10116 I
4 POST THIS CARD NEAR FRONT OF BUILDING
CITY OF" CUPER
' ` I Pv1JMIT NUMBER
.. TINO � � , � �
INSPECTION DIVISION
JOB INSPECTION RECORD
� PERMIT EXPIRATION
JOB ADDRESS Mid_ UNIT# LOT# t PERMIT EXPIRES IF WORK
OWNER CONTRACTOR ' IS NOT STARTED WITHIN
i INSPECTIO ATE INSPECTOR NSPECTION CORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR"180 DAYS FROM
_ LASTCALLE flEL1TION.
LIFER - a
PREGUNITE . Pe IJT VALIDATION , 1 . .
A-0leefl�6 - - AN 221998
POUR NO CONCRETE UNTIL ABOVE HAS B IGNED /� I
UNDERGROUND /SLAB } P'1 'Of CU0eft100
PLUMBING
ELECTRICAL I I r TE
SSUANC DATE
MECHANICAL - BLDG.- ELECT PLG. „MEC
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD F 00- INFORMATION '
PLUMBINGAv
VALUATION - SIFT.
- fL
MECHANICAL -
ELECTRICAL - PERMIT TO
FRAMING
INSULATION �� STORIES' TYPE CONSTR.
• ' .�—- &": .tis Z%
OCC.GROUP RES.UNITS
PLACE NO E FLDOR UNTIL ABOVE HAS BE N SIGNED %' I
r, ROOF SO.FT.FLOOR AREA TOTAL ACREAGE
t '
yCn
DIAPHRAGM
BUILDING USE
+ r RES ,IN coN PB OUher
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ '❑' ❑
ROUGH Durr- ASSESSORSPARCEUNO. .1
PLUMBING p
GAS.LEST ,TRACT NO.. PARCEL NO.
MECHANICAL
OATE ACC FILE NO.
ELECTRICAL L[ ,� FINALS DATE INSP. ACC. •
FRAMING SAN #'
INSULATION -
PL G . / ZONING ENG.SITE NO.
YJ
GAS
MECHANICAL, I 1 FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ iv❑ Y ❑ N❑
+n FLOOOZNE 'A,L.U.C.
LATH-INTERIOR Q=1-.% - ELECTRICAL O
C
LATH-EXTERIOR. - -f _ FIRE DEPT. Y❑ N❑ Y0 N❑
SHEETROCK - _ ., �_ . GRADE FEE SUMMARY -
SHEAR INTERIOR p= y--' ' BUILDING
SHEAR EXTERIOR — p_ TEMPORARY AP R_OVALS BUILDING
FIREWALLS ELECTRIC t 119 PLAN CHECK
. . GAS II I3 b FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED ITCCUPANCY I I SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING .
z PLEASE GIVE•JOB ADDRESS WHEN PHONING. .
— SEE PERMIT FOR EXPIRATION DATE — TAX
CONST.MECHANICAL
"
IMPORTANT! -
PLEASE READ REVERSE SIDE BEFORE
CALLING'FOR FINAL INSPECTION. TOTAL ! -
' OFFICE COPY - ,
PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
-� AUkDING PROJECT I DENTIFICATI ON J PERMITNUMBER
pU"LADDRESS APPLICATION & PERMIT 10116
AOOREss•
i �rr .� Lor' 6 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OW SR 9BCK VALIDATION
"AME OTY. ELECTRIC PERMIT FEE L,/
I.0 PNONE DSV
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 AN 2 2 1986
Fllx CIC. h LI.,No. LIGHTING FIXTURES 10.00/1.00 {
CONTRACTOR
ONT ACTORS APPLIANCES- 4.00 city of Cin
q _G vertino
PANELS 10.00 DATE OF APPLICATION
ARRCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO,
O
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH,EOR E"O' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH. I(J
AOOREss
SERVICE CHANGE 20.00
' 02
oo LICENS17D CONTRACTORS DECLARATION TEMP.POLE 30.00
¢ u 1 hereby affirm that I am licensed under provisions of Chapter 9 tISS2CE DATE
<a (commencing with Section 7000)of Division 3 of the Business and BLDG. CT. PLG. MECH.
r n i Professions Code, my license is in full force and effect. [:] ❑ ❑
p i H W License Class Lic.Number
F W H J
Date.Contractor
¢ 't rc a OWNER- BUILDING PERMIT
0 a D BUILDER DECLARATION INFORMATION
w ; u I- 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
ca �. O Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
,A0 Code:Any city or county which requires a permit to construct,alter q
¢ au ¢ o improve,dbnmlish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. B O C
i - O a- requires the applicant for such permit to file a signed statement that ' TOTAL p F/TYVV
w he is licensed pursuant to the provisions of the Contractor's License
z i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
w 1-
a l-$ the basis applicant
thea ora exemption.subjects
is the
plica oto action malty STORIES TYPE CONSTR.
a ; by any
.aretha fora permit subjects S500).licam toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 (.1
of no[mora owner
five hundred dollars(my em o C.!
❑ 1,as owner at the property,or my employees with re is not
BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the with
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 does such work FIXTURES-PER TRAP 5.00 SO.FT,FLO RAREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve- 3� QS''
ments are not intended or offered for sale.If,however.the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- . DING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES CON PB Omer
❑ 1,as owner of the property,am exclusively contracting with1:1 11
licensed contractors to construct the project(Sec. 7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPA EL NO.
and on
Professis Code:The Contractors License Law does nal apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 O
contracts for such projects with a contractmis)licensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 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,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5,00
1 hereby ffir a I ha e a certificate of consent to self-insure.
o a elai(ic to of o cis ompensation Insurance,or a certified ZONING ENG.SITE NO.
c P 0A 17
P
O ❑ Cert Ie coy s leve y rais FIRE SPR INK ENERGY T-24
Z Z jY Certified cop 's B d w t d , city inspection division.
� O Applicant MISC.- REFER TO ORD. YE) N� Y [] N�
CC to CERTIFICA E OF 'XEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.D.
LU COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG.
1 O (This section need not be completed if the permit is for one TOTAL Y[3 NY[] NE]
D Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for wbich this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F 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 Cldil'orniu.
y Date-Applicant BUILDING
} m NOTICE.TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
F Z emption,you should became subject to the Workers'Compensation APPLIANCE 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 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE ,5
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work Joe 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
Lender's Address ELECTRIC
1 certify Ihat 1 have read this apidicallon and state tlsal the above VENTILATION FAN (SINGLE) 4.00
• information is correct. I agree to comply with all city and county BOILER PLUMBING
ordinances and state laws relating to building Conslmetion, and (3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives forms of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
herebya authorize
property forinsp of
ction 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 o2'f lf4
may in any way accrue . ainst said City in consequence of the
grantin of m' p omit. MECH.CONT. LIC.NO. MECH.
,,�� I 1 Q TOTAL TOTAL Ui
Sign roof pplicant/Contractor Data
OFFICE COPY