C 9321 POST THIS CARD NEAR'FRONT OF BUILDING'
PERM,I NUMBER
". . . CITY OF--CUPERTINO �, 931
° . INSPECTION DIVISION
JOB INSPECTION RECOR
�c/L2 a
' I y/}• -�f�� PERMIT EXPIRATION ,
'p JOB ADDR ESSLIILiFJG I/IGt� CV• - # LOT#
_ PERMIT EXPIRES IF WORK
OWNER CONTRACTOF' jbjt- S IS NOT STARTED WITHIN ,.f '
INSPECTION DATE INSPECTOR I INSPECTION RECORD 180 DAYS-OF PERMIT ISSU'"
.R�! ,�� ANCE OR 180 DAYS FROM
FOUNDATION - AST LLEDINSPECTION.
UFER �Q -f
PREGUNITE E MIT VALIDATION
urate ��ae7tR�a .y'.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING - ,y,a.m._U,rp,.((.•d - a%//3/r/� o,,
ELECTRICAL (pF�a (NICE DATE
MECHANICAL ^ , a EL CT. PLG. MEC.. .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �� _,?Yr _ UILDING PERMIT
INFORMATION
WOOD FLOORVALUATION s/FT. -
PLUMBING
MECHANICAL
' ELECTRICAL • PERMIT.TO -
rt .
FRAMING
INSULATION . t .oRl TY4117eco"srR. -
• eA'� L
C.GROUP RES.UNITS '
_- --.AP.,LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED �
ROOF /O-F FS� Ff.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM,
OCRILDING USE
HES IND ' CON PB OIL.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - El ❑ •� ❑ E-)ROUGH AssessoR `IRCEL NO.
PLUMBING W '3-pS a T' TRACT NO.-
- GAS TEST - PARCEL NO.-
MECHANICAL '
ACC.DATE ACC.FILE N0,
ELECTRICAL FINALS DATE INSP.
FRAMING SAN # '
ZONING 'ENG.SITE NO.
' INSULATION � � PLUMBING ,
GAS
' FIRE SPRINK ENERGY T 24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ ', "❑ Y ❑ NE:]
FLOOD ZONE. A.LU,C.
.r LATH-INTERIOR ELECTRICAL. -
LATH-EXTERIOR - FIRE DEPT. . Y N❑ Y ❑ No
SHEETROCK GRADE - FEESUMMARY '
' 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 NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ..
ARRANGE FOR INSPECTION'BY PHONING 252-4505 ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
~O� PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE-BEFORETOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
B I LOI NO PROJECT I DENTI FICATION
PERMIT NUMBER
ADSD APPLICATION & PERMIT
ADDRESS
low
R� 1w C7 CV�op BUILDING - ELECTRICAL-PLUMBING-MECHANICALV ,• nn
._/ OWNER'STel ` PLAN CHECK VALIDATION
T
NAME
ply; > ELECTRIC PERMIT FEE
V
NAMERACTOWS r OUTLETS-SWITCHES-RECEP 10.00/1.00
uc.No, (JCI LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
-� ADDRESSAPPLIANCES-RESIDENTIAL 4.00
C
- L PNONE IS-5�3Z' PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
- LIC.NO. SIGNS TRANS. 3.00
ADDRESS E"D' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
'
ZIP EMP.METER OR POLE INS. 20.00 /1 �
ADDRESSTS MOTORS SEE FEE SCH. Ir-'
SERVICE CHANGE 20.00
Woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 •��' //bbb/ATE
< i u I hereby affirm that I am licensed under provisions of Cltapter 9 ISS ANCE
v, Q u (commencing with Section 7000)of Division 3 of the Business and EL ClrPLG. MECH.
r o z Professions Co e, d y license is in full fo d '�• ° '€•�pp
o 0 W Licens la Lic.Numbe �i U' ❑
Date - Con US tor�
� I J BIN99
a z w OWNER-BUILDER DECLARATION I of Cis(^�Pd99 PERMIT
a'x ;A I- I hereby affirm that I am exempt frmn the Contractor's License MISC.- REFER TO ORD
u o `� Law for the following reason.(Sec.7031.$,Business and Professions VALUATION $/FT.
- m - PERMIT ISSUANCE 10.00 �s
sew> 0
Code: structure permittoconsuance,lter, y7�/OOO.
2 ¢ Q O improve,demolish,or repair any structure,prior signed
its issuance,also ELEC.CONTR. LIC.NO. ELEC.
w -A O,u requires the applicant for such permit to file a signed statement that TOTAL PER
A w m he is licensed pursuant to the provisions of the Contractor's License
H z i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
14 c Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
M H the basis for the alleged exemption.Any violation of Section 7031.5 T RIES T PE CONST
d ; - by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN IEA.) 5.00 /.
of not mare than five hundred dollars($500).): Vl�
❑ Las owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 CC.GROUP RES.UNITS
their sole cowner short,will do the work;and the structure is sat
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SO,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-11NC.4OUTLETS 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 im • BUILDING SE
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 - RES IND C PB Other
. .
❑ I,as owner of the property,am exclusively contracting with 1:1 ID El E _
licensed contractors to construct the project,(See.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSOHIT PARCEL NO.
and Professions Code:The Contractor's License Law does not apply - -
to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contraclods)licensed pursuant l0 SEWER -STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ Inmexcmptunder 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 affirm that I have a certificate of Consent to sclGinsure,
7/ or a certificate of Workers'Compensation Insum nee,or a certified ZONING ENG.SITE NO.
copy thereof(See.38piC
PolicYN� -QorTarlY
❑ Certified copy is hereby furnished. FIRE SPR INK ENERGY T-24
Z Z ❑ CefY".pcF��j I1Y pfile�d with the city inspection division.
FO' Applicanfal}flyEv�xe MISC.- REFER TO ORD. y� N� Y NO -
CC W CE R,TIF`ICATE DEEXEM the City
PERMIT ISSUANCE 10.00 ,FLDDD 20NE A.L.U.C.
ION
W ' (This section need not beT<Ompl ted INSURANCE
he-permit is for one PLG.CDNTR. LIC.NO. TOTAL y❑ N Q y No
ao
• D Z hundred dollars IS 100)or less.) -
U O I certify that in the performance of the work for 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
O W become subject to the Workers'Compensation Laws of California. �p
CIL Date Applicant BUILDING
} ED NOTICE TO APPLICANT: If,after making this Certificate of F.x� ALTER OR ADD TO MECH. 5.00
ttnption,you should become subject to the Workers'Compensation APPLIANCE 5.001 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with U FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4,00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the 309performance
CivC jnce of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that I have read this application and state that the shove VENTILATION FAN (SINGLE) 4.00
information correct.1 agree t0 comply with all city and county
informordinances and state laws relating to building construction, any BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL x.
ubovt-mentioned property for inspection 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 or,, quence of the
g ti go
'I
ermiL MECH.CONT. LIC.NO. MECH. 7
TOTAL TOTAL
Signature of Applicant/Co tractor Date -
OFFICE COPY