18279POST THIS CARD NEAR FRONT OF BUILDING
PLUMBING ENERGY
CITY OF CUPERTINO
PERMIT NUMBER
18279
148279
INSPECTION DIVISION
MECH.ENERGY'
ELECTRICALOl
BUILDING ENERGY
JOB INSPECTION R ORD
I
`�']�
PERMIT•EXPI RATION
JOBAD RESS_�1 • UNIT# _LOT#
INSULATION
I
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
OR 180 DAYS FROM
LASTCALLED INSPECTION.
INSPECTION DATE INSPECTOR
INSPECTI N RECORD
FOUNDATIONANCE
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
UFER
PR EGUNITE
PERmn vnuunrloN
HEATING
CUPERTINO STANDARDS.
ELECTRICAL RELEASE
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICAL
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING
INSULATION
PAW
/AUG 2 41989
civ of Cupertino
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ROUGH SAN.tt
JILDING PERMI
INFORMATION
TOTAL
Rcs IND CON PR
=VC
TUBS &SHOWER PAN
PLUMBING ENERGY
CAC I NO,
PARCEL NO
MECHANICAL
MECH.ENERGY'
ELECTRICALOl
BUILDING ENERGY
ACC DATE
Acc. ERE No
FRAMING +�iC2�
ELECT. FINAL TEST
INSULATION
PLUMBING
ZONING
ENG SITE NO
GAS TEST
GAS
MECHANICALS
FWE SPRINI,
Y E) N[]
ENERGY T TE
I [D "EI
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE
ELOOD ZONE
Y ❑ "❑
ALUC
`" ❑ N
INTERIOR SHEAR
FIRE DEPT.
SHEETROCK O
GRADE
FEE SUMMARY
EXTERIOR LATH
BUILDING
BUILDING 4 ,
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY
SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
'ARRANGE FOR INSPECTION BY PHONING 252-4505,
LEI ONE WORKING DAY BEFORE REQUIRED INSPECTION.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
-SEE PERMIT FOR EXPIRATION DATE =
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING.FOR FINAL INSPECTION.
TOTAL
vrrwc
,GPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
:. BUILDING PROJECT I DENTIF [CATION
APPLICATION & PERMIT
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
PERMIT NUMBER
1 G
ED LDING
ADDRESS
OWNE
NAME I,
' y PHONE
QTY. ELECTRIC PERMIT FEE
PLAN CHC"I ATION
IF^,
�/ ( - ^�
1rvl-
51 9
O
DATE OF APPLICATION
C TRACTOR'S
E ///�
1. Ic.No. L
� OUTLETS -SWITCHES -RECEP 10.00/1.00
3 LIGHTING FIXTURES10.00/1.00
CONTRACTOR'S
ADDRESS I'yam
NONE {��
0 APPLIANCES -RESIDENTIAL 4.0
PANELS 10,00
ORRCHITECT
NGINEER
uc. NO
PANELS (OVER 200 AMP[ 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ARCH . OR ADORERS ENG.
➢P
SPECIAL CIRCUIT S.00
PERMIT VALIDATION
L
eR`�
DATE -
SLIGO, ELECT. PLG. MECIJ.
❑
TEMP. METER OR POLE INS. 20.00
APPucgrvrs
AOOR�Esj,
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
_
LICENSED CONTRACTORS DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9
(contmencing with Section 7000) of Division 3 of the Business and
Pofessions Code,' 1 my license is in (ell force any effe
License Class�y� Lic. Numbe -
Date F� 4x_ o� CoITtmcIo _
' OWNER -BUILDER DECLARATION
1 hereby aRinn that I am exempt from the Contractor's LicenseMISC.
Law for the following reason. (See. 7031.5. Businessand Professions
Code: Any city Or county which requires a permit m construct, alter,
improve, demolish, or repair any structure. prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that lie is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penally
of not more than five hundred dollars (55001.1:
❑ 1, as owner Of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work
mentslare not hrough improve-
ownemployees, for sale.
mems ore not intended or offered for sale. If, mpleveq the bei Wing
If, ed however, the
.,,Improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.).
❑ 1, as owner of the property, am exclusively contracting with
licensed contractors to construct the project [Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon. and who
contracts for such projects with a contractor(s) licensed pursuant to
the Contractor's License Law.
❑ I am exempt under Sec.-, BAP.C. for this
reason
i:�ISSUANCE
r
41
of
J. - M
BUILDING PERMIT
INFORMATION
- REFER TO ORD
PERMIT ISSUANCE 10.00 O
VALUATION
�O 5
/�a•`J
$/FT.
ELEC. CONTE. LIC. NO. ELEC. ^'7.Oh
TOTAL moi.] VV
QTV. PLUMBING PERMIT FEE
PERMIT TO
Ary. -,IT 0"
PV�V
STORIES
TYPE CONSTR.
ALTER -DRAIN & VENT -WATER (EA.) 5.00
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
FIXTURES - PER TRAP 5.00
GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00
SO. Fr. FLoo A
TOTAL ACREAGE
GAS - EA. SYSTEM - OVER 4 (EA.) 2.00
BUILDING USE
RES No CON PB Omer
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
ASSESSORS PARCEL NO.
u / - _
1 J 60
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
SEWER -SAN V -STORM EA. 200ft /10.00
TRACT NO.
Pq E NO.
WATER HEATER W/VENT 6.00
Owner Date
WATER SYSTEM 5.00
WORE; ERS'COSIPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure.
or a certificate of Workers' Compensation Insurance, or a certified
copy thereof (Sec. 3800, Lab.C.).
Policy No. Company
ACC.DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
ZONING
ENG. SITE NO.
-
❑ Bed y s y�fu to
art ified I tl aty inspection division.
Ap leant
GER' FICATEOE EXEMPTION FROM WORKERS'
CONIPENSATION INSURANCE
(This section need not be completed if the permit is for one
hundred dollars IS 100) or less.)
1 certify that in the performance of the work for which this per-
Pont is issued. I shall not employ any person in any manner so as to
become subject to the Workers' Compensation Laws Ella, ifornia.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec.
3097. Civ.C.L
Lender's Name
FIRE SPRINK
Y [:]NEI
ENERGY T-24
Y E] NEI
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00
FLOODZONE
Y ❑ N
A.L.u.c.
Y ❑ N
PLG. CONTR. ❑C. NO.
PLG.
TOTAL
QTY- MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
g
ALTER OR ADD TO MECH. 5.00 00
.
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10=C.F.M.1 4.00
PLAN CHECK
FEE
A
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00
SEISMIC FEE
ar
EXHAUST HOOD (WITH DUCT) 5.00
HEATING UNIT (TO 100,000 B.T.U.) 8.00
MICROFILM
Lender's Address
I certify that l have read this application and state that the chose
information is nacorrect. I agree to comply with all city and county
ordinances and state laws relating to building construction, and
hereby enthoed representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of
(Cupertino against liabilities, judgments, costs and expenses which
may 'n any ay accrue against said City in consequence of the
kraof This perm
HEATING UN IT (OVER 100,000 B.T.U.)9.50
ELECTRIC
3e(�
VENTILATION FAN (SINGLE) 4.00
BOILER H.P. or 100,000 B.T.U.) 6.00
PLUMBING
BOILER -COMP Over 100,000BTU)SEE FEE SCH.
MECHANICAL
(�
2J •SD
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00 .OG
CONST. TAX
MECH. CONT. LIC. NO. MECH.
TOTAL
IM
TOTAL
Slgnatureof Applican l/Contractor US
OFFICE COPY