL-PLUMBING-MECHANICAL 12624
OWNER'S PLAN CHECK VALIDATION
g=`� y7y NAME D OTY. ELECTRIC PERMIT FEE '
PNONE -f
CONTRACTOR'S
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
Lm.No. LIGHTING FIXTURES 10.00/1.00
auoeess TOR's APPLIANCES-RESIDENTIAL 4,00 - -
PHONE PANELS 10.00 DATE OF APPLICATION
ORRCHUECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH.OR
ADDRESS ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
Ars ZIP EMP.METER OR POLE INS. 2000.
ADDRESS
DRESS MOTORS SEE FEE SCH. / LLG�I.4•�`N
/
SERVICE CHANGE 20.00 'D
o m i LLL(((111
r o 0 LICENSED CON'IRACI'ORS DECLARATION '
a i w I hereby affirm that I am licensed under provisions of Chapter 9
4 n (commencing with Section 7000)of Division 3 of the Business and _ A Q 6uANCE DATE
m z Professions Code,and my license is in full force and effect. BL ` LECT. PLG. MECH.
o i ) License Class Li,.Number ❑
Dutc onmclor
asef CtCRY of
¢ R m 4 OWNER-BUILDER DECLARATION - BUILDING PERMIT
wO a" INFORMATION
g,� o, I hereby affirm that I am exempt from the Contractor's License MISC.-' REFER TO ORD
H u 0 4 Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION $/FT.
M PERMIT ISSUANCE 10.00 �/
Code:e,dem y demolish,
or r pair any requires a permit la construct,alter, /LED. rroO
ai IS 4 improve,demolish,or re Flair any structure,prior(a its issuance,also ELEC.CONTE. LIC.N0.
u m u requires the applicant for such permit to fila a signed statement that ' TOTAL PERMIT TO
he Is licensed pursuant to the provisions of the Contractor's License -
z a Law(Chapter 9(commencingwith Section 7000)of Division 3 Effie -7-/��1 /. r�`�
i 0 Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE ll/
x ¢ I-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n3 by any applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars CS500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compee nsation,will do the work,and thstructure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
•r 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
himself Or through his own employees,provided Ilial Sikh Improve. SO.FT.FLOOR AREA TOTAL ACREAGE
marts are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvemem is sold within one year of completion,the owner- GAS•EA.SYSTEM-OVER 4 IEA.) 2,00
builder will have the burden of proving that he did not build or im. BUILDING USE
prove for 1,as owner
of Sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ d as owner of the property,he exclusively contracting with ❑ ❑ El ❑ D
licensed contractors: construct the project Z.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does mat apply
to anowner of property who builds or improves thereon,and who LAWN SPR IN KLERS-OVER 5(EA.) 1.00
contracts forContractor's
h License
with u cnntracfor(s)licensed pursmma[to
the Contractor'spt under
Sec. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,R.&P.C.for this
masonWATER HEATER W/VENT 6.00
,--A Owner Dute WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATIOt WATER TREATING EQUIP, 5.00
I hereby affirm that 1 have a certificate of consent to self-insure,
or a cetlificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800.Lub.C.).
Policy No. Company
O O Certified copy is hereby furnished. FIRESPRINK ENERGY D]4
z Z 0 Certified copy is filed with the city inspection division.
� O Applicant MISC.- REFER TO ORD. Y [:] N Y � NC
� y CERTIFICATE OF EXEMPTION I7ROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the permit is for one TOTAL Y❑ N[ Y N�
D Z hundred dollars IS 100)or less.)
00
I certify that in (he performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mil is issued,1 skull not employ any person in any manner so as to -
become subject to the Workers'Compensation Laws of California `
i
Dale-Applicant ALTER OR ADD TO MECH. 5.00
BUILDING ITU
>_ to N01 ICE TO APPLICANT: If,after making this Certificate ofT.-
H Z emption;you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000QF.M.) 6.00 SEISMIC FEE �?tI
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(See. - MICROFILM
3097,Civ.C.). r HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC.
I certify (],at l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information n correct I agree to comply with all city and county PLUMBING
ordinances and state laws relating to comply
lith construction, andmy BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00
</ hereby authorize representatives of this city to enter upon file
above-mentioned property for inspection purposes. 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- _
CONST.TAX
may in any way accrue aaggainst'said City in consequence of the PERMIT ISSUANCE 10.00
gran,i IS Penni[. MECH.CONT. LIC.NO. MECH.
Signature of Appbcanl/ContraTOTAL
TOTAL
COPY
Uaf t
'OFFICE COPY