18508 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 18508
INSPECTION DIVISION
JOB INSPECTION
/RECORD
PERMIT EXPIRATION
JOB ADDRESS �i"� �wv UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER -5 CONTRACTOR .IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ' ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO-COMPLY WITH THE APPROVED PLANS AND CITY OF r mgt VALIDATIONS
CUPERTINO STANDARDS.
GARAGE SLABS � L�L
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL IL!�r%. DANCE DATE
MECHANICAL - eLD ELECT PLG, MEC"
AuG241989 ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
' of cupmft INFORMATION
WOOD FLOOR .o� VALUATION
PLUMBING
MECHANICAL !
ELECTRICALPERMIT TO I
FRAMING
`7'JJ'! ,
INSULATION s*ogles Tvre CONSTR.
OCC GROUP TIES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sO.Fr.FLOOR AREA TOTAL ACReAce
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING Res mo •roN PR O.o„,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. .❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY . .
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING ELECT.FINALTEST zaNlNc ENG.SITE No.
INSULATION - PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY L}<
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD 70NE A U,C.
INTERIOR SHEAR - FIRE DEPT. v❑ N❑ v ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH - TEMPO, A Y APPROVALS BUILDING .��,
SCRATCH COAT ELECTRIC PLAN CHECK
_ GAS FEE
NO TAPE OR PLASTER UNTIL ABOYE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE d
OCCUPANCY OF BUILDING IS NOTTERMITTED UNTIL BUILDING FINAL19SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING252-4505, ELECTRIC
. �� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z° PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
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
BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILOINGAPPLICATION & PERMIT
A�DRE� ,�` 1 `7 �J V jZ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ( V V O S
OWNER'S PLAN CHECK VALIDATION
• QTY. ELECTRIC PERMIT FEE
NAMf
^ PHGNE C, ICT-3
CONTRACTORS
NAME oZOUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.NO. LIGHTING FIXTURES 10.00/1.00
ADOR Ess TORS APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECTPANELS'IOVER 200 AMP) 20.00 PLAN CHECKFEE - P.C.N0,
ENGINEER
LIC'.NO. SIGNSTRANS. 3.00
ARCH.OR ENG. P MIT VALIDATION
ADDRESS - SPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE IN -20.00 -n 1l f i&U)
APPLICo.midsNrs - - MOTORS SEE FEE SCH. ./�/"P
ADOREss
SERVICE CHANGE 20.00 '
wO 0 LICENSED CONTR CTORS DECLARATION
U I hereby sflHin that I am licensed under provisions of Chapter 9 IS NCE DATE
w< a (commencing with Section 7000)of Division 3 of the Business and -% BLDG LECT. PLG. "MECH.
F O i Professions Code,and my license is in full force and effect.
zO i L W License Class Lic.Number vu9
in F
Date Contractor
M m M -+ BUILDING PERMIT
Ono -OWNCR-BUILDER DECLARATION INFORMATION
wg n I hereby affirm that I am exempt from the Contractor's License MISC.- RD
LL a. ¢ Law for the following reason.(Sec.7031.5,Business and Professions pERM1T ISSUANCE 10.00 VALUATION S/FT.
� - Code:Any city or county which requiresu permit to construct,niter,
re ac¢2O improve,demolish,or repair any slrucHoe,prior to its issuance,:,ISO ELEC.CONTR. LIG.NO.. ELEC. 't
sc W w¢ requires the applicant for such permit to file n signed statement that TOTAL PERMT TO
he is licensed pursuant 4l the provisions of the Contractor',License / r�.0/1/
H z i
Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe r
st Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
H the basis for the alleged exemption.Any violation of Seclion703L5 STORIES TYPE CONSTR.
n3 � by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollam($500)J:
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE '4.00
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
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5,00 SG,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
ments are not intended or oftered 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
builder will have the burden of proving that he did not build or int- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 HES IND CON PB other
❑ 1,as owner of the property,am exclusively contracting with ❑ o ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I 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 conlractols)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate ofconsent to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy themcf(Sec.3800,Lab.CJ. ,
Policy No. Company
6 0Certif red copy is hereby furnished. FIRE SPRINK ENERGY T44
Z Z O Certified copy is tiled with the city inspection division.
0 Applicant MISC.- REFER TO ORD. Y ❑ N Y [:] N�
~ m PERMIT ISSUANCE 10.00
LU CIiR1'IFICc6I OPE%IiION INS FROMWORKIiRS' FLOOD ZONE A.L.U.C.
W � COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. PLG.
0- Z 1 '1'his section need not he completed if the Permit is for one - _ TOTAL Y[] N Y 0 N
hundred dollars IS 100)or less.)
L) O 1 certify that in the performance of the work for which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY,
LL I. mil is issued,I shall not employ any person in any manner So as to
O W become subject to the Workers'Compensation Laws of California.
EL Date-Applicant ALTER OR ADD TO MECH. ' 5.00 BUILDING
} W NO17CIi TO APPLICANT': II',after making this Celificate of fix-
Z emption,you should become subject to the Workeri Compensal inn APPLIANCE
F- provisions of the Labor Code, you must forthwith comply with 5.00 PLAN CHECK
U Such provisions or this permit shall he deented invoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.00 FEE
CONSTRUC'T'ION LENDING AGENCY AIRHANDLING UNIT(OVER 10)=C.F.M.) 6.00 SEISMIC PEE x SU
Thereby-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,Cis.C,). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify list 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.6r100,000B.T.U.) 6.00
hereby above-mentioned
representatives for Ins Inspection
this city to enter upon the BOILER-COMP (CYST 100,000 BTU)SEE FEE SCH. MECHANICAL
hereby
authorize
red properly forinsp of
purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
kinagnnsl liahiliticsjudgmentscosts and exp ses which PERMIT ISSUANCE 10.00CONST.TAX
wayanstconthe ispMECH.CONT. LIC.NO. MECH.
TOTAL TOTAL f A ppli R ,Contractor Date e
OFFICE COPY