C 8177 POST THIS CARD NEAR FRONT OF BUILDING
PFRMIT NUMBER
CITY OF CUPERTINO '
INSPECTION DIVISION 1 O QQq i• [►y
7
JOB INSPECTION RECORD
PERMIT EXPIflATION
JOB ADDRESS - IIfI�A�l J # LOT# PERMIT EXPIRES IF WORK
OWNER - CONTRACTOR • . IS NOT STARTED WITHIN
INSP CTIO DATE INSPECTOR INSPECTION RECORD IOU DAYSOFPERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM.
LASTCALLED INSPECTION. .
LIFER . '
PREGUNITE " _ PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
All"
�P
PLUMBING �-
.
ELECTRICAL ISSUANCE DATE
MECHANICAL BLD ELECT. PLG. MECH,
E Ll
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WINFORMATION
WOOD FLOOR
VALUATION $/FT.
PLUMBING
MECHANICAL `
ER TO
ELECTRICAL
FRAMING
AST IES TVP ONSTR'
INSULATION
CC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
i ROOF SO.FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM '
BUILDING USE
RES IND CON PB Opel
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ASSES ORS PARCEL NO.
ROUGH
PLUMBING - ^
GAS TEST TRACT No. PARCEL No.
MECHANICAL
L ACC,DATE ACF FILE N0.
ELECTRICAL FINALS dATE INSP.
FRAMING, SAN # zoNiNc ENC,SITE No.
INSULATION PLUMBING y
GAS
MECHANICAL FIRE SPRINK ENERGYT.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NE) Y ❑ N❑
LATH—INTERIOR ELECTRICAL FLOOD ZONE A,L.U.C,
LATH—EXTERIOR FIRE DEPT. v Q N� v I] NEI
SHEETROCK -j - GRADEFEE 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 SEISMIC FEE
' OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED By BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. u«`° PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
— S EE PERMIT FOR-EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.rax
1'
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
-BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
no ILOING APPLICATION & PERMIT n 7
ADDRESS ^ D BUILDING-ELECTRICAL-PLUMBING-MECHANICAL CA1 I I
' ; - asiVALIDATION
. }1 / DTV. ELECTRIC PERMIT FEE
1 PHO,NrE
CONiRACTOR3 n A knA ' tt U�OPi(,
NAME C (�,f� V l UTLETS-SWITCHES-RECEP 10.00/1.00
uC.NO LIGHTING FIXTURES 10.00/1.00
RROroWs
ADDRESS PPLIANCES-RESIDENTIAL 4.00
aD
PHONE PANELS 10.00 DATE OF APPLICATION
OORRCHITECT PANELS (OVER 200 AMP) 20,08 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
AARCH.OR
DDRESS ENG. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zlv rrEMP.METER OR POLE INS. 20.00 ^ ,J,
aooREss
APPLAPPLICANTSMOTORS SEE FEE SCH. S
p iI e SERVICE CHANGE 20.00
,-02 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 /�/�S
1 i�i 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and
y Q a BLDG. ELECT. PLG. MECH.
H O i Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑
o i w W License Class Lie.Number
Date Contractor
BUILDING PERMIT
¢ o M u OWNER-BUILDER DECLARATION INFORMATION
X ; H 1 hereby affirm That I am exempt from the Contractor's License MISC.- REFER TO ORD
u_a- Q Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
PERMIT ISSUANCE 10.00 `P,♦, '
uty Code:Any city or county which requiresu permit loconslmct,alter, A/S7n_A-O
Q a Q Q Improve,demolish,or repair any Structure,prior to Its Issuance,also ELEC.CONTR. LIC.NO. ELEC.
c¢ requires the applicant for such permit to file a signed statement that TOTAL MIT TO
wZQ he is licensed pursuant to the provisions of the )o fDivision 3Critie `�gT `d
H i Law(Chapter and
Pro(commencingsionsde)or Section is exempt
the of o of the / T J
IS 4 O Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT F
IS r � the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
e. ; by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER IEA.( 5.00 of Cupertino
of not more than five hundred dollars(SSOOM: CI I)
❑ I,as owner of the property,or my employees with was
their sole compensation,will do the work,and the stnldure is ages no[ BACK FLOW PROTECT. DEVICE 4.00 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 -
propertywhobuildsorimprovesthereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such int prove.
building
Rents improv not mens is sold w thinoffered
one y ar o If.however,thetthe owner. GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 (EA) 200 BUILDING USE
builder will have tire - . - . .
e burden of proving that Ire did not build or int- RES IND CON PB Omer
prove 1,aso neeose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ d as owner of the properly,am exclusively contracting with
licensed inions od to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 A SESSORS PARCEL NO.
and Professions Code:The Contractor's License s th does not apply
to tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contrazlod s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
ilia Contractor's License Law. TRACT N0, PARCEL N0.
❑ lam axe t I r ec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owncr� NilWATER SYSTEM 5.00
ACC.OATE ACC.FILE NO.
WORK ERS'COMPENSAT1ON DECLARATION WATER TREATING EQUIP. 5,00 -
I hereby affirm that I have a Certificate of consent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ CerHtlCd copy is hereby furnished. FIRE SPRINK ENERGY T49
Z Z ❑ Certified copy is Bled with the city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
Q Applicant V N V N
CCH PERMIT ISSUANCE 10.00
Lu - CERTIFICATE OIENSATI PfINS FROM WORKERS' FLOOD ZONE a.L.u.c.
W > COMPENSATION INSURANCE , PLG.CONTR. LIC.NO. PLG.
CL Z( This section need not be Completed if the permit is for one TOTAL Y[-] N[] Y C:] N❑
hundred dollars IS 100)or less.)
0 O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
W F mit is issued,I shall not employ any person in any manner So as to
O W become subject to the Workers'Compensation Lows of California.
Date-Applicant BUILDING
} tan NOTICE. TO APPLICNT: If ,after making this Certificate of Ex ALTER OR ADD TO MECH. 5.00
H ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
C.) such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 1000041F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 11OLMC.F.M.) 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 fSec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name - HEATI NG U N IT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I Certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 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
) hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP(Over,100,000 BTU)SEE FEE SCH, MECHANICAL
(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 consequence of the
grand f this p Ron MECH.CONT. LIC.NO. MECH.
ff TOTAL TOTAL /V�.
Signa are of Applicant/Contractor U to
OFFICE COPY