8708 POST THIS CARD NEAR FRONT OF'BUILDING
PERMIT NUMBER
T CITY OF CUPERTINO
INSPECTION DIVISION 8708`""'^'-'�
JOB INSPECTION RECORD
- r
, ,I ,fjl FERMI T EXPIRATION
'l JOB'ADDR ESS' //� / 'Uh�7 1 ` ac . UNIT# ♦'LOT#
I 'PERMIT EXPIRES IF WORK
OWNER rrG (SOj'� CONTRACTOR - IS NOT STARTED WITHIN
INSPEC ON DATE NSIGNED
INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - - ANCE-OF, 180 DAYS FROM
' LAST CAL LE D I NSPECTION.
- UFER � - -
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BE
UNDERGROUND /SLAB
PLUMBING - �
i
ELECTRICAL - -
ISSUANCE DATE
MECHANICALBLDG ELECT. PLG. ' MECH.
'r . ❑ ' ❑ 1:1 -. . ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR a. INFORMATION '
PLUMBING ALUATI ON SIFT.
,L.
MECHANICAL
ELECTRICAL PERMIT ro ,�/
FRAMING
INSULATION
STORIES TYPE CONSTR.
i � � ,
OCC.GROUP RES.UNITS '
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED T
I,
ROOF. , SO.FT.FLOOR AREA TO ACREAGE
DIAPHRAGM fl -
BUILDING USE
RES IND CON • PB Oln,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH
ASSESSORS PARCEL NO.
' '
-PLUMBING -
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
FINALS ACC.DAT ACC.FILE NO.
ELECTRICAL � DATE INSP. ' -
FRAMING SAN #
INSULATION ZONING ENG.SITE NO.
PLUMBING -
GAS
MECHANICAL FIRESPRINK ENERGY T 24 .
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❑ Y ❑ 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 OCCUPANCY SEISMIC FEE
OCCUPANCY OFBUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. 'MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC r �,
Z� ' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
-.SEE PERMIT FOR EXPIRATION DATE - MECHANICAL r
CONST.ONST.TAX
PLEASE READ REVERSE SIDE BEFORE w"' „ ` TOTAL
r .
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PER IT NUMBER -
ADDA s°/ / / APPLICATION & PERMIT
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 8708
NAMER's PLAN CHECK VA�J�°ATION
0NAME / �__ OTV ELECTRIC PERMIT FEE /
/�^'/ A-s 11
PHONE - V CJ �
NAMERacTORs ( OUTLETS-SWITCHES-RECEP 1G:88/1.00
uc.No. LIGHTING FIXTURES -7&00/1.00-FO
ADDRESS APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 - DATE OF APPLICATION
ORRONITEOT PANELS 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER UC.No SIGNS TRANS. 3.00 '
ADDRRESS ENC. SPECIAL CIRCUIT 5.00 - PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS.
APPLICANTS - MOTORS SEE E
AOGRESS
SERVICE CHANGEi IN
oo LICENSED CONTRACTORS DECLARATION TEMP.POLE .0 �
a u I hereby affirm that I am licensed under provisions of Chapter 9 5 C
n <% (commencing with Section 7000)of Division 3 of the Business and CRY of tinuBLDG. ELECT. MECH.
H, w z Professions Code,and my license is in full force and effect �If ❑
Z o w- License Class Lic,Number 0
4 r w Date Contractor '
Y s - BUILDING PERMIT
¢ ¢ w OWNER-BUILDER DECLARATION INFORMATION
aO MISC.- REFER TO ORD
X a. 'y I hereby affirm that I am exempt from ilia Contractor's License /FT.
lir u o et Law for the following reason.(Sec.7031.5,Business and Professions VALUATION
-PERMIT ISSUANCE /?,
Code:Any city or county which requirese permit In construct,,also //AA��
¢ X Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. ELEC. dN � 000
a. a u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
K
he is licensed pursuant to the provisions of the Contractor's License
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe AJ11/..� Tie
i c Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢I- the basis for the alleged exemption.Any violation o'Section 7031.5 STORIES TYPE CONSTR.
a ;�' by any applicant fora permit subjects theapplicant Uoacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
o
of not more than Cohundred dollars(SS O).)
❑ 1,as owner the property, amp or 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 is not
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 F IXTUR ES-PER TRAP 5.00 SG.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- ,r
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-.1 INC.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 im- - REB IND CON PB OtM1e.
prove for purpose of sale.). 1 N DUSTR I AL WASTE INTER. . 30.00
❑ I,as owner of the property,am exclusively contracting with 1:1 1:1 1-1 ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions 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 - SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's Li ense Law. TRACT NO. - PARCEL N0,
X ❑. In e t u ec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Own Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKS OMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00 -
1 hereby affirm that I have a certificate of conserit to self-insom, ZONING ENG.SITE NO,
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.CJ. -
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division.
F O Applicant ' MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LIll. a UCOMPENSATION INSURANCE PLG.CONTR. LIC.NO. TOTPL Y❑ N❑ V❑ NC]Z (This section need not be completed if the permit is for one
hundred dollars($100)or less.)
0 O I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
U. { mit is issued,1 shall not employ any person in any manner so as to
0 W become subject to the Workers'Compensation Laws of California.
Date ApplicantBUILDING .�
} y NOTICE TO APPLICANT: If,after making this Certificate of Ex- I ALTER OR ADD TO MECH. 5.00 -
Z 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
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10PMC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMICFEE
I 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. MICROFILM
3097,Cia,C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
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 is correct. I 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
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL r �
above-mentioned property for inspection purposes.
(We) agree to save, indemnif nd keep harmless the City of MISC.- REFER TO ORD.
Cupertino against s,jud men costs end expenses which' pERM1T ISSUANCE 10.00 CONST.TAX
in any st rd C y.in consequence of the - V '�
gran permit MECH.CONT. LIC.NO. MECH.
s. TOTAL -� TOTAL 9
Signature of Appl" ant/Contractor - Date "
OFFICE COPY -