12454 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY. OF CUPERTINO . 12454
INSPECTION DIVISION
. JOB INSPECTION RECORD
- PERMIT EXPIRATION
JOB ADD E SUN IT# LOT#' PERMIT EXPIRES IF WORK
OWNEaI�IbIMIAAX,-' CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION /,"- - Wil ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
LIFER '
PR EGUNITE - - .. .---.,. . _. . _ _.
PER VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB ,
PLUMBING
ELECTRICAL ISSUANCE DATE
BLDG. ELECT. PLG. MECH.
MECHANICAL ❑ ❑ E 1-1
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR s INFORMATION .y
PLUMBING VALUATION �`
MECHANICAL /f` •-
PERMIT TO
ELECTRICAL - ._ _ __. . . .. , l v"7 ='fi"A0•� ;r`..:,•.;,✓=
FRAMING
77 o R I-ES TYPE CONSTR.
INSULATION
OCG GROUP •RES.UNITS ,
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SQ FT,FLOOR AREA TOT AL ACREAGE
ROOF
DIAPHRAGM
BUILDING USE
' HES' IND CON PB Orner
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ASSESSORS PARCEL NO,
ROUGH
PLUMBING
TRACT NO. PARCEL NO,
GAS TEST ,
MECHANICAL
ACC.OATE ACC FILE NO.
ELECTRICAL r FINALS DATE INSP.
FRAMING - SAN # ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
FIRE'SPRINK ENERGYT24
' MECHANICAL
YE] N[] Y E] No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLooD zaNE A.L.u.c.
LATH—INTERIOR ELECTRICAL -
LATH—EXTERIOR - FIRE DEPT. - v� N� .vo NC:]
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS - ELECTRIC - PLAN CHECK
GAS FEE'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. `MICROFILM
i
LU
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
�T FF_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLumewG
z PLEASE GIVE JOB ADDRESS WHEN PHONING'.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL . .
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL —`
CALLING FOR FINAL INSPECTION.
' OFFICECOPV
1 ; ,
r '
I 1- •tet .k� � '4.' / ':1. ��'i
1
Vs
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENT[FICATION PERMIT NUMBER
APPLICATION & PERMIT
BUILDING
ADDRESS
ILDING-ELECTRICAL-PLUMBING-MECHANICAL 1245
y HS / PLAN CHECK VALIDATION
NAME
TY. ELECTRIC PERMIT FEE
A- ( HONE 7
NToflx
NAMEAIVE OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
fls
ADDRESS
PPLIANCES-RESIDENTIAL '4.00
PHONE PANELS 10,00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
Ofl
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT. 5.00 PERMIT VALIDATION
AdDRESS
ZIP TEMP.METER OR POLE INS. 20.00 /1
APPLICANT-S MOTORS SEE FEE SCH.
ADDRESS
/ p q
SERVICE CHANGE 20.00
00 LICENSED CONTRACTORS DECLARATION (DD l
a v u I hereby affirm that I Am licensed under provisions of Chapter 9 PA�SSUANCE DATE
y a m( commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F,y Z I'rol'essinns Code,and my license is in full furcc add effect. E� `} ❑ ❑
Z O w- License Class Lic.Number-
2
H
9 m o Dale Contractor
F
¢ -s BUILOI ,�,js�ERMIT
¢ 0 w ¢ OWNER-BUILDER DECLARATION PitVNIRTION
w0 e' MISC.- REFER TO ORD
;u, y I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
r .. o a Law for the following reason.(Sea uiresa,Businessand Prufessions PERMIT ISSUANCE 10.00
Code:Any City or county which requirese permit to construct,itleq
Q M c o improve,demolish,or repair any structure,prior[o its issuance,also ELEC.CONTR. LIC.NO. ELEC.
- 0 LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n w m he is licensed pursuant to the provisions of the Contr'actor's License
i
Law(Chapter 9(commencing will,Section 7000)ofDivision 3 of th, p?
i < Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE I ��V�` !f��
¢H$ the basis for the alleged exemption.Any violation or Section 7031.5 STORIES TYPE CONSTR,
a ; by any applicant for a Permit subjects the applicant too civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK 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 (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Cade:The Contractor's License Law does not apply LL)an owner of
properly 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-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA ) 200
builder will have the burden of proving that h - . . .
ma.e did not build or . BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. - 30.00 RES IND CON PS Omer
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to 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 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 contractorfs)licensed pursuant to SEWER-SANITARYV-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
nexempt under Sec. ,B.S.P.C. 'n,this WATER HE W/VENT 6.00
naso
Ow' ` a( WATER SYSTEM 5.00
ACC.GATE ACG FILE N0,
WOIIKF-RS'COMPENSATION UECLARA'FION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate ofermsent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sea 3600,Lab.C).
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY L24
Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y ❑ IN V❑ N❑
� y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.L.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL v❑ N❑ Y❑ N❑
hundred dollars IS 100)or less)
U O I certify that in the performance of the work for which This per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL l- mit is issued, I shall not employ any Person in any manner so as to
0W become subject 1.the WOrkerf COmpensatinoLawsofCalifornia. ' BUILDING �,$ �s�
p• Date Applicant ALTER OR ADD TO MECH. 5.00
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z emption,you should become subject to the Workeri 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 10MC.F.M.) 4.00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE S
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 permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. [agree to comply with all city and county PLUMBING
ordinances and state Incas 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 Over 100,000 STU)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 10.001CONST.TAX
pvv�lin any way accrue against said City in consequence of the
g nth of this er MFFH.CONT. LIC.NO. MECH.
' ' TOTAL r OO
[Signature of ApISA
plican t/Contractor ate / TOTAL 3J �3
OFFICE COPY