8933 POST THIS CAPD NEAR FRONT OF BUILDING
CITAF CUPERTINO RAI U
' INSPECTION DIVISION / "!/L `
893
JOB INSPECTION RECORD
PERMIT EXPIRATION
/ JOB ADDRESS �/�(/��/{/ ��//! UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER ,i V l„(JC.J(. CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION LAST CALLED INSPECTION.
UFER
PREGUNITE PERMIT VA U CATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING —'/
ELECTRICAL ISSUANCE DATE
MECHANICAL aLOc ELEcr. PLG. MECH.
[ f D ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR vnwnnoN SIFT.
PLUMBING
MECHANICAL I �1
PERMIT TO
ELECTRICAL '
FRAMING '
INSULATION STORIES I ITVPE CONST.,
OCC.GHOUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.. SO.FL FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM
BUILDING USE
HES IND CON PB Omm
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ 1
ASSESSORS PARCEL No.
'ROUGH
PLUMBING ' '
?RACY NO. PARCEL NO.
GAS TEST
MECHANICAL
ACC.OATE ACG FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN #
ZONINf, ENG.SITE NO.
INSULATION PLUMBING �7—
GAS
FIRE SPRINK ENERGY T-29
MECHANICAL ,Y ❑ N[] Y ❑ N[]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH—INTERIOR ELECTRICAL
aooC zorvE A.L.u,c.
LATH—EXTERIOR FIRE DEPT. Y-� N� Y I] N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING I s',�-7—f(
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
FEE
EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING _
z� PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
CONST.TAX '
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. I .•
OFFICE COPY
I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BL I LDING PROJECT I DENTIFICATI t , PERMITNUMBER
BDLLDING P APPLICATION & PERNO8933
AD RE55
�A � _PC
BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
OWNER �y y�r.F�
NAMp I v .YV�- PLAN CHECK VALIDATION
NAME
` 1 QTY. ELECTRIC PERMIT FEE
I1 ts, PRONE 47
■I CONTRALTO 'S
I NAME UTLETS-SWITCHES-RECEP 10.00/1.00
16 IC.NT LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
OR
ARCHITECT
PANELS (OVER 200 AMP) 20,00 PLAN LHECK FEE P.C.NO.
ENGINEER
LIG NO. SIGNS TRANS. 3.00
ADDRESS ENG. 5.00 CIRCUIT $,QQ PERMIT VALIDATION
2,P EMP.METER OR POLE INS. 20.00
AMOTORS SEE FEE SCH. may/
ADDRESSDDRESS
SERVICE CHANGE 20.00 /�"
o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 �I/S /yf�
¢ v u I hereby affirm that I am licensed under provisions of Chapter 9 ISE ANCE DATE r
to< N (commencing with Section]000)of Division 3 of the Business and B ELECT. PLG. MECH.
H m z License Cla Codc, my license is in lull fort �j.�fl'eS1.�J/iQ ❑
2 o m- License Class_ Lin.Number
Q m Date /� Contractor
a �►� - BUILDING PER IT
¢ ¢¢¢ NCR-BUILDER DECLARATION
U REFER TO ORD INFORMATION
wLL H I hereby affirm that I am exempt loom the Contractor's License MISE- VALUATION 5/FT.
o0< Law for the following reason.(Scc.7031.5.Businessand Professions PERMIT ISSUANCE 10.00
EwCode:Any city or county which requires a permit to construct.alter.
¢Q 0 Improve,dermlisIt,or repair any structure,prior to its Issuance,alio ELEC.CONTR. 'LIC.NO. ELEC. U U U
D ¢ requires the applicant for such permit to file II signed statement that TOTAL ] ERMIT TO
a to m w he is licensed pursuant to the provisions of the Contractor's License
Hi >
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
- a Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ f$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIE TYPE CONSTR.
i 5_: by
any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars(55000.):
❑ 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
'Wended or offered In, sale(Sea 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 F IXTUR ES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
•
himselforof ugh intended
ownemployees,for sale,
If,ed however.
the
In'Prove.
GAS-EA.SYSTEM-l 6.00
mems are not lntc sold or offered for sale If,however,the building
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 (EA) 200
builder will have the burden of proving that h - . . .
e did not buil)ar im- BUILDING USE
prove fors owner of stheJ. � INDUSTRIAL WASTE INTER. 30.00 0RES IND EON PB 0
ther
❑ 1.d as owner of the property,he exclusively contracting with ❑ ❑ ❑ ❑ ❑and
Ped contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
to Professions Code:The Contractor's o improv Law docs not apply
to tr owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a conlradoR sl licensed pursuant to
the Conv;mtori License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
( ❑ lam exempt under Sec.-.B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACG FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certilicatc of consent mscll'-ooue, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
I'c tic No. Company
Q Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Certif co is fol t 'il i ection Division.
zp Applicant ri MISC.- REFER TO ORD, v ❑ N❑ Y ❑ N❑
Z;5 CER'rIFICA I'l OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 ODD ZONE A.L.U.C.
UU > COAPENSAT'ION INSURANCE PLG.CONTE. LIC.NO. PLG.
C Cl (This section need not be completed if the permit is for one TOTAL II�- Y❑ N❑ Y ❑ N❑
::) Z hundred dollars($100)or less.)
U O 1 certify that in the perfornwnce of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued,I shall not employ any person in any manner so as to
Ow become subject to the Workers'Compensation Laws of California. BUILDING JJ11
Date Applicant //(J
a ALTER OR ADD TO MECH. 5.00 l
} h NOTICI!TO APPLICANT: If,after making this Workers'
Compensation
of ion
F ? emptlom you she L become Code, you to use Workers'Compensation App LIANCE 5.00 PLAN CHECK
such lore io the Labor Code, you mus[ forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency lar EXHAUST HOOD(WITH DUCT) 5.00 Ile
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 6.00
lender's Name
Address Addre
Lenders H EATI NG UN IT(OV ER 100,000 B.T.U.)9.50
ELECTRIC
I certify that I have read this application aria state that the above VENTILATION FAN (SINGLE) 4.00
•
it is correct. I agree to comply with all city and county PLUMBING(3
ordinances and state laws relating to building construction, and BOILER-COMPH.P.or 100,000 B.T.U.) 6.00
hereby authorise representatives of this city uo enter upon the BOILER-COMP(Or 100,000 BTU)SEE FEE SCH. MECHANICAL
anmve
bove-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 expenms which CONST.TAX
may in any way ace, e m t S. C'yin eco seque ce of the PERMIT ISSUANCE 10.00
g go ''perm MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Igna are of Applican on roc or e -
OFFICE COPY