12280 POSTTHI CA RD NEAR FRONTOF.BUILDING '
OF CUPERTINO PE
RMITNUMRER
INSPECTION DIVISION .
12280
JOB INSPECTION RECORD. \
PERMIT EXPIRATION
JOB ADDRESS NI LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION- DATE INSPECTOR / I SP CTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
LIFER
PR EGUNITE - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG, ELECT.I PLG. MECH.
Il ID
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED B ILDING P RMIT
- INFORMATION
•WOOD FLOOR, vnwnnON
PLUMBING '
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING 'w
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT.FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM
_. BUILDING USE
LI7 , V f-M1.a.LY /TO-06, RES IND CON PB Go,,-,
APPLY NO ROOFING UNTIL ABOVE HAS B ENMCNED F L*,CeXl I] El ❑ E El
ASSESSORS PARCE
• ROUGH 7LNO,
PLUMBING
GAS TEST i , TRACT NO. PARCEL NO.
MECHANICAL
ACC.DATE ACC.FILE NO.
' ELECTRIC , ,2 2 �'/ FINALS DATE INSP.
AL ,
FRAMING , I SAN # ZONING ENG:SITE No.
INSULATION .L PLUMBING
GAS
FIRE SPRINK ENERGY TZ<
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� N[]
. LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.0 C.
LATH—EXTERIOR A FIRE DEPT. Y❑ N[:j Y ❑ IN
SHEETROCK - 3 GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVAL BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUIL DING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
I
uJ 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
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. '
OFFICE COPV
i /
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT ENTI TION - PERMIT NUMBER
BUILDING APPLICATION & MIT q ^^ O
ADDRESS I G G
C ti��5 �,� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
• NAME rtr,"LL PHOur P QTY. ELECTRIC PERMIT FEE
S.�
CONTRACTOR'S
NA r' OUTLETS-SWITCHES-RECEP 10.00/1.00
P Ic.uo. -/ v LIGHTING FIXTURES 10.00/1.00
CONTRACTOR PPLIANCES-RESIDENTIAL 4.00
ADo Es SCLy $t�uPLIVI ��
♦ C PHONE a.Q,-f2` PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CNECK FEE P.C.NO.
OR
ENGINEER
LIc.NO. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT S.00 PERMIT VALIDATION
ADDRESS
ZIP rrEMP.METER OR POLE INS. 20.00
APPucANr•s MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
'02 LICENSED CONTRACTORS DECLARATION
u I hereby affirm that I am licensed under provisions of Chapter 9 1ANLE DATE
Gz:w (commencing with Section 7000)of Division 3 of the Business and
0 2 Professions Cod' d y license is in full to ¢ff9C}. LOG. ELECT. PLG. MECH.
z o License C ss � Lic.Number- G'1L-1'= i111r ❑ ❑
9 w H w ate '� Contractor SMV
x s \ BUILDING PERMIT
5 ¢i OWNER-BUILDER DECLARATION INFORMATION
wa MISC.- REFER TO ORD
3 N I hereby affirm that 1 am exempt from the Contractor's License VALUATION $/FT.
F LLoa Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 j� 0
Code:Any city or county which requires a permit 10 construct,alter, O
2 a a p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
O to requires the applicant for such permit to file a signed statement that TOTAL ` PERMIT TO
n w$w he is licensed pursuant to the provisions of the Contractor's License /
H Z Q Law(Chapter 9(Commencingwilh Section 700()of Divisum3ofthe SO GHQ-,O,/ U/-I
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 Section 7031.5 STORIES TYPE CONSTR.
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 dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW 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
property who builds or improves thereon,and who does such work FIXTURES•PER TRAP 5.00 SEE 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-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM•OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors t0 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 forhprojects Law.withacontractor(s)licensed pursuant to
the Contractor'sctor'sh LicenseSEWER-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.DATE ALC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5,00
I hereby affirm that I have a certificate ofconwnt to self-insure.
or a certificate of Workers Compensation Insurance,or ttificd ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.I /
Policy No.-Company _f /)7
O 11 Certified copy is hereby furnish FIRE SPRINK ENERGY T24
Z _Certified copy filed sol C cl y itslpection division.
-�,o,•� MISC.- REFER TO ORD.
FPlicant2x•t_y^^__SIS - v❑ N❑ V ❑ N❑
it CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
aa (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
D Z hundred dollars(SI00)or less.)
U 0 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P mit is issued,I shall not employ any person in any manner so as to
OU become subject to the Workers'Compensation Laws of California.
Ed Date ApplicantALTER OR ADD TO MECH. 500 BUILDING
} % NOTICE TO APPLICANT: If,after making this Certificate of Ex . .
F. Z emption,you should become subject to the Workers'Compensal ion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Cade, you must forthwith Comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO I0=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE rST
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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.C.).
Lender's Name
Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that 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.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000BTUI SEE 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 'ud nts, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way ac a age. sa City in consequence of the
granting of tlsis rmi MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL Cf
Signature of ApplicanLICont actor Date
OFFICE COPY