C 8300 POST.THISCARD NEAR FRONT OF BUILDING
y I � PEHMp NUMBEN -
CITY OF CUPERTINO (�
INSPECTION DIVISION30
JOB
JOB INSPECTION RECORD
/ PERNII7 EXPI RATION�W"
JOB'ADDR ESS NIT# LOT# PERMIT EXPIRES IF WORK
owNER - CONTRACT IS NOT STARTED WITHIN.
INSPECT 15ATE INSPECTOR TNSPECTION RECO 180 DAYS OF PERMIT ISSU-'
FOUNDATION - - ANCE OR 180 DAYS FROM
LIFER .
LASTCALLED INSPECTION.
PREGUNITE
ps PERMIT VALIDATION '
. S ", -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB /� 'r
PLUMBING _� _�� -
ELECTRICAL 1 —21 ISSUANCE DATE
MECHANICAL _ BER. PL MECH.
7
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED U LOING PERMI
WOOD FLOOR
INFORMATION
VALUATION $/FT.
PLUMBING
MECHANICAL
ELECTRICAL - PERMIT Tp
FRAMING. '
INSULATION - - - - sTORIE Tv CONST �II'
OCC OUP ARES.UNITS V
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,FL FLouR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE .
RES IND J CON- PB Olney
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ El 13 .1:1 - ED
-ASSESSORS PARCEL NO.
ROUGH
PLUMBING i GAS TEST TRACT NO. PARCEL NO.
G. � � ,
• MECHANICAL
. . d]
ELECTRICAL - � FINALS . DATE INSP. ACCDATE ACC.FILE NO
FRAMING SAN # ,'
n ZONING ENG,SITE NO,
INSULATION PLUMBING
GAS
MECHANICAL FIRE SPRINK 'ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - - Y "o ° El, "�
LATH-INTERIOR ELECTRICAL FLOOD ZONE aL.u.c.
LATK-EXTERIOR FIRE DEPT. .. vo "E] .Y0 "[:]
' SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR '- BUILDING -
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GASFEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE, , f
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILOING FINAL IS SIGNED BY BUILDING INSPECTOR.�MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC.
F J�
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL —
-'SEE PERMIT FOR EXPIRATION DATE - r
IMPORTANT! CONST.TAX,
PLEASE READ-REVERSE SIDE BEFOREI
CALLING-FOR FINAL INSPECTION. TOTAL
, OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION _ PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS
/_ 'S
C �L, F BUILDING—ELECTRICAL—PLUMBING—MECHANICAL �� 8 3 0 O
OWNER'S U
NAME ) PLAN CHECK VALIDATION
STD,tJ `s[W•OOL/O OTV ELECTRIC PERMIT FEE /s = Q
PHON O /
CONT /V
NAME -.—R �f
\ �
CONTRACTORS
OUTLETS-SWITCHES 10.00/1.00
NITON D S
Lo,.No. 90/ 'LIGHTING FIXTURES 10.00/1.00
nooeess TOR`S I ' APPLIANCES-RESIDENTIAL 4.00 '
OJ t�)c N6S-rL- PHONEZ Y ZSR D PANELS 10.00 DATE OF APPLICATION
ORCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINE R n
D Z{ (T LIc.No. L Q SIGNS TRANS. 3.00
A oFEas ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
Sos;tH
I 0 z L zip TEMP.METER OR POLE INS. 20.00
APPLICANT'S
ADDRESS MOTORS SEE FEE ,r
SCH.
Q W AIG SERVICE CHANGE I AP^20.00,
.w eco LICENSED CONTRACTORS DECLARATION TEMP.POLE - n30�00
Q v o 1 hereby affirm that I licensed under provisions of Chapter 9
H ¢w _
(commencing with Sectionn 700of Division 3 0([ Business and ISSUANCE DATE
F w i Professions Code,and my license e i effect.
�-C C
s in full force and effect. � -T )[y 4d BLDG. ELECT. I PLG. MECH.
0 Z m W License Class Lic.Number
Date Contractor El El El
QYF
It rc w Q OWNER-BUILDER DECLARATION BUILDING PERMIT
w °' U MISC.— REFER TO ORD INFO MATIO
; LL H 1 hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
HLLoj Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 1096 —' _
EN0 Code'.Any city or county which requires a permit to construct,alter, ( BhpnpJ
6 6 Q D improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. a O (N /x¢
ro u requires the applicant for such permit to file n signed statement that TOTAL PERMIT TO
E:
he is licensed pursuant to the provisions of the Contractor's License S U/L LL( E
HiQLaw(Chapter 9(commencing with Section 7000)of Division 3 ofthe s
z o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE M Of
fic1- m the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CO TR.
d ; _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN (EA.) 5.00 p
of not more than five hundred dollars($500).):
❑ 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 F IXTUR ES-PER TRAP 5.00 S0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
or-co"ale notimprovement is sold w offethin one or year
If,however,thebuildingowner-
GAS-EA.SYSTEM-1 INC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4r(EA,) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- - RES IND
prove for purpose of sale.). INDUSTRIAL WASTE'INTER. 30CON PR Omer
.00
❑ I,as owner of the property,am exclusively contracting with
licensed Contractors to construct the project(See. 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
Won owner of property who builds or improves thereon,and who LAWN SPRINKLER •,-,OVER 5(EA.)_ 1.00 -
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITARV-STORMEA: /1200 .00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this
mason WATER HEATER W/VENT"' 6.00
Owner ��,,� Date WATER SYSTEM 5.00 ACL.DATE ACC.FILE NO.
°2 voal<—E1tS' 'oMPENSAnoN DECLARATION WATER TREATING EQUIP. 5.00
hereby affirm that 1 have a certificate of consent to Self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
X, Copy Policy N-.—Company offSec.3800, ) Writ IIS 9 1)'
O_ ❑ Certified Copy is hereby furnished.
Z� W—Certif co is ed with th city inspection division. FIRE SPRINK ENERGY T-24
O Applicant A„ A — ^- MISC.- REFER TO ORD. y E] N E] v ❑ No
N CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 1$66 G / FLOODZONE A.L.U.C.
LUQ COMPENSATION INSURANCE PLG.CONTR. v N v N
(This section need not be completed if the permit Is for one TOTAL W
Z� Z hundred dollars($100)or less.)
U O I certify that in the performance of the work for which this per, OTV MECHANICAL PERMIT FEE FEE SUMMARY
L U mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California.
It. Date Applicant BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
F. ? emption,you should become subject to the Workers'Compensation APPLIANCE R^� ° 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 10p00C.F.M.) 4:00
CONSTRUCTION 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 (WI {DUCT) QO
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U57 V8.00
Lender's Name O
Lender's Address - H EATI N G UN IT(OV ER 100;0 0B.T.U.)9.50 ELECTRIC
i -\ 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
/\I information correct I retcomply with all city and county PLUMBING // 00
ordinances and state lawss relating
ating to building construction, and BOILER-COMP(3 H.P.or 100,0008.T.U.) 6.00 W
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,1X10 BTU)SEE FEE SCH. MECHANICAL
14above-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 expenses which - PERMIT ISSUANCE 4800 3 CONST.TAX
may in any way a cue against said City in consequence of the
gra Ing Of is pe it. - MECH.CONT. LIC.NO. MECH. Z
5 c3-2f 8f TOTAL 7 6`-V TOTAL
,ognature ofApplicant/Contractor Date
OFFICE COPY
i. _ )
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