8693 POST THIS CARD NEAR FRONT OF BUILDING
CITY. OF CUPERTINO ' RMIT NUNBErv'
INSPECTION DIVISION 663
JOB INSPECTIONRECORD' '
I�,d ✓� P+1 � PERMIT EXPIRATION
D
JOB ADREn�/
SS UNI #; LOT# ' +'
- PERMIT EXPIRES IF WORK.
OWNER CONTRACTOR. IS NOT .STARTED WITHIN
INSPECTIO • DATE INSPECTOR - INSPECTION RECORD.- i80 DAYS OF PERMIT ISSU-.
FOUNDATION ANCE'OR 180 DAYS FROM
UFER - LAST CALLED INSPECTION.;
PREGUNITE - , PERMITVALIDATION '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED v(/)'/ 1 .>J
• UNDERGROUND /SLAB - ', (`v `
PLUMBING - I 111
ELECTRICAL - .i u cE TE
MECHANICAL . BLDG.' EL r, c M '
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED B LDI c FWRYAIT7
WOOD FLOOR -, INFORMATION
PLUMBING * vawarloN ::r '$/RT..
MECHANICAL
ELEC MCAL PERMITTO
FRAMING
INSULATION - STORIES �TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED •
' ROOF SO.FT,FLOOR AREA TOTNL ACREAGE
DIAPHRAGM
BUILDING`USE
HES IND CON' PB " Olney .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ' ❑ ❑ ' ❑ . ❑ ❑
ROUGH - ASSESSORS PARCELNO.-
PLUMBING
n GAS TEST, - TRACT NO. PARCEL NO. '
MECHANICAL -
ELECTRICAL FINALS.. DATE INSP. ACC.DATE , Acc:FaENo. ' I
FRAMING SAN # -
INSULATION PLUMBING ZONING ENc.SITE No.
—1p�'��
. - GAS
' MECHANICAL FIRE SPRINK - ENERGYT-24-+
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED IHEATING Y ❑ N❑ V [_] N❑'' ,
LATH—INTERIORELECTRICAL FLOOD ZONE A.L.UO.
LATH—EXTERIOR FIRE DEPT. °❑ "❑ °v ❑ NC] ,
SHEETROCK - GRADE n FEE SUMMARY n �
SHEAR INTERIOR - BUILDING
SHEAR EXTERIOR TEMPORARY, APPROVALS BUILDING
FIREWALLS' - ELECTRIC PLAN CHECK
' GAS -- FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC F,EE_'
- - OCCUPANCY OF BUILDING ISNOTPERMIT.TED UNTIL'BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. klICROFILM -
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC N
Z�' ONE WORKING DAYBEFOREREQUIREDINSPECTION. PLUMBING...•; . '
•PLEASE GIVE JOB ADDRESS WHEN PHONING.,,
= SEE PERMIT FOR, EXPIRATION DATE - MIMECHANICAL .:
IMPORTANT! CONST.TAX
"PLEASE•READ REVERSE SIDE BEFORE ' , TOTAL
CALLING FOR.FINAL INSPECTION. d ^"
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENT[FICATI ON PERMIT NUMBER
ADI APPLICATION & PERMIT
rl
.� Ao DRESS
So BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 8693
Ow ER'S PLAN CHECK VALIDATION
E 0' /N '1 QTY. ELECTRICPERMIT. ° ? FEE
�r AER^crop's OUTLETS-SWITCHES-RECEP -10:00/1.00 --
U.� LIC.NO. �j ) O LIGHTING FIXTURES 10-00/1.00
RADTOR PPLIANCES-RESIDENTIAL 4.00
ADDRESS C _
PHON5E PANELS 10.00 DATE OF APPLICATION
ARCHITECT - - PANELS (OVER 200 AMPI 20.00PLAN CHECK FEE P.C.NO.
ENGINEER -_
LIC.NO. SIGNS TRANS. 3.00
ARCH OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDIRES i�
. zIP TEMP.METER OR POLE INS. 20.00 '
APPLICANTS MOTORS
AooREss ` AIDE FEE SCH.
L ISERVICE CHANGE 20.00
C o LICENSED CONTRACTORS DECLARATION TEMP,POLE 30.00
< U U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE
y a uWAi (commencing with Section 7000)of Division 3 of the Business and Lupe I BLDG. ELECT. PLG. MECH.
F o z Professions Cod ls_n y license is in full f vGl �pp
z 0_ llu
L- License la� Lic.Number V V El RI �i 1
O y Dalc Contractor 'L_l' CI
< x ce < BUILDING..PERMIT q
K 5 w a OWNER-BUILDER DECLARATION i 1 ; A-��"
D a 0 p jtiIN FORNIATIONJ g.4-)
`i ; O m 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
r =O a Law for the following reason.(Sec.7031.5,Business and Professions pERM1T ISSUANCE .70,80 VALUATION S/FT.
Zq Code:Any city or county which requires a permit to construct,alter, lie
"SE Sa¢0 improve,demolish,Or repair any structure,prior to its issuance,also EC.CON[\R._ LIC.NO.' ELEC. / G11
i w 0 LL requires the applicant for such permit to file a signed statement that Q W W 10 TOTAL F �-- PER T T
he is licensed pursuant to the provisions of the Contractor's License � 7 R��T
H z i Law(Chapter 9(commencing with Section 7000)of Division3ofthe i? 3 s " f J /
f 4 Qo Business and Professions Code)or that he is exempt therefrom and OAiiz
T V. PLUMBING PERMITFEE7
It r the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
A. 3 � by any more
for ive permit subjects $500).he licaN too civil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00
of not more than five hundred dollars(55DD1.1:
❑ 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 the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 •6r88 50.FT.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-1 INC.4 OUTLETS 6.00
or improvement 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 purpose of sale.). INDUSTRIAL WASTE INTER30.00 RES IND CON PB oma,
.
' ❑ I,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not 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 contractons)licensed pursuant to SEWER-SANITARY-S A.200f1/10.00
the Contractor s License Law. TRACT NO. PARCEL NO.
❑ lure
under Sec..,B.&P.C.for this WATER HEATER 6.00
rellSnn
Owner - _ Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS-COMPENSATION DECLARATION WATER TREAT O P. 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a lertified e I ZONING ENG.SITE NO.
copy they f ec.3800,Lab.C.).. •`�,� f� l I
Policy Npj!(,Compamy ,/_�\ ll sss"M1LL� Q
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY TQ9,
Z Z ❑ CC it c py is tie with the ci inspection division.
CC ApplicentlGFLA� MISC.- REFER TO ORD. v ❑ N❑ y ❑ N❑
``__ PERMIT ISSUANCE
�'- CERTI FICATI OF EXEMPTION FROM WORKERS' -�8 � FLOOD ZONE A.L.U.C.
CIL 0 (This section need not becompletediINSURANCE
the,permit is,for one L .0 TR� uC.NO. O TOTAL �� V❑ N❑ V❑ N❑
ao
� Z hundred dollars($1001 oric..) - - -
U O I 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 "
Q w become subject to the Workers Compensation Laws of California.
y Date - Applicant BUILDING
>_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
Z emption,you should become subject to the Workers'Compensation APPLIANCE PLAN CHECK
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 lomc.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WI H DUCT) 5.00
the performance of the work for wIT IT this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT TO 1 0, B. 8.00
Lender's Name
Lender's Address
HEAT I NG UNIT I 1 ,000B.T.U.18.50 ELECTRIC
I certify that I have read this app cation and state that the above VENTILATION FAN (SIN a 4.00
• information is correct. I agree to comply with all city and county PLUMBING
ordinances and stale laws relating to building construction, and BOILER-COM
H.P. O ,000 B.T.U.) 6.00 O
above- authorize representatives tire - MOver 100,000 BTU)SEE FEE SCM. MECHANICAL
ticreb coauthored property for inspection
this city to enter upon tion purposes. BOILERCOP
(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
y in way accrue against said City in consequence of tire PERMIT ISSUANCE 4BdB O
gr ting ( his perm's. - ECH.CONT. LIC.NO. MECH.
s- 1 TOTAL {� TOTAL" �/
kiiIiiIjiture of A 1 c / ontractor Data Val LN -
OFFICE COPY -