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POST THIS C NEAR FRONT OF BUILDING
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I C`I.TF CUPERTINOp IF
RMIT NUMBER
1 .
Nr.i
y.
INSPECTION DIVISION,,-,
JOB INSPECTION RECORD " " w '
PERMIT EXPIRATION-'
JOB.ADDR ESS 4hl NIT# c c `LOT# = by Ki••. *r
PERMITF EXPIRES IF WORK,
DviNER. -"e1.' '-CON aAcroR IS^NOT STARTED!WITHIN!
c'
• INSPECTIONi . DATE'S INSPECTOR_ INSPEfCT N,-R . .,, 180,DYS,OFPERIT ISSU� ei' .
'
.: FOUNDATION 4 t '. r _/f�— 'C L "t tt
I ". ANCE OR 180;DAYS FROM
LAST AL-ED NSPECTIOM
r
PREGUNITE a pERMlr vnuoarlON
POUR NO CONCRETE'UNTIL ABOVE HAS BEEN SIGNED
".'' . UNDERGROUND-/SLAB
' PLUMBING
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+
ELECTRICAL . '�. - #' �Lr, a.:�" s rR "Aw
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ELECTRICAL
'MECHANICAL emc:' E E r. LG. + MEc
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etc, OO,NOT POUR FLOOR,UNTIL ABOVE HAS-BEEN.SIGNED' , ">-' BULL INC,PERMIT; ,
WOOD FLOOR s 4. .+ - " F INF RMATION
+ ' t.
e
V PLUMBING .�:,-,. f ,m '.:wr 'e,r . j A -
_ CUATION $FT
MECHANICAL '
'ELECTRICAL - '' . +. + . 't PERM rO
FRAMING
INSULATION %
y w Sro IEs r cDNSTR.
;" - M1
OCC.GROUP Z,. t RES UNITS -
" PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SD FL FLODR AREF TOTAL ACREAGE
.• ' ROOF'; , x , ;
, r
DIAPHRAGM 'u •;. dl
,.,
'.BUI DIN E+
r + 1" a - 'F " ' r T ry.- ''•4 f .IND PB OP
APPLY NO'ROOFING UNTIL.ABOVE HAS BEEN SIGNED `
ROUGH, 2 "
• M1
^1/ A$$E$ �$ CEL NO.
PLUMBING .` "'; �'" ,.4
TRACILNO,-' 'PARCELNO'.
;r GAS TEST ' _
. MECHANICAL
Y •: m `
ACC.DATE ACC:FILE NO.
ELECTRICAL '' ' ' " r,:.. „ - FINALS ' DATE •, INSP.
' FRAMING ' i u 1
r 1 r SAN #, ," t e •- -
- INSULATION. PLUMBING' s" i4N',"rC ENG.SITE No '
s 'c r by GAS " _
FIRE SPRINK , ENERGYT24
.
M H NICAL _ y3_. . . . :� ...
COVER NO•WORK UNTIL ABOVE HAS BEEN SIGNED , I H ATING^ . �• ""� "
2 i
FLOOD ZONE JA LUC. u,
s ` LATH"—INTERIORn`" _ •* +'? "-,,,' '. E ECTRICA ,9
5- LATH—EXTERIOR, '.^n' - i. 6 ., a. FI ° , rQo, N� v ❑ +N
SHEETROCK ' - ',i" �•, GRADE n:: .a'- - FEE SUMMARY
SHEARd NT.ERIOR BUILDING:I, », -
+.„ SHEAR EXTERIOR , + .BUILDING .+ -1 ✓ s jTJ
".TEMPORARY'APPROVALS z + C
Lg FIREWALLS._ }:, -' , 'f,'", - '. )•1 ELECTRIC'; ' _ " '" "` " + „ PLAN CHECK ' e -
s - + p, FEE:'
. GAS
s .
NO TAPE OR PLASTER UNTI L'ABOVE HAS BEEN SIGNED occuPANCY SEISMIC FEE: w r
i OCCUPANCY OF BUILDING IS NOTPERMITTEDU NTILBUICDING FINAL ISSIGNED BYBUILDING INSPECTOR. MICROFILM ♦'i ,
ARRANGE FOR.INSPECTION BY'PHONING 252,4505r E�gCTRIc '
UJ'
`
ONE'WORKING''QAY BEFORE REOUIRED',I'NSPECTION ",F
r: PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING
Z MECHANICAL i -+
— SEE`PERMITFO^R EXPIRATION 0ATE
+ nCONST:,TAXL
IMPORTAN;TI 4
+ .nq�, y. (PLEASE-READ REVERSESIDE BEFORE "^
'
CALLING,FOR FINAL`INSPECTION _ +T
OTAL
+ e " +OFFICE COPY '' „" v
-APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BA' 1. POINT PEN ONLY
• BUI LDI NG PROJECT 1 DENTI FICAT PERMIT NUMBER
BUILDINGAPPLICATION& PER
ADDR SS ry - 1 1
�, ct,2's ss I lit, ,..�G BUILDING - ELECTRICAL-PLUMBING-MECHANICAL I f O/8H
OWNER'S �1wE��f•� PLAN CHECK VALIDATION
NAM r� OTY. ELECTRIC PERMIT FEE
PRONE `% 4^'I_ ,.
corvrnacroRs OUTLETS-SWITCHES-RECEP 70.00/1.00
NAME
LIC.No. LIGHTING FIXTURES 10.00/1.00 '
CONTRACTOR'S ADORESa APPLIANCES-RESIDENTIAL � 4.00 -
-
PHONE PANELS 10.00 DATE Of APPLICATION
ARCHITECT - PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER //'��
uc.rvo.l� fK_' SIGNS TRANS, 3.00 's ARCH.OR ENG. - - PERMIT VALIDATION
ADDRESSS p SPECIAL CIRCUIT -5.00
7S>b'l-BL'0 MIDDLEF�,�� ZIP l EMP. METER OR POLE INS. 20.00
ADDRESS TS - MOTORS , I SEE FEE SCH. `i2<
SERVICE CHANGE 20.00 �j/
o O o LICENSED CONTRACTORS DECLARATION s�ppyss� ///O
• a t U ' I hereby affirm that I am licrawd'under pmvislons of Chapter 9 �TSSI CE DATE
< i (commencing with Section 7000)of Division 3 of the Business uldBLDGR. ELECT. PLG. MECH.
H N i Professions Code,anJ my license is in full force and effect. �" •CQ ❑
z O m- License Class Lie.Number f�
0 r Date Contractor
'ac m s s BUI DING PERMIT
w OWNER-BUILDER DECLARATION Clt G FIRJON
w ; LL I_ I hereby affirm that I am exempt'from tern Contractor's License MISC.- REFER TO ORD
u04 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
E - -' Code:Any city or county which rccluiresa permit to construct,alter, v�
Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR.' LIC.NO� ELEC.. J/ � '
iL u requires the applicant for such permit to file a Signed statement that - _ TOTAL PERMIT TO
w m ,r, he is licensed pursuant to the provisions of the Contractor's License /�7-���d 2 1/J0RJVC.
Hz� Law.(Chapter 9(commencing with Section 7000)of Division 3 of the
4 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
r o the basis for the alleged exemption,Any violation of Section 703 1.5 STORIES TYPE CONSTR.
w. F, by any applicant fora permit subjects the applicant to a civil penally ALTER-DRAIN -WATER IEA.) 5.00 -
of not more than five hundred dollars($500).1:
❑ I,as owner of the property,or my employees with wages as Bq'CK FLOW PROTECT. DEVICE 4.00 - OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ,
Code:The who
r License Law docs not who o an owner of -
property who builds or improves thereon,andwhoto docs such work FIXTURES-PER TRAP 5.06 SO.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided that such improve-
ments arenot intended oroffered for sale.If,however,the budding , GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EA.SYSTEM-OVER 4 (EA.) 200
builder will have the burden of proving that lie - . .
C did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omar
❑ I;as owner of the property,am exclusively contracting with - ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Businnss LAWN SPRINKLERS-.1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
' and Professions Code:The Contractor's LicenseLowdoes not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) ' 1.00
contracts for such projects with a contractorts)licensed pursuant to
the Contractor's License Law. I SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
1)) ❑. hunt cxc7npt under$ .�_,B,&P.C.for this WATER HEATER W/VENT - 6.00 -
• reason
-IF- Owne ./ Duta WATER-SYSTEM 5.00 ACC.DATE• ACC.FILE NO.
WORKI: S'COMP r'rN WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent to self insure. .ZONING ENG.SITE NO.'
or a certificate of Workers'Compensation Insurance,0,a certified
copy thereof(Sec.3800,Lab.C.). ,
Policy No.' - Company -
O ❑ Certified COPY is hereby fumishCd.'' FIRESPRINK ENERGY T-24
Z Z ❑ Certified copy is filed witlr the city inspersion division. MISC- REFER TO ORD. -
O Applicant Y.❑ N❑ Y ❑ N❑
cc N CERTIFICATE 017 EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 • -
"FL000 ZONE' A.L D.C.
'LU > COhIPFNSATION INSURANCE PLG.CONTR. - LIC.No. PLG.
d O (This section need not be completed if the permit is for one e' TOTAL Y❑ N❑ Y ❑ N❑
Z . hundred dollars($100)or less.) - - -
U O I certify that in the performance of the work for which this per- GTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
U become:subject to the Workers'Compensation Laws of California.
O tat - BUILDING - - 'R
C. Date 'Applicant ALTER OR ADD TO MECH. 1 .00
} N NOTICE TO APPLICANT: If,alter making this Certificate.ol'fix-
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of Ore 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 10p00GEM.) 6.00 SEISMIC FEE '
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permifis issued(Sec. MICROFILM
3097,civ.c.). "• e � , HEATING UNIT(TO 100,000 B.T.U.) 8.00 s
Lender's Name
Lender's Address HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
-, . 1 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
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
(Wu)-agree to save, indemnify and keep harmless the City of - MISC.- REFER TO ORD.
Cupertino against liabilities,judgments,costs and expenses which CONST.TAX
• may,in my way accrue •Igamst said City in consequence of the PERMIT ISSUANCE 10.00
gran fads er It ,MECH.CONT. LIC.NO. MECH.
ly �/ TOTAL TOTAL
gnature ofA Uate J
- - OFFICE COPY -