12332 POST THIS CARD NEAR FRONT OF BUILDING
PFRAIIT NUMBER
CITY OF CUPERTINO 12332
INSPECTION DIVISION
JOB INSPECTION %ORD
L PERMIT EXPIRATION
JOB ADDRESS ✓`-V �P` T# LOT It
+ PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTIO TE I INSPECTOR /114SPItICTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
1LASTCALLED INSPECTION.
PREGUNITE
UFER E O W0
PERMIT VALIDATION
'
SHow6e
'ICf6le DANZ
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
ISSUANCE GATE
MECHANICAL BLDG I ELECT. PLG. MECH.
❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION SIF^.
-
MECHANICAL
ELECTRICAL - PERMIT TO
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
` ROOF SD.FT,FLOOR AREA TOTAL ACREAGE
Nw DIAPHRAGM-' '
- BUILDING usE
_RES IND CON PB OIM1vI
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST - TRACT NO, PARCEL NO.
MECHANICAL
ACCDATE ' ACC.FILE NO. .
ELECTRICAL FINALS DATE INSP.
FRAMING - SAN *
INSULATION PLUMBING
/ ZONING ENG.SITE NO.
'
1 13 cns
MECHAN GAL FIRE SPRINK ENERGY TN
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATIN r ❑ - "❑ Y E] �
LATH-INTERIOR 1-1-6- 'J ELECT CAL FLDODZONE A.L.0 C.
LATH-EXTERIOR FIRE DE T. Y❑ "❑ r Cl N❑
SHEETROCK } GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING p
SHEAR EXTERIOR TEMPORARYPP OVALS BUILDING 'J
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 ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
t — SEE PERMIT FOR EXPIRATION MECHANICAL
DATE —
�1 IMPORTANT! RCONST.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
BUI LDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION &PERMIT 12332
\i Ao Baso )� BUILDING - ELECTRICAL-PLUMBING -MECHANICAL
/` Ow .a "PLANCHECK VALIDATION
NAME
OTY. ELECTRIC PERMIT FEE
PHONE -
e CONTRACTORS
`( NAME UTLETS-SWITCHES-RECEP 10.00/1.00
1 J Fir LIC.No, / LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS
W HONE PANELS 10.00 DATE OF APPLICATION
OR
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .C.NO.
ENGINEER
TIC.No, SIGNS TRANS. 3.00
�ooaess
eea SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 20.00
APPLICANTS
ADDREss MOTORS SEE FEE SCH. .,-�
SERVICE CHANGE 20.00 -/If p �f
Woo LICENSED CONTRACTORS DECLARATION PA
�/S /a /
¢ u I herebyaffirm that I am licensed under provisions of Chapter 9 - DATE
(commencing with Scctiun 7000)of Divkion 3 of the Business and
res ¢ n EL PLG! MECH.
H N i Professions Cod' nil my license is in fullfore cl. ❑ ❑
Z, i o License Number
as Lic.Numb
L H Uum - Contractor
se a OWNER-BUILDER DECLARATION PERMIT
a o a D MISC.- REFER TO ORD INFORMATION
w
3.. LL 1 hereby affirm that 1 am exempt from the Contractor's License VALUATION E/FT.
F n-O Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 �/
n0 Cale:Any city or county which requires a permit to construct,alter, a T7 )
¢ rt 4 ca Improve,demolish,or"pair any itrawnim prior to its issuance,also ELEC,CONTR, LIC.NO. ELEC. ^C
ui G u requires the applicant for such permit to file a signed statement that TOTAL PERMIT T
' w he a licensed pursuant to the provisions of the Contractor's License q
HiQ law.(Chapter9(commencing with Section 7000)ofDmsion 3 of the
i D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
/ ¢ H 0 the baso for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d ; by any applicant fora permit subjects theappplicant has civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500)J:
❑ 1,as owner of the property,or my employees with wage as BACK FLOW PROTECT.DEVICE 4.DO 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,AR Eq COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 MFT,FLOOR AREA TOTAL ACREAGE
( himself or through his own employees,provided that such improve-
mints sec not intended or offered for sale,If,however,the building GAS-EA.SYSTEM-1 I NC.4 OUTLETS 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-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and ProfessionsCode:The Contractor's License law does not apply
to an owner of property who builds or improve thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
Contracts fors' ecwith a Contractor(s)licenud Panamintanto
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
O l am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner 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 certificate ofconsent to self-inoue' ZONING ENG.SITE NO.
or a certificate of Workers'Compensation 4ourance,or a cvnificd
Copy there S 3800,Lab.C.) b
Polis No. c Company
Q ❑ Cert Idro hereby(sera shed FIRE SPRINK ENERGY T-ZO
Z ❑ Cel]if �o,J�' Is ed c ity inspection division.
V Applicant (�(/aJ�-�,CfG1 MISC.- REFER TO ORD. V❑ N❑ v ❑ N❑
cin CERTIFICATIi0FEXEMPT10N FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A-L.0 C.
W 5 COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. ❑ N❑ v ❑ N❑
CL Z Inis section need not be completed if the permit is for one TOTAL y
hundred dollars IS 100)or I.0
U O 1 certify that in the perfomwnce of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
U_ U it is issued,I shall not employ any person in any manner so a to
become subject to the Workers Compensation Laws of California, v�
i Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING a
} N NOTICE.TO APPLICANT: IL after making this Certificate of Ex-
F = emption,you should become subject to the Workers'Compensation APPLIANCE 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, AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNrr(OVER 10,0MC.F.M.) 6.00 SEISMIC FEE fv
1 hereby effort that there is is construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work Ibr which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ C.).
Lender's Name
Lender's AddHEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
ress
I certify that 1 have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
'information u correct.I agree to Comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinynces and state laws rehiring to building construction, and
•- het'\ ithorize representatives for ins inspection
this city m enter upon the BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
eM �.emioned property for inspection purposes.
( ') agree to sive, indemnify and kap limitless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which' CONST.TAX
may in any way accrue against said City in Consequence of the PERMIT ISSUANCE 10.00
IU-anli g of this permi6 MECH.CONT. LIC.N0. MECH. A-'
/- _ TOTALa;;P 02 TOTAL 9 VL
Signatu fApplicanU ontmctor Da to
OFFICE COPY