8414 POST THIS CARD NEAR FRONT OF BUILDING
RMIT NUMBER
r, CITY OF 'CUPERTIN0 414
INSPECTION DIVISION
!
JOB INSPECTION,RECORD, _
PERMIT EXPIRATION '
JOB ADDRESS OO � G UNI 4t—,LO T#
' PERMIT•EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPE TION E INSPECTOR INSP C ION RECO/RD 180 DAYS OF PERMIT ISSU-
FOUNDATION _ _ - meg. 8�0 LLT ANCE OR 180 DAYS FROM ,
LIFER 'LAST CALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE-HAS SIGNED /� /1
UNDERGROUND /SLAB
PLUMBING - of�„ ''
ELECTRICAL
r. .5
' ISSUANCE DATE
MECHANICAL
BEELECT. PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION $IFT.
MECHANICALt — -
ELECTRICAL - PERMIrT -
FRAMING -
INSULATION TDR TYPEc NSTR.
O .G UP FRE UNITS .
PLACE NO-SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROOF SO.FT,FLOOR AREA TOTAL ACREAGE
DIAPHRAGM;
r BUILDING USE
RESIND CON- PB 001e'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ' ❑ .❑ ❑ ❑
ROUGH - ZZASSES50 RS PARCEL NO.
PLUMBING -
r
GAS TEST TRACT NO. -PARCEL NO.
MECHANICAL-
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC FILE ND.
FRAMING SAN tF -
INSULATION - PLUMBING zoNlNc ENC.SITE No.
GAS
° MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' Y ❑ N❑ Y ❑ -N❑
LATH—INTERIOR ELECTRICAL - FLOOD ZONE A.LX,
LATH, EXTERIOR FIRE DEPT. . Y,❑ N❑ Y ❑ No _
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORAR APPROVAL BUILDING
FIREWALLS - ELECTRIC - PLAN CHECK
GAS1 FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. `
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, - ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE #NJ TOTAL •
CALLING FOR FINAL INSPECTION.
OFFICE COPY '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDING PROJECT 1 DENTI FICATION PERMIT NUMBER y
X BUILDING. APPLICATION & PERMIT
AOOR 5R
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK V LIOATI N
ROAD 4
NAME CITY. ELECTRIC PERMIT FEE
PXON {�
CONTRACTOR'S
NAME OUTLETS-SWITCHES-RECEP, 10.00!1.00
. LID.NO. LIGHTING FIXTURES 10.00/1.00
DDRESS DRs
ADDRESS _ PPLIANCES-RESIDENTIAL 4.00
A
PHONE PANELS 10.00 DATE OF APPLICATION
ORCHITECT PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
'IC.No. SIGNS TRANS. 3.00
ADDREOR SS END' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 Y ✓
o ar o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
a u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
r w' (commencing with Section 7000)of Division 3 of the Business and
y ¢ H ELECT. PLG. MECH.
w z Professions Code,and my license is in full force and effect - ❑ ❑
m -
0 o
0 m -w Date - Contractor
0 Lic.Number
License Class
¢ m It DING PERMIT
0
¢ w u OWNER-BUILDER DECLARATION INF ATION
wn w 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD $/FT.
F u 0¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city Dr county whichrequires a permit to construct,alter, ti
ELEC.CONTR. LIC.It¢ improve,demolish,or repair any structure,prior ID its issuance,also ELEC.
w0 u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
Ct w he is licensed pursuant to the provisions of the Contractor's License
H z t
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
¢ Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ r 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
ai$ by any applicant for a permit subjects the applicant toacivilpenalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500)):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Occ.GROUP RES.UNITS
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 ar improves thereon,and who docs such work FIXTURES,PER TRAP 5.06 SO,FT,FLOOR AREA TOTAL ACREAGE
himself re through his own employees,Provided that such improve-
mentsare throughot his orofferedemplo employees,
or pavidedt that
building GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im E IND CON PB Omer
prove for purpose of sale.). I INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to Construct the project(Sea 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 contractors)licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exel rpt and Sec. ,B.&BC.for this. WATER HEATER W/VENT 6.00
on
Owner Dale /d'Q2 WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WO CF. &'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate ofx,mient to self-insure,.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0,
copy thereof(Sec,3800,Lab.CJ.
Policy No.- Company
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T24
Z Z ❑ Certified copy is filed with the city inspection division.
MISC.- REFER TO ORD.
O Applicant V C] N❑ V ❑ N[]
�' rnPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
LU - CERTIFICATE LU I COMPENSATION EXEMPTION PROM WORKf:RS'
fL CI (This section need not becompleted Rif he Fpermit i5 for one PLG.CON LIC.NO. TOTAL Y❑ N❑ Y ❑ N❑
=) Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued,I shall not employ any person in any mannerso as to
O GO become subject to the Workers'Compensation Laws of California.
BUILDING
Date Applicant .
Is. '
} NOTICE TO APPLICANT: If,after making This Certificate of 8x-
ALTEROR ADD TO MECH. 5.00
Z empsyou should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisionions the Labor Code, you must forthwith comply with FEE.
U such provisions or this permit shall be Aeemed revoked AIR HANDLING UNIT(TO 10,OODCF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=11F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency For EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which his permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING-UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
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 relating to building construction, and BOILER-COMPO H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 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 expenses which PERMIT ISSUANCE - 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
granting Of this permit. MECH.CONT. LIC.N0. MECH.
TOTAL TOTAL 33 °U-
SignatureofApplicant/Contractor Date
OFFICE COPY '