8382 "POST THIS CARD NEARFRONT OF BUILDING '
PFRMIT NUMOFR
CITY. OF CARTINO'
INSPECTION DIVISION 8382
JOB INSPECTION RECORD
PERMIT EXPIRATION'
JOB ADDRESS. ffl 'UN # _LOT# '
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT'STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECOR 180 DAYS OF PERMIT ISSU-,
FOUNDATION
ACE OR 180 DAYS FROM
LIFER LAST CALLED INSPECTION.
2
' P,REGUNITE " .E - - PERMIT VALIDATION'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /
SLAB
y
PLUMBING ' ' w
ELECTRICAL'
ISSUANCE DATE
MECHANICAL a ELECT, PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR
PLUMBING ALUAT,ON $)FT,
' - � '- � a ,
MECHANICAL
ELECTRICAL - ERMITTO
. FRAMING '
STORI S
INSULATIONVPE CDNSTR. -
f,
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,FT FLOOR AREA 'TOTAL ACREAGE
ROOF
1� DIAPHRAGM BW.WING USE
RES- IND CON. PB GO,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑
ROUGH
ASSESSORS PARCEL NO. ,
_ I
PLUMBING
GAS TEST TRACT NO. PARCEL NO,
MECHANICAL -
' 'ELECTRICAL
FINALS. DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING .y SAN #
ZONING ENG.SITE N0.
INSULATION PLUMBING '
r GAS
FIRE SPRINK ENERGY T-24
MECHANICAL'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' V ❑ N❑ Y ❑ N❑
LATH—INTERIOR - ELECTRICAL FLOOD ZONE A.L.U.C.
LATH—EXTERIOR FIRE DEPT. : . Y❑ •.N❑ Yo No
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'
77— SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING:INSPECTOR. MICROFILM
uJ ARRANGE FOR INSPECTION BY PHONING.252.4505, ELECTRIC
I.- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING:
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
4
IMPORTANT! CONST:TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
i CALLING FOR FINAL INSPECTION'.. j /I
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
. BUILDING PROJECT,IDENTIFICATION I PERMIT NUMBER
BUILDING APPLICATION & PERMIT ^
Ao s G
BUILDING-ELECTRICAL-PLUMBING.-MECHANICAL
owNER'a . CHECK VALIDATION
J'M1E I DUY,. ''ELECTRIC PERMIT ` ' FEE
tow
NA PHONE •1
P NAMERACTORs UTLETS-SWITCHES-RECEP 10.00/1.00
psi LIc.No. LIGHTING FIXTURES 10.00/1.00
rUNTADDDRESS TDR's APPLIANCES-RESIDENTIAL 4.00
OPHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT - - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDRESS END' SPECIAL CIRCUIT -5.00 PERMIT VALIDATION
APPLICANT'S
ZIP ITEMP.METER OR POLE INS. 20.00
ADDR ss MOTORS SEE FEE SCH.H.
QrAA - SERVICE CHANGE 20.00
w0_o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
Q -
i I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
commencing with Section 7000)of Division 3 of the Business and
m i Professions Cade d m license is in full for�/�Idyf(q��� 0 ELECT. PLG. MECH.
oZ ut o License Class Lie.Number_ !O T'7/ El El
H m H J Dale Contractor �'�-I--+-_-
rt¢ a OWNER-BUILDER DECLARATION
BUILDING PERMIT
` o a U INFORMATION
Ixa 3: u H 1 hereby affirm thatLI am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION E/FT.
F LL O Law for the following reason.(Sec.703 1.5,Businessand Professions
PERMIT ISSUANCE ' 10.00
P, Code:Any city or county which requires a permit to construct,alter,
IS O improve,demolish,or repair any-structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL
w m w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
ri>
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
i 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ H $ the basis for the alleged exemption.Any violation of Secfoa703I.5 STORIES TYPE CONSTR,
d ; .. by any applicant for u permit subjects the applicant to a civil penalty - ALTER-DRAIN (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ Les owner the property,or my employees with wages as
their sole compensatat ion,will do the work,and y e structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions 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' F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 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 sale.). OEM INDCON PB Other
❑ I,as owner of the properly,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ 11licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 600 aEEEEsoRE PARCEL No.
and Professions Cod.;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 contraclorts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
D 'I am exempt under Sec..,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner• Dale , WATER SYSTEM 5.00 ACC.DATE ACG FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EOUIP. 5.00
1 hereby affirm that 1'have a certificate ofconsent to self-insure.
ora certificate of Workers'Compen.tio Insum cc,or' edified ZONING ENG-SITE NO,
copy thereof(Sec.3800,Lab C.)
O Policy No. - Company
s O Cetifted co rs hereby furnished. , FIRE SPRINK ENERGY T-24 ,
Z 2 dCertifie y Is Pled the city inspection division,
O ApplicanEXEMPTION
misc.-
p: REFER TO ORD. Y ❑ N❑ Y ❑ N❑
CC to CE WICATE OF E EMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CIL O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
� Z hundred dollars($100)or less)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mit is issued,I shall not employ any person in any manner so as to
U become subject to the Worker'Compensation Laws of California. D
W Date Applicant ALTER.OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,,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 U FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=0C.F.M.) 4.00
- CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE
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,CP.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.19.50 ELECTRIC I,
I certify Ihat 1 have read this application and stale 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
herebyauthorize representatives this city l0 enter upon the
above- BOILER-COMP(Over 100,000 BTU)BEE FEE SCH. 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,to nts, costs and expenses which PERMIT ISSUANCE 10,00 CONST.TAX
ma in y accrue ag said City in consequence of the
gra is permit.
i y CH.CONT. LIC.NO. TETAL TOTAL
azure of Applicant/Contractor ate ,
I OFFICE COPY