10017 POST THIS CARD NEAR FRONT OF BUILDING
CITY ' OF CUPERTINO .• RMITNUMBER
INSPECTION DIVISION 1 001 7 '
"+.I? JOB INSPECTION RECORD "
�.F ' ., PERMIT EXPIRATION
{l `�Tf v -0 0
^.�%•" JOB ADDRESS UNIT# _LOT# "
-- PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS..NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 186 DAYs,oF PERMIT ISSU,
FOUNDATION - - ANCE OR 180 DAYS FROM I
UFERJ�' LASTCALLEDINSPECTION.
tr
PREGUNITE PERM ION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �ov "Floss
UNDERGROUND /SLAB CRY,of CUpBPIIDO
PLUMBING
ELECTRICAL
- ISSUANCE.DATE,
MECHANICAL. - L G. ELECT. PLG.- MECR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - ' BUILDING
PERMIT
E M T
WOOD FLOOR - vn INFO � siET.
• PLUMBING - � � - � .- _P
MECHANICAL' : + i
ELECTRICAL ' PEMI TO
FRAMING - - 7
' INSULATION , - - STORIES STYPE CONSTR.
OCC.GROUP RES.UNITS
-:,,PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,FT.FLOOR AREA •TOTAL ACREAGE
DIAPHRAGM
9UI LING USE
' ] RE IND CON PR O,nw
-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ! ❑ ❑ ❑ ❑
'ROUGH - ASSESSORS PARCEL NO.
PLUMBING -
GAS TEST TRACT NO. .PARCEL NO.
MECHANICAL
ELECTRICAL _ ACC.DATE- ACC.FILE NO.
—1 FINALS DATE INSP.�� '
FRAMING -ZAOL SAN # '
ZONING !ENG.SITENO.
INSULATION - PLUMBING - - -
GAS
MECHANIC L -FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED H A ING Y ❑ NEI : ❑ N[3
LATH-INTERIOR E EC CAL .FLOOD ZONE, A.L.U.C. ,
LATH-EXTERIOR FfIRVEPT. Y❑ N❑ Y ❑ N❑
SHEETROCK - -4 DE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR - - TEMPORARY APPROVAL
FIREWALLS' ELECTRIC PLAN CHECK
GAS FEE ,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEISMIC'FEE
OCCUPANCY OF BUILDING ISNOTPERMI,TIED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
UJ 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.— MECHANICAL
IMPORTANT! coNsr.rnx
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
ADDRaIAPPLICATION & PERMIT 10 017
11RESSSS
`DSII _S Jbi/Iy e() BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
NAMEPHO
OWNER S'D 14r1• t�sv1 'R 9� - PLAN CHECK VALIDATION
2SZ �flS�p QTY. ELECTRIC PERMIT FEE
NE
rNAMECONTRAcraGRs SlcZ lfLtl. UTLETS-SWITCHES-RECEP 10.00/1.00
13CAIZ G�d"S 1 .LIC.NO, ' LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL' I 4.00
ADDRESS
3 4CJ PHONIE Il Ew„f, PANELS 10.00 DATE OF APPLICATION
ORRCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER -�
uc.No. SIGNS TRANS. 3.00 ii?
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS f� SPECIALCIRCUIT 5.00 NOVZIP EMP.METER OR POLE INS. 20.00 'rll - 51985
aPPucanrs MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 City Of Cupertino -
w o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
a i W I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE GATE
Q % (commencing with Section 7000)of Division 3 of the Business and BLD . ELECT. PLG. MECH.
H m z . Professions Code, d my license is in full force I d feel e ❑ ❑ ❑
at o m - IAcense Class Lic.Number 7. SOL
0N1-wDate '9-4b< Contractor
Or Q OWNBR.BUILDER DECLARATION BUILDING PERMIT
E
a a ° MISC.- REFER TO ORD + INFORMATION
w ; y I hereby affirm that I am exempt from the Contractor's License
F .. 0 st Law for the following reason.(See.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION SIFT.
� m0 Code:Any city orcounly which requires a permit construct,alter,
K oe Q O improve,demolish,or repair any structure,prior to its issuance also ELEC.CONTR. LIC.NO. ELEC. �OO,
a wc¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
m u. Ito is licensed pursuant to the provisions of the Contractor's License
Fii Law(Chapter 9(commelicing with Section 7000)ofDlvisjon3 ofthe
F 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE C?
H m the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR.
i 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 dollar,($5000:
❑ I,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
intendedoroffered 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 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
Paentsarenotintendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
�''• or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.1 2.00
dI r .v builder will have the burden of moving that he did not
'build or im- BUILDING USE
prove for purpose of sale.). IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 A55E550R5 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
cc atiocts fur such projects with a contractoes)licensed pursuant to SEWER-SANITARY-STORM EA.200f1/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ lam 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'COMPENSATTON DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certi OCme of consent to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ. .
Policy No. Company '
O ❑ Certified copy Is hereby furnished' FIRE SPRINK ENERGY T-24
Z Z ❑ Certified opy is filed with the city inspection division.
O ❑ C] [3_ Applicant �/ MISC.- REFER TO ORO. , V N V No
cc W CBRTIPICA'I'EOE EXEMPTION I'ROM WORKERS' PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U.C.
LU > COMPHNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL 0 (This section need not be completed if the permit is for one TOTAL V❑ N V F] No
D Z hundred dollars($100)or Tess.)
U OI certify that in the performinice of the work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- nil is issued,I shall not employ any person in any manner so as to
U W become subjec to the Workers' I pens tion awy o(�alili Tom
Q. [)ata pplicant /1 2L� BUILDING
} m NOTICE TO APPLICANT: If,after making Ili ertificate of Ex-
ALTER OR ADD TO MECH. 5.00
F Z emption,you should become subject to the Workers Compens:Wmt 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=C.F.M,) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby uftirm 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,CN.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
a'- I Certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county PLUMBING
Jordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or 100,000B.T.U.1 6.00
hereby authorize representatives of this city to enter upon the
✓i 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 WJ cu PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accre uagainst said City in consequence of the
granting of this permit MECH.CONT. LIC.NO. MECH.
�� `j,� /„l, I TOTAL TOTAL l�
$I�nattur'e o`ff Applicant/Contractor Date -
OFFICE COPY
• I