C 8345 POST THIS CARD NEAR FRONT OF BUILDING RMIT Nun+BeR
8(�
CITY OF CUPERTINO 45
INSPECTION DIVISION C7�
JOB INSPECTION RECORD
-� D✓ - PERMIT EXPIRATION
JOB ADDRESS
— PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTIONIRECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PERMIT VALIDATION
PR EGUNTE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING - •/E Dare
ELECTRICAL ISSOAN
'BLDG. CTr PLG. CR.
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION VFT.
PLUMBING
MECHANICAL
ELECTRICAL PERM/ J �
FRAMING ry
STORIES TYPE LONBTH.
INSULATION
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- SO.fi.FLOOR ARE4 LOiAL ACREAGE
ROOF
'DIAPHRAGM
NuaoIuse
RES IND CON., PB OInPI
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ASSESSORS PARCEL NO.
ROUGH '
PLUMBING
iNAcr NO. PARCEL NO
GAS TEST .
MECHANICAL
ACQ DATE ACG FILE NO.
ELECTRICAL / FINALS DATE INSP. -•
FRAMING SAN ZONING ENG.SITE NO.
INSULATION PLUMBING ..S^
GAS
FIRE SPRINK ENERGVT'34
MECHANICAL - v O NC] Y ❑ IN
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
s - FLODD{o IN
LATH-INTERIOR A.L.u.c.
ELECTRICAL
v0 NF] v ] N[:]LATH-EXTERIOR FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING 3%7't-.r BUILDING
SHEAR EXTERIOR TEMPORAYAP ROV
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
Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBINd
0� PLEASE GIVE JOB ADDRESS WHEN PHONING:
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
CONST.TAX
IMPORTANT!
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
SUI LDI NG PROJECT I DENTI FICATI ON ERMIT NUMBER
auaDlrvc
APPLICATION & PERMIT
A Ki OA 345
DREBS 1I .M LBUILDING-ELECTRICA -PLUMBING -MECHANICAL
o�
OWNERS HECK VALIDATION
NAME 714 22 71 CITY. ELECTRIC PERMIT FEE
D t PHDNF
CO/p/NTRACTOR sSQ 11 .y/- UTLETS-SWITCHES-RECEP 10.00/1.00
/ NG 0 &-SAN911 /O.V sea.NO. LIGHTING FIXTURES 10.00/1.00
r,ONTRAcrons APPLIANCES-RESIDENTIAL 4.00
%s A O Ess Sfi
/ )3t� �j reorvF yY PANELS 10.00 DATE OFAPPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
OC.NO, SIGNS TRANS. 3.00
nooaESS Ervc' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP,METER OR POLE INS. 20.00
APPLICANTS MOTORS EE FEErSCH.
ADORES
SERVICE CHANGE 20.00,
i
woo LICCNSI>U CONTRACTORS DECLARATION TEMP.POLE L30.00 rIP�B'S ��r
a U U I hereby affirm that 1 am licensed under provisions of Chapter 9 _ 46-L. Q ISSUANCE DATE
m a y (commencing with Section 70 se)i of Divi Ion 3 ofthe Business and It O BLDG. Eti6�T, rj el I�f. H
H w z ProfessionsC hhN license is in full for 090 eR/ Ller}:,jJl IIiL--II
z D m - Licens .las Con Number
10
o m r Date Contractor
a m f BUILDING PERMIT
¢ ¢w ¢ OWNER-BUILDER DECLARATION INFORMATION
O REFER TO ORD
wn y I hereby affirm that 1 am exempt from the Contractor's License MISC.- VALUATION E/FT.
IS .. o j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE
Code:Any city orcounty which requires a permit to construct,alter,
6 Q G improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
o¢ requires the applicant for such permit to file a signed statement that TOTAL `'� w PERMIT TO
wmhe is licensed pursuant to the provisions of the Contractor's License
h-ve Law(Chapter9(commencing with Section 7000)of Division 3 ofthe
¢ Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
ea 5- by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS 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 FIXTURES-PER TRAP 5.QU SO.FT.FLOOR AREA TOTAL ACREAGE
h-[self or through his own employees,provided that such improve-
mentsare not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00 4-'.
or improvement is sold within one year of completion,the prowner- GAS-EASYSTEM-OVER 4 IEA) 200 BUILDING USE
�✓ builder will have the burden of moving that he did not build or i . . .
m- RES IND CON PB Ohber
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting withr ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 I Y 5 V.B.I` 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 contractor(s)licensed pursuant to SEWER-SANITARY- TORM EA.200ft/10.00 TRACT NO, PARCEL NO.
the Contractors License Law.
❑ 1 am exempt under Sec. ,B.&P.C.for this WATER HEATER W VENT ti' " 6.00
reason
Owncr Date WATER SYSTEM _ .00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATERTREATING 'UI .'s PV 5.00
I hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
�! ar u cu
Ideate f Workers'Compe In94[ARee,oro certified
copy lhupp( 9gp Lab C,)
Y
Policy Nh/-3/X1 --�nnany P r
O C) Certified copy is hereby furnished FIRE SPRINK ENERGY T-24
Z-Z. ❑ Certi' o isy,ry��d-/,{,w�_it-h the city inspection division. MISC.- REFER TO ORD. y q y N
O� ADD licant.- 4..- /TaQ� ❑ ❑ ❑ ❑
F- wPERMIT ISSUANCE -IA.AO (o FlOODZONE A.L.U.C.
UJ CIi R'(IIICCO :OP SATION INS PROM WORKERS'
UJ _ COMPIiNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
TOTAL Y❑ IN❑ v C] N❑
CL o (This section need not be completed if the permit is for one
=) Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued.I shall not employ any person in any manner so as to
OW become subject to the Workers'Compensation Laws of California.
d Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} y NOTICE TO APPLICANT: 11,after making this Certificate of Ex-
F ? emption,you should become subject to the Workers'Compensal ion APPLIANCE 1117 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 1000DC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING Nrrj(OVER IQOOQC_F.M.) 6.00 SEISMIC FEE 7�
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the pertimnanre of the work for which this permit is issued(SeaHEATING UNIT ITO 700;000h�.(T{91.1 8.00 MICROFILM
3097.Cie.C.). L. /
Lender's Name
Lender's Adds HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
res
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4,00 d'.>
information is correct. I agree to comply with all city and county BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building cunst,uetiou, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,0000TUISEE FEESCH. MECHANICAL
♦ above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE J CONST.TAX
may in any way accrue against said City in consequence of the
Ag goIlh' per L MECH.CONT. LIC.NO. MECH.
: s TOTAL // TOTAL /Jo2 `
Signature of plicant/ ontraclor Date
OFFICE COPY _
/