10230 a'
POST THIS CARD NEAR FRONT OF BUILDING,
PERMIT NUMBER
CITY OF CUPERTINO 1 R30
INSPECTION DIVISION
JOB INSPECTION RECORD
M �
PERMIT EXPIRATION �
JOB ADDRESS ' U T# - L T# ,' "' `
• - I PERMIT EXPIRES IF WORK
OWNER F,4 CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPEC ION ECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE,OR 180 DAYS FROM
UFER "�6 LASTCALLED INSPECTION.'
PREGUNITE, - pp�.IE- PERMIT VALIDATION
Pr
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
PAIL
UNDERGROUND /SLAB VEC 31
PLUMBING 19
ELECTRICAL DATE
'MECHANICAL BLDG. PLG. EC(+.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR � 1 � vALunnoN $/FT.
PLUMBING
MECHANICAL ••
ELECTRICAL - PERMIT TO
FRAMINGI
6 t-
' TORIES ` TYPE CONSTR.
INSULATION' " 6
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- ROOF • SO.PT.FLOOR AREA TOTAL ACREAGE .
DIAPHRAGM
BUILDING USE
R s IND CON PB - Dom.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El 1:1 ' ❑ ❑
ROUGH AS5ESSORS PARCELNO.
PLUMBING
GAS TEST
TRACT NO. PARCEL NO,
� - � � -
MECHANICAL
ELECTRICAL 'f— (� FINALS DATE INSP. ACC.DATE ACC.FILE No.
FRAMING +. SAN k '
INSULATION jPLUMBING - ZONING ENG.SI TE NO.
GAS
FIRESPRINK ENERGY T-24' MECHANICAL — �
COVER NO WORK UNTI L•ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
. .
LATH—INTERIOR ELECTRICAL - FLOODZONE ALU.C.
LATH—EXTERIOR - —). FIRE DEPT, - Y E] N❑ Y ❑ NI-1
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING '
SHEAR EXTERIOR ITEMPORARY APPROVALS `BUILDING .,
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE yn'•"
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC /
�� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL '
IMPORTANT! coNST.TAx fes,
PLEASE READ REVERSE SIDE BEFORE f
CALLING FOR:FINAL INSPECTION. TOTAL
OFFICE COPY _ i
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION . PERMITNUMBER
BUILDINGAPPLICATION & PERMIT
ADDRESS
flS BUILDING-ELECTRICAL-PLUMBING-MECHANICALaRLAP i
10230
NAME PLAN CHECK VALIDATION
PHONE
V. ELECTRIC PERMIT FEE
NAME OUTLETS
UTLETS-SWITCHES-RECEP 10,0011.00 f
uc.NID 3 LIGHTING FIXTURES. 10.00/1.00
AUOR ENS TOR'S PPLIANCES-RESIDENTIAL- 4.00
n� r PHONE PANELS 10.06 DATE OF APPLICATION
ARCRREDr /„".x`1,1 FiHG PANELS (OVER 200 AMN 20,06 PLAN CHECK FEE P.C.NO.
OR N.hJYI V FRi
ENGINEER
LIC.NO. ISIGNS TRANS. 3.00
ARCH.ORRESS ENG. SPECIAL CIRCUIT 5,66 PERMIT VA LIGATION
ZIP EMP. METER OR POLE INS. 20.00
ADDDREDRESSS SP�i�
AMOTORS SEE FEE SCH.
t/T pp pp '
Inn Aa SERVICE CHANGE 20.00 LC J 19p5
. 02
02 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
City `
iW I hereby affirm that I am licensed under provisions of Chapter ISSUANCE Cipertiao
a n (commencing with Section 7000)of Division 3 of the Business and
In BLDG. ECT. PLG. ECH.
H D z Professions Co and my license is in full fore .
Z o..- License Class_ Lic.Number
2 N r w Datei l7-.. Contractor
< se J BUILDING PERMIT
a ce w< OWNER-BUILD17R DECLARATION INFORMATION
a'xv; n H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO OR
u_ o ot Law far the following reason.(Sec.7031.5,Business and Professions VALUATION ^S/CFT�. /
- g PERMIT ISSUANCE 10.00 F ,I� ��_ iWT
iwYE Code:Any city or county which requiresu permit toconstruct,aheq -
rt R <O Improve,demolish,or repair any shucture,prior lU its iasuunee,x150 ELEC.CTONTR. LIC,NO. �� ELEC. I�x 1
a w m u requires the applicant lot such permit to file a signed statement that K4�x' 39 TOTAL J RMIT TO
he is licensed pursuant to the provisions of the Contractor's License
r z ¢ Law.(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4 o Business and Professions Code)or that he is exempt therefrom and. T PLUMBING PERMIT FEE
RX) 71
M r $ the basis for the alleged exemption.Any violation of Section 7031.5 STOFHE TYPE CONSTR.
u 3 .- 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:
❑ 1,as owner of the property,or my employees wi .00
th wages as BACK FLOW PROTECT. DEVICE 4
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
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 docs such work FIXTURES.PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve.
meats are not intended or offered for sale.If,however,the budding 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
builder will have the burden of proving that he did not build or an. BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB OThar
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
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.200ftI10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
O I am exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKFRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate of consent to vel Ginsure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.L
Policy Na. Company
O $❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
Z Z T Ce died copy`Is t the ci inspec 'on division. MISC.- REFER TO ORD.
Ox App muni V❑ N❑ V ❑ N❑
CC y PERMIT ISSUANCE 10.00
0: CIiRTIFICATF.OPIi MPTION FROM WORKERS' FLOOD ZONE A.L.u.C.
LU COMPENSATION INSURANCE PLG.CDNTH, LI PLG. /
Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ V E] NE]
dollars(S 100)or less.) r
U O I certify that in the performance of the work fur which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued, I shall not employ any person in any manner so as to
0 U become subject to the Workers.Compensation Laws of California.
Date A Imam BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 -�•
2 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 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00 FEE x
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,000CF.M.) 6.00 ISMIC FEE rJ
I hereby affirm that there is a construction lending agency for I 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
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 3
Lender's Address ELECTRIC
I certify That 1 have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 r
information is correct.I agree to comply with all city and county PLUMBING (J,
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby entbori"med representatives Porinspection
ns of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEESCH. MECHANICAL �.
above-mentioned property tativ spe f this
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 10.00 CONST.TAX
may in any way accrue against Said City in eonsequencu of the -
granting oP[his perm'. MECH.CONT. LIC.NO. MECH, p
\� T (358)-T.3 TOTAL TOTAL °
Signature of Applicant/C mclor Date TKE '
- OFFICE COPY