11248 POSTTHIS CARD NEAR FRONT OF BUILDING
.. CITY OF CUPERTINO PERMIT NUM R
L'
INSPECTION DIVISION 11248
- �� JOB INSPECTION RECORD.
fAl, II PERMIT EXPIRATION
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^~=`� JOB ADDRESS IJG na�C NI l� ��' UNIT# LOT# '
I_! I\ PERMIT EXPIRES IF WORK
owNER y r L L VC/I-s Tot S CONTRACTOR hQ Mark WK IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PERMIT VALIDATION
PREGUNITE -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB /U
PLUMBING -Z- Y O o o LLS
ELECTRICAL _ - e/. ISSUANCE DATE
MECHANICAL I BLDG, ELECT. PLG. MecR.
ED El ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT:
PLUMBING �...•
1MECHANICAL '
f ELECTRICALvERMITTo-
FRAMING '
STORRIESS TYPE CONSTR..
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT GLOOR AREA .TOTAL ACRETGE
ROOF
DIAPHRAGM
BUILDING USE
' RES IND CON PB OIFa
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED '
ASSESSORS PARCEL NO,
ROUGH
PLUMBING TRACT NO. PARCELNO.
-
GAS TEST
MECHANICAL
ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS, DATE INSP.
FRAMING - SAN #
ZONING ENG.SITE NO,
INSULATION PLUMBING
GAS
MECHANICAL FIRE SPRING ENERGY U2E
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y NE Y E] NE]
LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.u.c.
LATH-EXTERIOR FI RE DEPT. - Y❑ No vI] No
SHEETROCK GRADE - FEE SUMMARY
SHEAR INTERIOR BUILDING.
SHEAR EXTERIOR - TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT.PERMITTED UNTIL BUILDING FINAL ISSI GNED BY BUILDING INSPECTOR. ,MICROFILM
ARRANGE FOR INSPECTION BY PHONING.252-4505,' ELECTRIC
UJ ONE WORKING DAY BEFORE 'REQUIRED INSPECTION.
0 -PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
Z
- SEE PER FOR EXPIRATION DATE - MECHANICAL
IMPORTANTI CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. `r
OFFICE COPY -
APPLICANT�TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BIJI LDING PROJECTIDENTIFICATION PERMIT NUMBER
• SoILDwG APPLICATION & PERMIT ^ n A
AODRESS I G L�
.�B-�/L3 p�-N� [,� 2 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'5 PLAN CHECK VALIDATION
NAME CITY. ELECTRIC PERMIT FEE
X 7- R E tN Ues osP«DNE 739-S4N
CONTRACTOR'S
4 NAME AA OUTLETS-SWITCHES-RECEP 10.00/1.00
N M 2t 1Dek1t _r N.1 LIGHTING FIXTURES 10.00/1.00
ntONT"sTORS C.apat�I ,Z, PPLIANCES-RESIDENTIAL 4.00
lobo /Jb szy ej PHONE 7213 7c7 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OP
ENGINEER
LIC.No._ SIGNS TRANS. 3.00 -
AARCH.ORDDRESS ENG. SPECIAL CIRCUIT S.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 n
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
Woo LICENSED CONTRACTORS DECLARATION
<is I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE '
y 2 w (commencing with Section 7000)Of Division 3 of the Business and BLDG ELECT. PLG. MECH.
r w Z Professions Code,ynd my license is in full fgc t.
z Out - License Class Lie.Lie.Nu
Rmber '-J}(ZJ 4 9 ❑ ❑ - ❑ ❑
O f O Date a L-Q 5" Contractor
2 J BUILDING PERMIT
W ¢ OWNER-BUILDER DECLARATION INFORMATION
wo A D MISC.- REFER TO ORD
;LL N I hereby affirm that i am exempt from the Contractor's License VALUATION $/FT.
F u_ 0 J Law for the following reason,(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00. l
in Code:Any city or county which requiresa permit to construct,alter, �9o-mJ !
2 R ¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. ,LIC.NO. ELEC.
a- - O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
E
2 he is licensed pursuant to the provisions of the Contractor's License
V Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE r
M I-g the basis for the alleged exemption.Any violation or Section703L5 STORIES TYPE CONSTR.
by any applicant for a Permit Subjects the applicant to a civil penalty gLTER-DRAIN -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
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 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsam of intended or offered for Sale.If,however,the building GAS-EA.SYSTEM-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 int RES IND CON PB other
prove.for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I 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 IEA.) 1.00
contracts for such projects with a contractors)licensed punuentto
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL No.
0 I um exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofconsent to Self-insure, ZONING - ENG.SITE NO.
Or a certificate of Workers'Come ton s w�rryy,� etimed
copy lhereof(Sec.3gOQ Lab.CJPF,g 10Prw�
*/ Policy No. Company A& Nils
Q /v ❑ CerlifiedcopyishcrebyfufniShed. FIRE SPRINK ENERGY T 24
Z Z\ ❑ Cc I 'ed - py n f d th the cit inspection division. MISC.- REFER TO ORD.
O Applicant Y❑ N❑ Y ❑ N❑
Fy PERMIT ISSUANCE 10.00 . FLOODZONE A.L.U.C.
CERTIFICATE OF EXEMPTION FROM WORKERS'
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. YE] NE] Y ❑ N❑
�' CI (This section need not be completed if the permit is for one TOTAL
D Z hundreddollars(5100)orlessJ
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,1 shall not employ any person in any manner m as to
U become subject to the Workers'Compensation Laws of California.
0 w Datc Applicant BUILDING Sa
a ALTER OR ADD TO MECH. 5.00 /3
}
In N TO APPLICANT: If,after making this Certificate Ex-
I..
? eruption,idion,you should become subject to the Workers'Compensation
tion' APPLIANCE 5.00 PLAN CHECK Z�
provisions the Labor Code, you must forthwith comply with FEE T2
' (.1 such provisions Or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,00DGF.NL) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10PWC.F.M.) 6.00 SEISMIC FEE - 33
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(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3091,Civ.0 J.
Lender's Name HEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC
Lender's Address
1 Certify Ilet 1 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 001L:ER-COMP(3 H.P,or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to buildconstruction, and
hereby authorize representatives of this ciing ty to enter upon the BOILER-COMP (Over 100,000 STU)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 CONST.TAX
may in any way accrue ag iny�ah'�//�. I�n,fJ nsequen of the PERMIT ISSUANCE 10.00
gra �f th' emit. L�C MECH.CONT. LIC.NO. MECH.
�� /_ I� Cl/ TOTAL TOTAL a 3 a
Signature ofAppcanl/Conmetor Date OFF
6FICE COPY