09931 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF . CUPERTINO a �
INSPECTION DIVISION
JOB INSPECTION'RECORD'
PERMIT EXPIRATION
• JOB ADDRESS LOT#
F PERMIT •EXPIRES IF WORK
OWNER CONTRACTO IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
UFER
LASTCALLED INSPECTION.
PREGUNITE - PERMIT VALIDATION 1�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL a ELECT. PLG. MECH.
❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 'I BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION $/FT.
- - � ,
MECHANICAL
ELECTRICAL PEHMITT .
FRAMING
INSULATION STORIES TVP CONSTR.
OCC,GROUP RES
UNIT
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED _
ROOF * I • SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM -
BUILDING USE
HES IND CON PB Otnw
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ❑ ❑'-' ❑ ❑
ASSESSORS PARCE L NO.
ROUGH
PLUMBING ,
GAS TEST TRACT NO. ,PARCEL,NO.
MECHANICAL '
ACC.GATE AC�FILTE NO.
ELECTRICAL FINALS DATE INSP. .
FRAMING SAN # _
r ZONING ENGNO.
INSULATION PLUMBING
GAS
MECHANICAL' FIRE SPRINK ENERGVT.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ - y ❑ "❑
LATH—INTERIOR ELECTRICAL FLOODZONE A.L.V C.
LATH—EXTERIOR FIRE DEPT. P❑ N❑ v ❑ N❑ '
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING .. -
SHEAR EXTERIOR TEMPORARY'APPROVALS' BUILDING
FIREWALLS ELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, .MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ID'- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING:
- SEE PERMIT FOR EXPIRATION-DATE - MECHANICAL
IMPORTANT! CONST..TAX
r PLEASE READREVERSESIDE BEFORE, .,-TOTAL '
CALLING'FOR FINAL INSPECTION:
• OFFICECOPV
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATION - PERMITNUMBER
EBs
AQ7tc _ - APPLICATION & PERMIT
y A;� 09931
( C2 MO,S.A BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
oNAME s PLAN CHECK VALIDATION
L
NAME
t QTY. ELECTRIC PERMIT FEE
q � cicflt PHGNE371-g2Ct7
CONTggCTO '
y/ rvamE OUTLETS-SWITCHES,RECEP 10.00/1.00
VlC-�GG- -Ptf-f uc.ry a LIGHTING FIXTURES 10.00/1.00
CONTEAsrorvTRCONTRACTORSAPPLIANCES-RESIDENTIAL 4.00 -
55� Me- Cvhfuee 1HONE377 3H$ PANELS 10.00
ARCHITECT DATE OF APPLICATION
ORPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH.OR ENG.
ADDRESS SPECT AL CIRCU IT 5.00 PERMIT VALIDATION
ZIP - EMP.METER OR POLE INS. 20.00 q
APPucarvrs MOTORS
aooREss SEE FEE SCH. -
SERVICE CHANGE 20.00
W O LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
tii w 1 hereby aflirm that I am licensed under provisions of Chapter 9 -
m a n (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
r 7 2 'Professions Code nd my license is in full force an eft et. - BLDG. ELECT. PLG. MECH.
z O�_ - icense las Lic.Num6erQ�
z w DIale /p, �j75+�j��/-
F m I- on actor. ❑ ❑ ❑
E ¢ w BJai OWNER-BUILDER DECLARATION BUILD NG PERMIT
w3 a- uHi I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD 111 MATION
F u O at Law for the following reason.(Sec.7031.5,Business and Professions - VALUATION $/FT.
m PERMIT ISSUANCE 10,00 / ^
Aic my Code:Any city or county which requires permittoconslruct,Aller,
Q Q improve,demolish or repair any structure,prior l0 its issuance,also5D;FRIAINS-
LIC.NO. ELEC. p O
u ar c LL requires the applicant for such permit to file a signed statement that TOTAL CI
m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Czi Law(Chapter 9(commencing with Section 7000)of Division 3 of the
x o Business and Professions Code)or that he is exempt therefrom andPLUMBING PERMIT FEE r"�sv7E-T
lC H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n3 by any applicant for a permit subjects the applicant to a civil penaltyALTERDRAIN -WATER (EA.15.00
of not more then five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages asBACKW PROTECT.DEV ICE
their sole compensation,will do the work,and die structure is not 4.00 OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and ProfessionsLOOR,ROOF,AREA,COND. 5.00Code:The Contractor's License Law does not apply to an owner ofproperty who builds or improves thereon,and who does such workF IXTUR ES-PER TRAP 5.00
'. himself or through his own employees,provided that such Improve- SO.FT.FLOOR AREA TOTAL ACREAGE
ments are not intended oroffered forsale.If;however,the building GAS-EA.SYSTEM-i INC.4OUTLETS 6.00
or improvement 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
prove for purpose of e.)' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Grner
th
❑ a5 owner of the property, exclusively contracting with El El El El El.V.B. .00
licensedd contractors to Construct thehe project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 VB6
and Professions Code:The Contractor's License Law docs 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 for such projects with a contreetod s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00TRACT NG. PARCE_LN 0
❑ Into exempt under Sec. ,BAP.C.for this
reason WATER HEATER W/VENTY 6.00
Owner nate WATER SYSTEM 5.00
ACC.GATE ACC,FILE NO. -
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate of consent to self-insure;
or a certificate of Workers,Compensation Insurance,or a certified ZONING ENG.SITE N0.
cmtllpWy;tlf]��Vrjgof( eC 3800,�L(apb�.C. .
O ❑ Certified cavy is h eO�rnishe
Z Z ❑ lific CeroPy is ith he city inspection division. FIRESPRINK ENERGY T 24
F Applicant �15MISC. REFER TO OR D. ,r'i Y NE Y ❑ N[
ir > CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 1 FLOOD ZONE a.L.u.C.
W ' COMPENSATION INSURANCE PLC.CONTE. LIC.NO. PLG. 1
1 O (This section need not be completed if the permit is for one TOTAL t Y N� Y❑ IN
Z hundred dollars IS 100)or less.)
U,O I certify that in the performance of the work for which this per-
LL F mit is issued,I shall not employ any person in any manner so as to CITY. MECHANICAL PERMIT FEE FEE SUMMARY
O W become subject to the Workers'Compensation Laws of California.
y Applicant
Date ALTER OR ADD TO MECH. Z
} to Date
TO APPLICANT: If,after making this Certificate of F:x- F. 5,00 BUILDING Sa S
)- Z emption,you should become subject to the Workers'Compensation APPLIANCE x 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,0010C.F.M.) 4,00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MCF.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec.
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
Information correct 1 agree to comply with all city and county PLUMBING.
ordinances and state laws relating to building construction, the BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree W save, indemnify and keep harmless the City at MISC.- REFER TO ORD,
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue Aga' st said City in consequence Of the PERMIT ISSUANCE 10.00
gra oft his pet MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
PC o pp Ica on tactor IJate
OFFICE COPY