8839 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINOnQ Q
INSPECTION DIVISION 8?839
JOB INSPECTION RECORD
I aD PERMIT.EXPI RATION
I JOB ADDRESS U IT# ' LOT
PERMIT EXPIRES IF.WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR I iftP—ECTION RE OR 180 DAYS OF PERMIT ISSU-
FOUNDATION fb . w� ANCE OR 180 DAYS FROM
UFER
G LASTCALLED INSPECTION.
PR EG UNITE A PERMIT VAUDAiON
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING �A/a--
ELECTRICAL �IssuArvCE onrE
MECHANICAL R a ELECT. PLG. MECH.
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION SIFT.
MECHANICAL
- a
ELECTRICAL PERMrt ro
FRAMING
INSULATION s IEs TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF 50 FT,FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
I BUILDING USE
E INp CON PB Ocher
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED E] ❑ ❑ ❑
ROUGH nssessUHS PARCEL• NO.
PLUMBING
GAS TEST -TRACT NO. PARCEL N0.
MECHANICAL
ELECTRICAL _ FINALS DATE IN ACC.DAiE ,ACC.FILE NO.
FRAMING SAN #
INSULATION PLUMBING - zowrvc ENG SIrE No.
GAS
MECHANICAL FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
LATH—INTERIOR ELECTRICAL FLOODZONE A.L.U.C:
LATH—EXTERIOR - FIRE DEPT. Y❑ N❑ Yo No
SHEETROCK GRADE
SHEAR INTERIOR BUILDING FEE SUMMARY
SHEAR EXTERIOR TEMPORARY.APPROVALS
BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY .SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
0ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC '
� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL _
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENT[FICATION _ PERMIT NUMBER
AmLLS
APPLICATION & PERMIT
ADDZi - ICIRESS Q AL 8839 839
owNER'S
NAME PLAN CHECK VALIDATION
OTV. ELECTRIC PERMIT FEE
NOMpRACTDRs UTLETS-SWITCHES-RECEP 10.00/1.00
N'TNON sec.rvo. rf LIGHTING FIXTURES 10.00/1.00
noo esgs'oR's APPLIANCES-RESIDENTIAL 4.00
/®
if
{lis PHONE dF Y - PANELS 10.00
DATE OF APPLICATION
AR HITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMPI 2000.
ENGINEER
LIG NO. SIGNS TRANS. 3.00
ADD ESS srvo. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zlv TEMP. METER OR POLE INS. 20.00
APPLICANT ORFss MOTORS SEE FEE SCH. gA�
SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION TEMP.POLE
30.00
a u 1 hereby affirm that I am licensed under provisions of Chapter 9
y¢ N (commencing with Section 7000)of Division 3 of the Business and DATET. PLG. MECH.
F w z Professions Code =d ense is in full force an fleet
2 o m- License Class_ Le.Number- )
4 z lu Uatt Contractor
�
E, w a OWNER-BUILDER DECLARATIO BUILDING PERMIT
A o soINFORMATION
X ; y I hereby affirm that 1 an exempt from the Contractor's License MISC.- REFER TO ORD
u o v, Law for the following reason.(Sec.7031.5,BmSHICSSand Professions VALUATION $/FT.
r - PERMIT ISSUANCE 10.00
f '^ 0 <in 2 Code:Any city or county which reyuiresa permit reconstruct,alter,
Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
-O¢ requires the applicant for such permit to file a signed statement that TOTAL
u w m m he is licensed pursuant to the provisions of the ContraClor's License PERMIT TO Ew
�Za Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the Swl.L,A-l.r1/� ;40i o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
r the basis for the alleged exemption.Any violation of Section7031.5
STORIES TYPE CONSTR.
a ; by any applicant fora permit subjects the applicant oacivil penalty ALTER-DRAIN ^
of not more than five hundredproperty,
dollars1my employees
IEA.) 5.00 C�Ny�
❑ I,as owner at the will do I of my employees with wages as BACK F LOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not UCO.GROUP RES.UNITS
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 $o.FT FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ment,amnetintendedorofferedforsale.If,however.Ole budding GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose ofsaleJ. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omar
❑ I,as owner of the property,am exclusively contracting with
licensed contractors in construct the project(Sec. 7044,Business0 El LAWN SPRINKLERS-1 INC 5 V.B. 6.00 1
and Professions Code:The Contractors License Law does not apply ASSESSORS PARCEL NO.
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts I,or such projects with v contractoq s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
ZO%Yy� .OX-7- Date WATER SYSTEM 5,00
PCC.DATE ACC,FILE N0.
WORK IiRS'COh1P1iNSAT'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofennsent to self-insure.
or is certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy themof(Sec.3800,Lab.C)'�.'',/I
Policy No. Company_W_6_Qd9 U 1
0 ❑ Certified copy is hereby furnished.
zF,O" Ap❑lcQnrt tifirb �sevil witFIRE SPRINK ENERGY T-24
® ey 'ns ection division.
MISC.- REFER TO ORD. Y 0 N❑ v N�
DCN CER'IIFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U,C.
CL > COMPENSATION INSURANCE PLO.CONTR. ❑c.NO. PLG.
Z (This section need not be completed if the permit is for one TOTAL Y N Y ry
hundred dollars($100)or less.)
EI
0 O I certify that in the performance of the work for which this per- JAURHANDLINGUNII
MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued, I shall mot employ any person in any manner so as to
0 DD become subject to the N'orken'Compensation Laws of California.
Q. Date Applicant LTER OR ADD TO MECH. 5.00 BUILDING /1 y,SZ
} W NOTICE TO APPLICANT: If,after making this Certificate of fix- el
F Z emption,you should become subject to the Workers'CompensationPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. R HANDLING UNIT(TO iQj"r_F.M.) 4.00
CONSTRUCTION LENDING AGENCY T(OVER10=C.EM.) 6.00 SEISMIC FEE /
1 It ere by affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
tine performance of the work for which this permit is issued(Sec.
3097,Civ.C.). HEATING UNIT(TO 100,000 BTU) 8.00 MICROFILM
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
. 'Information is correct I ugly, to comply with all city and county PLUMBING
ordinances and state laws relating to building construction,.and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-
above-mentioned property for inspection puquues. COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs an J expenses which CONST.TAX
may in any way ace a against said City in consequence of the PERMIT ISSUANCE 10.00
\
grant ip¢of[h' perm) MECH.CONT. LIQ NO. MECH.
sl nature of A y y �� rOTAL TOTAL l� 9 Io
g plica.../Contractor Date
OFFICE COPY