9145 j POST THIS CARD NEAR FRONT OF BUILDING ,
PFRNIi NUMBER
CITY41 FCUPERTINO -�_ qi 5
INSPECTION DIVISION
JOB® INSPECTION RECORD JOB ADDRESS -7� / Q Sha&o hi I ILK'u`' UNIT# / _LOT# PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
OWNER Q CONTRACTOR Aly IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSP CTION RECORD 180DAYS CIE PERMIT ISSU-
FOUNDATION /' ANCE OR 180 DAYS FROM
LIFER 7f iA- ° LASTCAGLED INSPECTION.
PREGUNITE � LIFZ= - . d� PE MIT VALIDATION
61
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ir--y'j.g�
UNDERGROUND /SLAB 2
PLUMBING o
ELECTRICAL
ISSU NCE-0ATE
MECHANICAL B DG. ELECT, PLG. MECH
N E4,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION $LFT.
MECHANICAL ��jl �J
ELECTRICAL G TPERMIT TO
FRAMING 5 r bW L
INSULATION STORIES TYPE CONSTR.
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF \ SO,FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUIL usE
CON
'
NO CON PB Olftn
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING _
GAS TEST / jr TRACT NO. PARCEL NO.
MECHANICAL �, .e
ELECTRICAL ff� ,yy FINALS DATE INSP. ACC.OATE ACC FILE NO.
FRAMING SAN #
INSULATION PLUMBING ZONING ENG,SITE NO.
( � GAS Pw
MECHANICAL /-/ FIRE SPRINK ENERGY L24
O'��
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED IHEATING Y ❑ N❑ Y ❑ N❑
LATH-INTERIOR ELECTRICAL _ FLOOD ZONE A,L.U,C.
LATH-EXTERIOR. FIRE DEPT. Y❑ N[:] Y❑ I
SHEETROCK _ y GRADE FEE 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 NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU
Z� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANTI CONST.TAX
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 I DENTI FICATI PERMIT NUMBER
�
BUILDING APPLICATION & PER
a BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 914 COINED S ( yo
TIME PLAN CHECK VALIDATION
PJM ^ QTY. ELECTRIC PERMIT FEE
LC PHOrvE `( t
NAMERAcrDR's UTLETS-SWITCHES-RECEP 10.00/1.00
LC,No. LIGHTING FIXTURES 10.00/1.00
CONTRADDRESS APPLIANCES-RESIDENTIAL 4.00
AS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC NO, SIGNS TRANS. 3.00
ARCH OR ADDRESS END SPECIAL CIRCUIT S.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 SPA
ADDRESS SCH.
ES
ADDRESS r MOTORS SEE FEE
S J U(J/• /
a��Ui Pitta SERVICE CHANGE 20.00 7 S
o oLICENSED CONTRACTO S DECLARATION TEMP.POLE 30.00 �I Cu Bf�jllll
G ,, 1_ 1 hereby affirm that 1 am licensed under provisions of Chapter 9 N
pity
y a N (commencing with Section 7000)of Division 3 of the Business and SSUANCE AT
D ELECT.
0 z Professions Code,and my license is in fuBLDG. PLG. MECH.
force all fond effect. ❑ 1:1 E] ❑
i m License Class Lic.Number
m Dme Comractor
¢ rs
er Ic w a OWNER-BUILDER DECLARATION BUILDING PERMIT
°A U MISC.- REFER TO ORD INFORMATION
E:
;n 1- 1 hereby affirm that 1 SRI exempt from the Contractor's License
u O j Law for the following reason.(Sec.7031.5.Businessand Professions VALUATION S/FT.
- PERMIT ISSUANCE 10.00
Code:Any city or county which Structure permit to construct,alter. y,1
ac M¢ improve,demolish,or repair any stnmlme,prim iD its issuance,also ELEC.CONTR. LIG NO. ELEC. 0!a y
O u
u requires the applicant for such permit to file a signed statement that TOTAL PERw m he is licensed pursuant to the provisions of the Contractor's License MIT TO
Fzi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthr aS/PVG(� Fg y,L
x o Business and Professions Code)or nRR h )itx'�
e is exempt therefrom and QTV. PLUMBING PERMIT FEE
¢ Ho the basis for thealleged exemption.Any violation Of Section]031.5 STORIES TVP CONSTR.
A. ;m by any applicant for a permit subjects the applicant toe civil penalty
of not more than five hundred do0ars(S500L): ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as
Ihefr sBACK FLOW PROTECT.DEVICE 4.00 Dec.GROUP RES.UNITS
ole will compensaaiolr, d0 life work,and the slruCt.rc is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 _ 3
Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 $0.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees.provldcd that such improve-
n'ents are not intended or offered for sale If,however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00 d9
or improvement is Sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im, GAS-EA.SYSTEM-OVER 4(EA.) 2.00 UILOING USE
prove for purpose of sale.). RES IND CON PB Other
IQI,as owner of theproperty, INDUSTRIAL WASTE INTER. 30.00
he exclusively contracting with
licensed colons od In construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to tincts for
ouch projects with
builds a ontrimproves thereon.
andPursuant
who LAWN SPRINKLERS-OVER 5(EA.) 1.00 36a -4-0-o9l
convects for such ce near with a contracmr(s)licensed pursuant to
the Contractor's escLicense Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam extra under :. ,B.&P.C.for this WATER HEATER W/VENT 6.00
repSDll
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKH. 'COAIPE:NSATION DIiCLARATIOi WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of cunlent to self-insure,
or a certificate of Workers'Compensdtion Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Certified ropy is hereby furnished.
Z Z ❑ Certified copy is filed with the city inspection division. FIRE SPRINK ENERGY T 24
FQ Applicant MISC.- REFER TO ORD. Y[] N] Y ] N[]
M LO CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00
FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLC.CONTR. LIC.40. PLG.
EL 0 (This Section need not be completed if the permit is for one TOTAL Y[] N Y[] N
Z hundred dollars IS 100)or less.) -
U O 1 certify that in the performance of the work I'or which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued, I shall not employ any person in any manner so as to
0 L) become subject to the Workers'Compensation Laws of California. �a
} y Date Applicata g ALTER OR ADD TO MECH. 5.00 BUILDING s�O
W NOTICE: TO APPLICANT: If,after Rla kin this Certificate of Ex-
H ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10ACC.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY NIBOILER-COMP
NDLING UNIT(OVER 10=C.EM.16.00 SEISMIC FEE / 7
1 hereby affirm that the C is a construction lending agency forUST HOOD(WITH DUCT) 5.00
the performance Of I fe w r for iph this permit is issued(Sec. MICROFILM
3097,Civ.C.). G ,p NG UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and staa that the aboveLATION 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 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the (Over 100,000 BTU(SEE FEE SCH.above- 'one petty for inspection purposes, MECHANICAL
( ) agr e o xa Z&,namd keep harmless the City of REFER TQ ORD.
Cup r inn a sl Iia -liencs, costs and expenses whichCONST.TAX fidam a y ac rueaid City in copse uence of the PERMIT ISSUANCE 10.00
gra r t. ! MECH.CONT. LIG NO. MECH.
D TorAL TOTAL
Si afore ofA ca Com tactor Uat
OFFICE COPY