8949 POST THIS CARD NEAR FRONT OF BUILDING
PCRMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION
OB INSPECTION RECORD `
A117 PERMIT EXPIRATION
JOB ADDRESzfmwlf_�o
UNIT' LOT# PERMIT EXPIRES'IFWORK
OWNERCONTRACTOR - IS NOT STARTED WITHIN
INSPEC ION DATE INSPECTOR INP TION RECORD iBO DAYS OF PERMIT ISSUIt
r FOUNDATION ANCE OR 180 DAYS FROM
UFER '
LASTCALLED INSPECTION,
� � � .
PREGUNITE � _ •
• PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .T f /•{ I/J/J7IX v/
UNDERGROUND /SLAB i
PLUMBING-
ELECTRICAL
LUMBING ELECTRICAL -
ISSUANCE DATE
- MECHANICAL By ELECT. 'PLG. MECR.
❑ ❑ _I❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED / BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION S/FT.
MECHANICAL -- ) /1 !Y
ELECTRICAL - PE
FRAMING ru In 71
INSULATION _ s IESjMCcbNSTH.
OCG GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
SO_FT,FLOORAREA TOTAL ACREAGE
DIAPHRAGM Il
BUILDING S
RES IND CON GO....
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - . ❑ ❑- ❑' .' ' ❑
ASSESSORSP R LNO.
ROUGH ,
PLUMBING '
GAS TEST
TRACT NO. PARCEL NO.
MECHANICAL '
ELECTRICALFINALS DATE INSP, ACC.DATE ACC FILENO'
,
FRAMING SAN # - ..
INSULATION PLUMBING - ZONING ENG,SITE NO.
GAS
MECHANICAL. FIRE SPRINK ENERGYT 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - y ❑ "❑ •Y ❑ N
LATH—INTERIOR - ELECTRICAL FLOOD ZONE AL.U.C.
e
LATH—EXTERIOR - FIRE DEPT. �`'❑ N❑ Y�❑ IN
SHEETROCK - GRADE - FEE SUMMARY
SHEAR INTERIOR' BUILDING
SHEAR EXTERIOR - T,EMP.ORARY'APPROVALS BUILDING
FIREWALLS IELECTRIC PLAN CHECK
GAS r FEE +'t
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTEDU NTIL BUILDING FINAL IS SIGNEDBY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC
1--w
w- ONE WORKING DAY BEFORE REQUIRED 'INSPECTION. . PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL
Z
- SEE PERMIT FOR EXPIRATION DATE =
CONST.TAX,
:IMPORTANT!- I`
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
BEII LDI NG PROJECT 1 DENTI FICATI ON - PERMIT NUMBER
9UILGING APPLICATION & PERMIT
A°GRE55 8949
CLsL i3uJD BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
Nq
CITY ELECTRIC PERMIT FEE
3 PHON
NAMERAc]ons UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.NO. LIGHTING FIXTURES 10.00/1.00
COCONTRACTOR
TRA TOR5 PPLIANCES-RESIDENTIAL 4,00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLA EE P.G.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
uc.rv0. - SIGNS TRANS. 3.00
ARCH.OR ENG. P TVALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
ZIP ITEMP.METER OR POLE INS. 20.00 {,' 1986
moo ESSTS MOTORS SEE FEE SCH. City Of CU
P,ertino
SERVICE CHANGE 20.00
wo LICENSED CONTRACTORS DECLARATIONTEMP.POLE 30.00
a u I hereby affirm that I am licensed under provisions of Chapter 9
Z w ISSUANCE DATE
y a y (commencing with Section]00e)i in Division 3 of the Business and B D ELECT. PLG. MECH.
0 y z Professions Code,and my license is in full force and effect ❑ ❑ ❑
2 o w - License Class C.n Number
o� r w Uate Contractor
Q y E
OWNER-BUILDER DECLARATION BUILDING PERMIT ..
-D. y I hereby cllo that 1 am exempt from the Contractor's License MISC.- REFER TO Ot
RD
INFORMATION
F u O¢ Law for the following reason.(Sec.7031.5,Business and ProfessionsV LUATION $/FT.
F �v+i Code:Any city or county which requires a permit to construct,alter, PERMIT ISSUANCE 10.00
S K er O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
o LL requires the applicant for such permit to file a signed statement that TOTAL
u w m y he is licensed pursuant to the provisions of the Contractor's License PERMIT
,10
F i 4 Law(Chapterand
Professions
Cng with Section is exempt
theref o and
Iso Business and Professions Code)or that he is exempt senor 0 and DTV. PLUMBING PERMIT FEE
¢ I-$ rhe basis far the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR.
u ; -. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(8500).):
❑ I,as owner of tum property,Or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP AES.UNITS
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 docs such work FIXTURES-PER TRAP 5.00 50.FT,FLOOR AREA TOTAL ACREAGE
himself re of rote his own employees,Provided thin such improve-
rentsarenotitissoldor withinroneyeaale.l completion
tire the owner-
GAS-EA.SVSTEM-l1NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner-
[�bldcr will have the harden ofproving that he did mtbuild it im- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
for purpose of Sulu.). INDUSTRIAL WASTE INTER. 30.00 RE IN❑D C❑ON 0,I,as owner of the property,am exclusively contracting withd contractors to construct the project(Sec.7044, Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESBORSP RCEL NO.
ofessions Code:The Conlmelor's License Law does nor 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 e.mbacums)licensed pursuant to
tum Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL No.
❑ 1 am exemp�t under Sec._ ,B.&P.C.fin this
WATER HEATER W/VENT 6.00
Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORT:F.RS'COMPENSA'I ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.L
O Policy No. Company
eRTIFICATEOFE�EMITTION
ied copy is hereby famished. FIRE$PRINK ENERGY T34
Z ied co is til wi the ci inspection division. MISC.- REFER TO ORD. Y 0 N Y E] N[]
Applicant "
PROM WORKERS' PERMIT ISSUANCE 10.00FLOOD ZONE A.L.u.G.
LUCOMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
C O (This sectilin need mol be completed IF the permit is for one TOTAL Y E] IN Y C] NE]
0 Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per. OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued, I shall not employ any person in any Intoner so as to
become subject to the Workers'Compensation Laws or California.
Q a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ N NOTICE.TO APPLICANT: If,after making this Certificate of Ex-
Z emption,you should become subject to the Workers'Compensation APPLIANCE 5,001 PLAN CHECK
provisions of 0m Labor Code, you must (doth Oul, comply with U FEE 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.FM.) 6.00 'SEISMIC FEE'
I hereby affirm that then 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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 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 BOILER-COMP IDY81100,BOB 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. li
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against mid City in consequence of tire PERMIT ISSUANCE 10.00
granting a![Imis pentlll. MECH.CONT. LIC.NO. MECH.
/ //Y/h-_Y`/v TOTAL TOTAL
IVy Ssgnaturc of Applicant/Contractor Umc
OFFICE COPY `