8230 POST THIS CARD NEAR FRONT OF BUILDING.
PFRAIIT NUMBER
M . CITY OF CUPERTINO �3Q
INSPECTION DIVISION
JOB INSPECTION RECORD
�• PERMIT EXPIRATION
JOB ADDRESS 10 /- UNIT LOT# '
• - PERMIT EXPIRES IF WORK
OWNER coNTRAcrOR - IS NOT STARTED WITHIN.
INSPE TION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- '
FOUNDATION NCE OR 180 DAYS FROM
UFER
LASTCALLED INSPECTION.
� ,
PREGUNITE - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED (3
UNDERGROUND /SLAB J/
PLUMBING - 5 ' I 7 I '
ELECTRICAL
I ISSUANCE DATE
MECHANICAL - BLDG. ELECT, PILO. MECH.
❑ j ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED- BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION' $/FT.
MECHANICAL
ELECTRICAL
J PERT.uT To
i
FRAMING
INSULATION STORIES .TYPE CONSTR.
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNElsA
ROOF SO.FT,FLOOR AREA TOTAL ACREAGE
DIAPHRAGM CIN
BUILDING USE
RES IND CON PB Olnrr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ El El E] E
ROUGH
ASSESSORS PARCEL NO.
GAS TEST ,�
PLUMBING '
TRACT NO. PARCELNO.
-
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING N # '
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS
MECHANICAL + FIRE SPRINK ENERGY T.2<
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y "� Y "[_]
LATH-INTERIOR ELECTRICAL ' FLOODZONE AL.UC.
LATH-EXTERIOR FIRE DEPT. Y,o -❑ y N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING I '
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
UCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY 13UILOING INSPECTOR. MICROFILM' '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 1
I- 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
CALLING FOR FINAL INSPECTION. - TOTAL { '
OFFICE COPY
APPLICANT TO,FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT /� 1
G3
aDDRE95 ,l / ^O
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL j�(J
OWNERSPLAN CHECK VALIDATION
NAME PTV ELECTRIC PERMIT FEE
ouE
nque CHES
acrona / UTLETS-SWIT -RECEP /1.00 PMD
rn
/LRS/L S ��L/ LIC.NO Y6s LIGHTING FIXTURES 10.00/1.00 p g
CONTRACTOR SC/O/ PPLIANCES-RESIDENTIAL 4.00 MAR 18 1998
6 vHon S PANELS 10.00 DATE OF APPLICATION
ARCHITECT
OR PANELS (OVER 200 AMPI 20.00 '"fir"m 0 .C.NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDRESS Eua SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
APPLICANTS
ADDRESSMOTORS SEE FEE SCH.
' SERVICE CHANGE 20.00
w
09 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
a u 1 hereby affirm that 1 am licensed under provisions of Chapter 9
z ISSUANCE DATE
a (commencing with Section eose i of Division 3 of the Business and BLDG. ELE T. PLG. MECH.
c, o z LicenProfessionsla Cole,_and my li�enx is in full force n cffe L - ❑ ❑ ❑
i'�', License Class_sem-_/ !L IL NumM;r
,a F Date Conlmelor
y w M
m a OWNER-BUILDER UE RA ON BLAILDING PERMIT
E
a o> D INFORMATION
w 3 0 N I hereby affirm that 1 em exempt Irom the Conlrector'a License MISC.- REFER TO ORD
u O j Law for the following feasor.(Sea 7031.5,Burivessand Professions VALUATION 5/FT.
- PERMIT ISSUANCE 10,00
Code:Any City or county which requires a permit to comtroct,alter,
a improve,demolish,orrepair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
- DLL requires the applicant for such permit to File A signed statement that TOTAL
m he u licensed pursuant to the provisions of the Contractor's License P MIT TO
ce a a Law(Chapter 9(commencing with Section 7000)of Division3ofthe
i D Business and Professions Code)or that he is exempt therefrom and PTV. PLUMBING PERMIT FEE
r$ the basis for the alleged exemption.Any violation of Section 7031.5
a ; by any xpplicim for a permit subjects the applicant In a civil penally STORIES TYPE CONSTR.
of not more than five hundred dollars(S500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ 1,as owner of the or my employees with wage
will do the
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. 7000, Rusinas and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code: The Contractor's License law doe,not apply to an owner of
properly who builds or improves thereon,and who does such work F IXTURES-PER TRAP 5.00 50.Pr.PLooq agEa 'orae ACREAGE
® himself or through hu mprove-
own employees,provided that such improve- -
menti are not intended or offered for sale if,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or unprovemenf is Sold within one year of completion, the owner-
builder will have the burden of Proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
Poole for 1,as ownerose
of Nalthe
INVUSTR1AL WASTE INTER. 30.00 RES I❑ ON ❑ Obur❑
❑ I,as owner of the pmtruct he exclusively contra, ing with
IicenxJ contractors to construct the project(Sec 71340,liminess LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
a"Professions Code:The Contractor's License law does not apply
to an owner of n,perty who builds ur imp s thueon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
C
n acts to
c projects with a act licensed pursuam to
th antr tor's i SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO.
I e, cx P u ec. this WATER HEATER W/VENT 6.00
son
caner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
W'ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a cerlificam of consent to self houre.
or a certificate of Workers'Compensalion Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lub.C.). +'
Policy No. Company
0 0 Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is fled with the city inspection division.
0 Applicant MISC.- REFER TO ORD. V ❑ IN Y ❑ NE]
CC LO CE R'TI FWATE OF E%IiMPfION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR.
CL 0 (This Section need not be Completed if the f!r LIC.NO. TOTAL Y[] N� V� IN
� Z p permit is for one
U O hundred dollars($100)or Icss)
I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUARY
LL F mit is issued,I shall not employ any person in any manor's,as to MM
U become subject to the Workers'Compensation Laws of California.
W Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Ccoific.m of Ex-
? emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall he deemed revoked, AIR HANDLING UNIT(TO 10=1C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,0000.E14) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the perfnmlance ,f the work for which this pen it is issued(Sec. MICROFILM
3097.Civ.C.1. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nome
Lender'sAddress HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify Ihat I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree 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
herebhereby authorize roperty forms of this city es citler upon the BOILER-COMP (Oxer 100,000 BTU)SEE FEE SCH. MECHANICAL
y
authorize
property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cu 'to mist liabilities,judgments, costs and expemes which CONST.TAX
m in4M .Way accrue again aid Cil in conx ucnce of the PERMIT ISSUANCE 10.00g ruingl3 permit MECH.CONT. LIC.NO. MECHTOTALTOTAL
Si A licmnl/Contractor Date
OFFICE COPY -