11583 POST THIS CARD NEAR FRONT OF BUILDING RNIITNUMIIER
CITY OF CUPERTINO 11583
'INSPECTION DIVISION
(C ` JOBV INSPECTIO�iN'RECORD '
{�J j'1s �j/e�i E� PERMIT EXPIRATION
JOB ADDRESS /QJA�S UNIT# LOT PERMIT EXPIRES IF WORK
OWNER U'J CONTRACTOR - IS NOT STARTED WITHIN
INSPECTION DATE INSP CTOR SPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION Q- LASTCALLED INSPECTION.
LIFER
- - PERMIT VALIDATION
' PREGUNITE
Cv Z( �(�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND SLAB, /
PLUMBING
ELECTRICAL IssuAN EUATE
MECHANICAL eLDc- ELECT., PLc. MECH.
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
PLUMBING WOOD FLOOR V/uATION $jFT,
MECHANICAL -
QLJ
ELECTRICAL PERMIT TO
FRAMING - '^ �i/Y 61,05al?&
INSULATION .STORIES TYPE CONSTR.
' - - - - OCC.GROUP RES.UNITS ,
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF SSD.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
• HES IND CON PB OII1Y1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ [:1 ❑ ❑ 1:3
ROUGH ASSESSORS PARCEL.NO.
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL - -
ACC.DATE ADD FILE N0.
ELECTRICAL FINALS DATE INSP.
FRAMING - SAN 0
ZONING ENG.SITE NO.
INSULATION PLUMBING '
GAS
• MECHANICAL FIRE EPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING " Y (] "F
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.u,c.
LATH—EXTERIOR • FIRE DEPT. Y❑ N❑ I Y 0 N
SHEETROCKGRADE 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 JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED LINT ILBUILDING FINALISSIGNED BY BUILDING INSPECTOR: MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
. O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFOREi
CALLING FOR FINAL INSPECTION. TOTAL
' OFFICE COPY -
�. APPLICANT TO FILL IN INFORMATION WITHIN RED, LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING
APPLICATION & PERMIT
ADDRESS /J BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 11583
OWNER'S PLAN CHECK VALIDATION
'NAME
g/)elp eO [% OTY. ELECTRIC PERMIT FEE G 3 l' '
p" PHONE 31r/- 1 U J�
CONTRACTORS 1
j
NAM
OUTLETS-SWITCHES-RECEP 10.00/1.00 a, 7 � (/
/7 ^ C
LION.. LIGHTING FIXTURES 10.00/1.00
C,ONTRACTqAS� ��� S APPLIANCES-RESIDENTIAL 4.00
ADDRESS JO n ���
'fant1�11f PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.0.NO.
OR
ENGINEER
uc.No. ISIGNS TRANS. 3.00
ADDRESS ENG. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
Ar$
ADDDRESSDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION
<u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
in< w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
0 w z Professions Code,a my license Li is in full force c� ❑ ❑ ❑ ❑
m O y- License Cl ass Con Number
o m r coo Date-7ZZ Contractor,"
¢ m 2 � %-' BUILDING PERMIT
¢ 0 M V OWNER-BUILDER DECLARATION INFORMATION
w ; w I hereby at that I am exempt from the Contractor's License MISC.- REFER TO ORD
u LL0 < Law for the following reason. 7031.5,Businessand Professions pERMIT ISSUANCE 10.00 VALUATION
FN0 Code:Any city or county which requiresa permit to construct,alter,
¢ ec¢2O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
iL c
¢ requires the applicant for such permit to file a signed Statement that TOTAL PERMIT TO
n w m he is licensed pursuant to the provisions of the Contractor's License
Fzi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ $ the basis for file alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i ; _ by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW 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 (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
• property 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- GAS-EA.SYSTEM-11NC.40UTLETS 6.00
mems are not intended or offered for sale.If,however,the building
of improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,run exclusively contnmting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC S V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code: Me 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
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO, PARCEL NO.
❑ Iamexemptunder Sec ,B.&I'.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofemment to self-insure, ZONING
of a Curti fico to of Workers'Compe sa Ron Insurance,or a cerci •d ENG.SITE NO.
copy lhcrcol'IScc.3gOQ 1.ub.0 kp r
Policy No. Company
0 ❑ Cerlif,edcopyisterebyffnislted. FIRE SPRINK ENERGY T-24
Z 2 O Certifie coy rs IjFr1J��ith the cit tion division. MISC.• REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ No
~ as - PERMIT ISSUANCE 10.00
cc -
CE I FICATF CRT EXEMPTION FROM WO 'I!RS' FLOODZONE A.L.U.C.
LLI COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
EL 0 EL Z (This section need nut bn completed if the permit is for one TOTAL Y❑ N E] Y❑ N❑
hundred dollars IS 100)or leas.)
U O 1«rtify 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 lite Workers'Compensation Laws of California.
Ca. Date Applicant BUILDING
} SO NOTICE TO APPLICANT: If,after making Ihis Certificate of fix- ALTER OR ADD TO MECH. 5,00 /7,
r 2 eruption,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 IOAODC.F.M.) 6.00 SEISMIC FEE 7S�
I hereby affirm 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,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender's Address ELECTRIC
• 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
ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.of 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOvar 100,000 BTU)SEE FEE SCH. MECHANICAL
above-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 mid City i consequence of the
grant in f th s •unit. � MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL I7A
Si re of pelican Contractor ate
' o
OFFICE COPY