11085 POST THIS CARD NEAR FRONT OF BUILDING
' PFRMIT NUMBER
CITY OF CUPERTINO 11085
INSPECTION DIVISION
JOB INSPECTION RECORD
X�j PERMIT EXPIRATION
• JOB ADDRESS� I LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
UFER
LASTCALLED INSPECTION.
PREGUNITE
PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB "
PLUMBING
ELECTRICAL
ISSUANCE GATE
MECHANICAL BLDG. ELECT. I PLG. mECH.
❑ ❑ ❑ ❑-.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION $/FT.
MECHANICAL 1
ELECTRICAL PERMIT TO
FRAMING
INSULATION 6-Z'3.-flb STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50.Fi.FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM
BUILDING USE
RES IND CON PB O,he,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH J I
ASSESSORS PARCEL NO,
PLUMBING I�
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL // FINALS DATE INSP. ^cc.DATE - ACC.FILqNo.
FRAMING / —wiSAN u
ZONING ENG.SITE NO.
INSULATION .-I PLUMBING �2-2�
VE
_ Z FIRE SPRINK ENERGY T-ZC
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED Y ❑ N❑ Y ❑ N❑
FLOOOZONE A.L.U,C.
LATH—INTERIOR _
LATH—EXTERIOR Y❑ N❑ Yo N❑
SHEETROCK _ FEE SUMMARY
SHEAR INTERIOR BUILDING _Zy
SHEAR EXTERIOR TEMPORARYAPPROVALS ' BUILDING _
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED I OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR- MICROFILM
n, w
ARRANGE FOR INSPECTION BY PHONING 2S2- CT5, ELECTRIC
F- ONE WORKING-DAY BEFORE REQUIRED INSPECTION. PLUMBING u
z PLEASE GIVE JOB ADDRESS WHEN PHONING. -
- SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE $I,
CALLING FOR FINAL INSPECTION. TOTAL
I
OFFICE COPY
APNUCANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION PERMIT N NUMBER
' BUILDING APPLICATION 11085
s
DING —ELECTRICAL—PLUMBING—MECHANICAL
OW PLAN CHECK VALIDATION
"AMER'B. SO N�A' QTV. ELECTRIC PERMIT FEE
PHONE DOQ
corvT croRs 2�" �� UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
LIC.No. LIGHTING FIXTURES 10.00/1.00
DoR's
ADDRESS
PPLIANCES-RESIDENTIAL 4.00
DRE55
PHONE PANELS 10.00 DATE OF APPLICATION
ARGHITEgT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
Y�
OR q
c�G.
ENGINES Y� %1�� \V�I�N SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIALCIRCUIT 5.00 ' PERMIT i6DATION
S TEMP.METER OR POLE INS. 20.00
/ ADDRE55Ts MOTORS SCH.SERVICE
�
' SERVICE CHANGE
IDt o a LICENSED CONTRACTORS DECLARATION n'f p1{yt�I 4
¢is w I hereby affirm that I am licensed under provisions of Chapter 9 CIS NANO DATE
(commencing with Section 7000)of Division 3 Of the Business and aVV ry, BLOC. ELECT. PLG. MECH.
Ni Professions Code,and my license is in full force and effect. V
O w License Class Lie.Number
Z
9 z L Date Contractor
¢ x s -I BUILDING PERMIT
¢ ¢ w st OWNER-BUILDER DECLARATION INFORMATION
w0 o D MISC.— REFER TO ORD
g LL H 1 hereby affirm that 1 am exempt from the Contractor's License VALUATION $/FT.
Fuo ¢ Law for the following reason.(See,703 1.5,Businessand Professions PERMIT ISSUANCE 10.00 Qom'
Code:Any city or county which requires a permit to construct,alter,
R ¢s- 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL 7 PERMIT TO
n w m he is licensed pursuant to the provisions of the Contractor's License
H z i
Law(Chapter 9(ccmmencingwith Section 7000)Of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ r o the basis for the alleged exemption.Any violation Of Section 7031.5 STORIES TYPE CONSTR.
n gm by any applounifor a permit subjects the applicant to a Civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 --
of not more than five hundred dollars($500)d:
❑ 1,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,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 BO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS
or
SYSTEM-1INC.4 OUTLETS 6.00
mrnts are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS EA.SYSTEM-OVER 4 IEA.) 2,00 BUILDING USE
builder will have the burden of proving that he did not build or im- - RES IND CON PB Otber
'Iro for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 El El 1:1 El 1:1L as owner of the property,am exclusively contracting with
sedcontractors t0 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-STORM EA.200ft/10,00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ 1 am ee crapI under Sec. ,B.&P.C.for this WATER HEATER W 6.00
on
caner Date WATER SYSTEM is _,.( 5.00 ACC.DATE ACF FILE N0.
WORKF-RS'COMPENSATIO ECLARAT(ONa—1 'WATERTREATIN EQUIP.) 'r" 5.00
1 hereby affirm that I have a certificate of consent to self-insure, V ` ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy lherarof(Sec.3800,Lab.C.). CUp
Policy No. Company
0 ❑ Certified Copy is hereby furnished FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is fled with the city inspection division.
O Applicant MISC.- REFER TO ORD. Y ❑ N❑ v ❑ N
Hy PERMIT ISSUANCE 10.00 V� FLOOD ZONE A.L.U.c.
CERTIFICATE OF EXEMPTION FROM WORKERS'
UJ > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. /
CL Cl (This section need not be completed if the permit is for one TOTAL �a� Y❑ N❑ v ❑ N❑
hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any manner so as to
0
U become subject to(he Workers'Comp ensation Laws of California.
00 Date Applicant _
BUILDING � .(a
} to NOTICE TO APPLICANT: If,after making this Certificate Ex-
L.. ? emptio you should become subject to the Workers'Compensation
tion APPLIANCE 5.00 PLAN CHECK
pr Visions
s the Labor Code, you must forthwith comply with FEE
U such provisions Or this permit shall be deemed revoked. AIR HANDLING UNITp(TO 10,000 C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT IOVFR 10AWe. .M.16.00 SEISMIC FEE 0
I hereby affirm that there is a construction lending agency for EXHAUST H000_IIWfTH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,0_ 8?no 6.00 MICROFILM
3097,Cie.C.),
Lender's Name HEATING UNIT(OV,' 000 B.T.U.)9.50
Lender's Address �*� 0•. ELECTRIC A,4a03�
x� I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws Gritting t0 building construction, and BOILER-COMP(3H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to eater upon the BOILER-COMP IOver 100,000 BTU),SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, Indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and ex,i which PERMIT ISSUANCE 10.00 d i CONST.TAX
may in any way accrue against said City in consequence of the
grantii O'BU m MECH.CONT, LIC.NO. MECH.
TOTAL l9 w TOTAL 13 if
q�%'
X Sig tote of Applicant/Contractor Date ('
OFFICE COPY