11135 POST THIS CARD NEAR FRONT OF BUILDING
PFFIMIT NUMBER
CITY OF, CUPERTINO 111.35
INSPECTION DIVISION
JOBINSPECTION RECORD
,I�je PERMIT EXPIRATION
JOB ADD S (J/ N (�q'UNI LOT-#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR I SPE 10 RECORD� 180 DAYS OF PERMIT ISSU
ANCE OR 180 DAYS FROM
FOUNDATION IRs � LASTCALLED INSPECTION.
UFER
PR EGUNITE PERMIT VALIDATION
S
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISE ANCE( TE
RLOG. E CT LG. MECH.
MECHANICAL
❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION $/FT.
PLUMBING -
MECHANICAL
PERMIT TO
ELECTRICAL -
FRAMING
STORIES TYPE CONSTR.
INSULATION-
, OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT FLOON AREA TOTAL ACREAGE
ROOF
DIAPHRAGM"
RUILOIUSE
1 NES IND CON
PB OrRxr '
APPLY NO ROOFING UNTIL ABOVE HAS-BEEN SIGNED ❑ ❑ ❑ ❑
ASSESSORS FARCE L NO.
ROUGH
PLUMBING
' TRACT NO. PARCEL NO.
GAS TEST ,
MECHANICAL
ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING - SAN # I ZONING ENG.SITE No.
INSULATION PLUMBING �--fr7
GAS
FIFES RINK ENERGY T-29
ME ANI L Y [3 N❑ Y ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HE TING
FLOOD ZONE ALLLC.
LATH—INTERIOR EL CTRICAL '
LATH—EXTERIOR - FI EDEPT. Y IN Y,❑ N❑
SHEETROCK GR DE FEE SUMMARY
SHEAR INTERIOR BUIL NG 0 „
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 ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
w ARRANGE FOR INSPECTION BY PHONING'252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING I t
0 . PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL .� .i
OFFICE COPY
,.APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BDILDING APPLICATION & PERMIT
BUILDING PROJECT IDENTIFICATION - - PERMIT NUMBER
47 s I
AOOREss
E Gw ,.. �/ BUILDING —ELECTRICAL—PLUMBING—MECHANICAL � 1
OWNER'S PLAN CHECK VALIDATION
NAM/EE ..l OTY. ELECTRIC PERMIT FEE
( e,I e V PHONE /.S�V V
CONTRACTOR'S ,�y/- OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
o
1/1W LIGHTING FIXTURES 10.00/1.00 O —
CON ACTOR'sw vr.p PPLIANCES-RESIDENTIAL 4.00
so �"n I U PHONE y�n p /( PANELS 10,00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
'uc.Na. SIGNS TRANS. 3.00
AARCH.OR DDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 pr
AMOTORS SEE FEE SCH.
ADDRESSDDRESS _
SERVICE CHANGE 0 11 1I
w o o LICENSED CONTRACTORS DECLARATION Ippol
a u I hereby affirm that I am licensed under provisions of Chapter 9 i ISSUAN E ATE ..
y a a- (commencing with Section 7000)of Division 3 of the Business and 1 BLDG. Effto ECH.
r 7Profession,Code, nd my license is,in full force o c St./s,5
z o
L__ License Class Lic.Number
4 u Cont, tll1�
Y 2 ; of Cupe
¢ ¢ ¢ OWNER-BUILDER DECLARATION C11Y BUILDING PERMIT
'o w U INFORMATION
E
3 a- m 1 hereby affirm that I am exempt from the Contractors License MISC.— REFER TO ORD
uo¢ Law for the following reason. 7031.5,Business and professions PERMIT ISSUANCE 10.00 _ VALUATION $/FT.
� - J Code:Any city or county whichrequiresa permit m construct,alter,
pu,Q 2O Improve,demolish,or repair any Structure,prior to its ISSnunee,also ELEC.CONTE. LIC.NO. ELEC.
4 m LL requires the applicant forsuch permit 10 file a signed statement that TOTAL �`-( �•
whe is licensed pursuant to the provisions of the Contractor's License PERMIT TO
H z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe TQCS 4•Q,y �Md (.
¢ Business and Professions Code)or that he iS exempt therefrom and OTY. PLUMBING PERMIT FEE A-F /amu
a $ the basis for the alleged exon tion.An
g p Any violation of Section 7031.5 1 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(8500).1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 400
their sole compensation,will do the work,and the structure is no ! . OCC.GROUP RES.UNITS
intended or offered for Sale (Sc,, 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 S
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does suclh work FIXTURES-PER TRAP 5.00 — s0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provideA that such improve- GAS-EA.SVSTEM-11NC.4 OUTLETS 6.00
mems are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the Owner. GAS EASYSTEM OVER 4 (EA.) 200
builder will have the burden of proving that he did not build or im- - . - . .
BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Ohhe,
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(See.7044,Rnsiness LAWN SPRINKLERS-1 INC 5 V. -I 6.00 ASSESSORS PARCE L 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-OVE -) 1.00 h
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft
the Contractor s License Law, TRACT NO, PARCEL NO.
❑ I an.exempt under Sec. ,BAP.C.for this WATER HEATER W/VEN 6.00
reason
Owner _ Date WATER SYSTEM 0 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUI 'f O .00
I hereby affirm that I have a certificate of-consent to self-Insure, ZONING ENG.SITE N0.
of a certificate of Workers'Compensation Insurance,or a certi((Cd
copy thereof(Sec.3800.Lab.CJ. I d
Policy No. 'Company �I OI'11[4AuS Fv
O ❑ Certified copy is hereby furnished, FIRE SPRINK ENERGY T-24
Z Z ❑ Certifiedopy i EIeJ h the city ins -tion division.
- MISC.- REFER TO ORD:
O Applicant Y❑ N❑ Y ❑ N❑
C N CF.RTIP 'ATE OF FXP-MPTION FROM WORKERS' PERMIT ISSUANCE 10.0q'0 . FLOOOZONE A.LU.C.
L COMPENSATION INSURANCE: PLG.CONTE. LIC.NO. PLG.
1 O (This section need not be completed if the permit is for one TOTAL O Y❑ IN Y❑ N❑
D Z hundred dollar.,(S 100)or less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- 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.
0 i
Date--ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE TO APPLICANT: If,after making this Certificate of 8x
-
F Z emption,you should become subject to the Workers'Compensation 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 1OX0C.F.M.) 6.00 SEISMIC FEE 3 dD
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH 5.00
the performance of the work for which this permit is issued(Sec. ' MICROFILM
3097,Civ.C.). - HEATING UNIT(TO 100,0 0 B.T.U. 0
Lenders Name HEATING UNIT 0 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SIN LE) $
information is correct. I agree to comply,with all city and county BOILER-COMP I3 H.P.or 10 i 6.00 PLUMBING Q
ordinances and state laws relating to building conSt Hiction, and
hereby authorize representatives of this city to enter upon the ver 100,00TUI SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. BOILER-COMP IOS
(We) agree to save; indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, Costs pn expenses which PERMIT ISSUANCE 10.00 Q — CONST.TAX
may in any way accrue against said City in consequence of the
grantingofthis permit, MECH.CONT. - LIC.NO. , MECH.
G S TOTAL �S— TOTAL
Si are of Applin n[/Contractor Duet,
OFFICECOPY