C 8662 POST THIS CARD NEAR FRONT OF BUILDING
' 'PERMIT 4UM8EN
CITY OF"CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
�J.// �/ PERMIT EXPIRATION„
JOB ADDRESS / / UNI # LOT#
PERMIT,EXPIRES IF WORK-
. OWNER CONTRACTOR - IS NOT STARTED'WITHIN
INSPECTION DATE INSPECTOR I INSPECTION RECORD Iso Dgvs of PERMIT ISSU `
FOUNDATION - ANCE OR 480 DAYS FROM
UFER .. LASTCAL L ED INSPECTION. I
` PREGUNITE ,, PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - J r /rt l/`•I
UNDERGROUND /SLAB / I
PLUMBING .
ELECTRICAL
ISSUANCE'DATE
M_ ECH ANICAL' -BLDG ELECT. ., PLG. . MECH. ,
❑ ' E ❑. .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 1 BUILDING PERMIT
WOOD FLOOR - - .INFORMATION
VALUATION
' PLUMBING
MECHANICAL
PERMILTO
ELECTRICAL
FRAMING •• j.r✓��.G'1 \ri �I d l
INSULATION
STORIES.. - TYPE CONSTR.
' � � - -
- - _ - OCG GROUP ','RES.UNITS
\`�•��,, PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- ROOF SO,FT,FLOOR AREA TOTAL ACREAGE
Ay DIAPHRAGM
ygy7J BUILDING USE
♦ RES IND - CON PB Omr,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH - .•
PLUMBING
GAS TEST' TRACT NO. PARCEL NO,.
MECHANICAL -
,
ELECTRICAL FINALS '. DATE INSP. ACC.OATE ACC.FI LE NO,
-
FRAMING _ SAN
ZONING ENG.'SITE NO."-
INSULATION - � PLUMBING � '
GAS ,r
MECHANICALFIRE SPRINK ENERGYT'44
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED . HEATING ❑ "0' "••❑ "❑ ,
LATH—INTERIOR ELECTRICAL FLOOUZONE, A1.U.C.
t ,
LATH—EXTERIOR - FIRE DEPT. ❑ NE1 : ° O ' N❑
SHEETROCK GRADE FEESUMMARY
SHEAR INTERIOR - BUILDING - r�
SHEAR EXTERIORBUILDING
TEMPORARY APPROVALS 1 ,
FIREWALLS ELECTRIC ,PLAN CHECK .
GAS . . . FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY -SEISMIC FEE
OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING.FINAL IS SIGNED BY,BUILDING INSPECTOR. MICROFILM -
LE
w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ]
o� ONE WORKING DAY BEFORE REQUIRED INSPECTLON. PLUMBING
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
BUILDING PROJECT IDENTIFICATION PERMITNUMBER
BOILE'SS - APPLICATION'& PERMIT �g 6 6 2
AOGaEss BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
NAME P=TION
J(P/i�•1TION
NAM
OTY. ELECTRIC PERMIT FEE
GA TOSV1 PHONE
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
r0. sM MAY 15. 1985
M� C.NO. S �S3 LIGHTING FIXTURES 10.00/1.00 ,
AA.�TRE�TGR's 5PPLIANCES-RESIDENTIAL 4.00 City of Cupertino
W�L F& 'HONE J�0') a P' PANELS 10.00
GATE OF APPLICATION •
OgcnrtacT PANELS (OVER 200 AMPI 20,00 PLAN CHECK FEE PC.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH
HEENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
1 ZIP rFEMP. METER OR POLE INS. 20.00
AVP LICA NTS
ADDRESS MOTORS SEE FEE SCH.
lzzege SERVICE CHANGE '20.00 �I
w o o LICENSEDCONTRACTORS DECLARATION TEMP.POLE 30.00 (/
a v I hereby affirm that 1 am licensed under provisions of Chapter
w w (commencing with Section 7000)of Division 3 of the Businessand ISSUANCE DATE
P
H 7 i Professions Code,and my license is in full foB ELECT.rce and eflec[ LG. MECH.
❑ ❑ ❑
0 O�$ Llc=uc Clv ' Lr-a.g-,y.. Number
4 �)S•�
ZZ H °w Dmc ]
_ ' 1 �11+ -fr c Cnntracmr
w ¢ OWNER-BUILDER DECLARATION
BUILDING PERMIT
a'xi 0 u H I hereby affirm That I am exempt from the Contractor's License
MISC.- REFER TO ORD INFORMATION
ceLLo Law forthefo0owingreason.(See.7031.5,Business and Professions pERM1T ISSUANCE VALUATION S/FT.
Code:Anycityorcoanty which requir=e permit to Construct,alter,
10'00
BE
2 Q ELEC.
Q improve,demolish,or repair any structure,prior to its issuance,am ELEC.CONTR. LIC.NO.
P.
0 LL requires the applicant forsuch permit to fik a signed statement that
w m he is licensed pursuant to the provisions of lire Contractor's License TOTAL PER
HiQ
I..(Chapter 9 fcommencing with Section 7000)ofDivision 3 ofthe
s 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
T H the basis for the alleged exemption.Any violation of Section 7031.5
n 3 - by any applicant for a permit subjects the applicant Oa civil penalt STORIES T PE CONSTR.
of not mase than five hundred dollen( ):
y ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ Las owner the property,or my 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 u not
intended or offered for sale(Sec. 7044, Business unit Prufcssions DRAINS-FLOOR,ROOF,AR EA,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 so.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
r improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- - . - .
BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER30:-0:0: 11
00 E IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with . 11 ❑ ❑ 1:1lCerI contractors to construct the project(Sce. 7044,Business LAWN SPRINKLERS.- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Prfessiorn Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA,200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec,..BAP.C.for this
res on WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORK ERS'COM PENSAI'ION DFCLARA MON WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent la self-insure, ZONING ENG.SITE NO.
or a certificate of Worken'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby f rnis FIRE SPRINK ENERGY T 24
Z Z J2-CertiOc rs e It the c apection division.
F O Applicant d MISC.- REFER TO ORD. Y [DN❑ Y ❑ NE]
cc CERTIFICATIi OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.O.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
Il O (This section need not be Completed if the permit is for one TOTAL Y❑ N❑ v ❑ N❑
::) Z hundred dollars(S100)or less.)
U O I certify that in the performance of the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit N issued,I shall not employ any person in any t=anner so as to
O w become subject to the Wtolo rts Compensation Laws of California. yy r
CL Dmc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING GG
} w NOTICIS TO'APPLICANT: If,after making this Certificate of Ex-
F.. ? emptlon,you should become subject to the Worken'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 a�
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1C.F.K06.00 SEISMIC FEE aVJV
1 hereby affirm that there is a comtruccion lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lundcri Name
Lender's Address HEATING UNIT(OVER I D0,000 B.T.U.)9.50 - ELECTRIC
I certify that 1 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
f IYdinances and state laws relating to building construction, and BOILER-COfuP(3 H.P.or 100,0008.T.U.) 6.00
teby authorize ed roperty talions of on city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH.
I ubovrmemioned property for inspection purposes. MECHANICAL
(We) agree to sive, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgment,, Costs sad expenses which CONST.TAX
may In any way acc a against said C' in consequence of the PERMIT ISSUANCE 10.00
granting of this perm' MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
re of A pliant Commetor Date
OFFICE COPY