13049 POST THIS CARD NEAR FRONT OF BUILDING PFRM1,iTNUMBER
CITY 01" CUPERTINO
INSPECTION DIVISION 13049
S
N'RE .
" JOB RD '�INSPECT O CO
PERMIT EXPIRATION
rr G/ STo Es ';.
JOB A V
ADDRESS Q K`=r UNIT# LOT PERMIT EXPIRES IF WORK
OWNER ti nj zc aGC_:Z— CONTRACTOR ' ' IS NOT-.STARTED,WI.THINL-
180,DAYS,OF PERMIT ISSU.
{ ' , INSPECTION DATE INSPECTOR - , INSPECTION RECORD
FOUNDATIONr - _ - LASTCANC CALLED
INSPECAYS TION.- LASTCALLEDINSPECTION:
.! UFER i
PREGUNITE„ PERMIT VALIDATION
p,
_ POUR-NO,CONCRETE UNTIL ABOVE HAS BEEN SIGNED _ - l I`� .•'.�.�T✓' -
- ;,'. UNDERGROUND'/SLAB
PLUMBINGA �1 }jG1 •'C ,
ELECTRICAL ' - RP.I`IRISSUANCE DATE
'MECHANICAL • - RL�c,; EL�r, 1 PLaG.• MECH.: ,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
_ _ - w,,i INFORMATION
."- ,WOOD FLOOR '. " r:. .' VALUATON
PLUMBING - -
x MECHANICAL
ELECTRICAL"'. ?ERMrt
�. FRAMING - FTO R I-ES TYPECONSTR.
INSULATION;
OCC.GROUP 'RES.UNITS
t ,
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
�, „oIW� U.FT.FLOORAREATOTAL ACREAGE
• U. `Y 'u✓
ROOF
�!• GrT� ,dry ou�S.�f,' f' .DIAPHRAGM. q
JG USE
RES 'IND CON I PE' UNnr
APPLY,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED1 s ❑ E' El , E E '
ASSESSORS PARCEL NO.
ROUGH
f r 'PLUMBINGgy -- r. .
_ GAS TEST' .TRACT,NO. .PARCI. No.
MECHANICAL` - -
' - + ACC.'OATE ACC.FILE NO.
.. , .
ELECTRICAL;,' ..: � , ..,,-.. ,:� �.,. FINALS ZI � '. . , - ' .
FRAMING SAN # ,ZONING ENG.SITE NO.
'INSULATION PLUMBING
GAS
MECHANICALFIRE SPUNK - .ENERGY T]4
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATINGY N❑ "Y ❑ N❑
; LATH=INTERIOR,' ELECTRICAL : FLOOD ZONE IA.L.0 C. -
LATH-EXTERIOR FIRE DEPT.• vN[ Yo NQ,
SHEETROCKGRADE FEE SUMMARY a
SHEAR INTERIOR ' BUILDING,
SHEAR EXTERIOR TEMPO RARY'APPROVALS BUILDING'
FIREWALLS •s. ELECTRIC + 'PLAN CHECK
GAS �.� FEE . .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE .
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTI L BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM �
ARRANGE FOR INSPECTION BY PHONING'252-4505, F ELECTRIC /
F_ ONE WORKING DAY,.BEFORE 'REQUIRED INSPECTION PLUMBING
zPLEASE GIVE'JOB ADDRESS WHEN PHONING. ' MECHANICAL
. .
SEE PERMIT FOR,EXPI RATION,DATE .—
��+- CONST;TAX',- '
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE ,'`
CALLING'FOR FINAL INSPECTION. TOTAL'
�' OFFICECOPY _ ' .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATIONPERMIT NUMBER
BUILDING APPLICATION & PERMIT '
k REBS 349
ADD -
S-I��Lts VC.. BUILDING-ELECTRICAL-•PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
CPHONE
F '
NATRACTORS NOME OUTLETS-SWITCHES-RECEP 10,00/1.00
ME .
LIC.No. LIGHTING FIXTURES 10.00/1;00 -
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE - PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEERI.E. , .
' c.No. SIGNS TRANS. . •3.00
AARCH.OR DDRESS ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP INS.INS. 20.00 q '
APPLICANTS - MOTORS SEE FEE SCH. Ob ' •.� I/:/
ADDRESS
- ' - SERVICE H20.00
U`¢O.DD LICENSED CONTRACTORS DECLARATION-
U v I hereby affirm that I am licensed under provisions of Chapter 9 PIN of 'ISS ANCE DATE
n Q w (ar Imre ncing,with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH.
0 z Professions Code,and my license Is in full force and effect. ❑ ❑ ❑
z 0 . - License Class Lie.Number • -
9 Date Contractor `
a r f
BUILDING PERMIT
E Ix w u _ OWNER-BUILD17R DECLARATION INFORMATION
X 0 A h 'I hereby affirm thm I am exempt from the Contractor's License MISC.- REFER TO ORD
�+ a-y - VALUATION $/FT.
r a 0 J Law for the following reason(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 0
w0 Code:Any city orcounty which requires a permit to construct,alter,
re U,¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. 77
0 M requires the applicant for such permit to file a signed statement that TOTAL /�� PERMIT TO
A w m"
he is licensed pursuant to the provisions of the Contractor's License
r 2 t Law(Chapter9(commencingwiti,Section70001,,fl)ivision3ofthe
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
'% r 0 the basis for the alleged exemption,Any violation of Section 7031.5 STORIES TYPE CONSTR.
i;� by any applicant for a permit subjects thcapplicanl on civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).) r
❑ 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
Code:The Contractor's License Law docs not apply to an owner of '
o properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP - 5.00 SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
cents are not intended or offered for sale.ll',however,the building GAS-EA.SYSTEM-1 INC.40UTLETS 6;00
or improvement is sold within one year of completion,the owner- - GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im.
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB 'Omer
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the Proicct(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contructor'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 tell such projects with a contrachrfs)licensed pursuant to SEWER-SANITARY-ARV-STORM EA.200ft/10.00
the Contractor's Licensc1aw. ' TRACT NO., PARCEL NO.
❑ lam exempt Iunder Sec. ,B.&NC.for this WATER HEATER W/VENT 6.00 H
\ Wne
Ol
�( Owner, - Date . WATER SYSTEM 5.00
VVV ACC.GATE ACC.FILE NO.
WORKERS'COMPENSA' N DECLARATION WATER TREATING EQUIP. 5.00 `
1 hereby affirm that 1 have a cetlillcute of consent to sell-insure, - ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy IhereoffSec.3800,Lab.C.). -
Policy No. Company '
• 0 ❑ Certified copy is hereby furnished. - FIRE SPRINK ENERGY T 24
Z Z ❑ Certified.copy is filed with the city inspection division. MISC- REFER TO ORD.
•0 Applicant `, _ Y ❑ N❑ Y ❑ N❑
Hy ' PERMIT ISSUANCE 10.00 RLooD zorvE A.L.u.c.
- CE RTI 171CATEOF EXEMPTION I7ROM WORK 1;RS'
LLI 1 COMPENSATION INSURANCE PLG.CONTH. LIC.NO. PLG' '
1 Y❑ N❑ V ❑.. N❑
6. O el dollars-Iced not be completed If the perinit is'for one TOTAL
humb
drtd dollars(5100)or lrss.) I I I -
U O 1 certify that in the-performance oI'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 - .
17 U,become subject to the Workers'CnmpenamiUU Laws ol'Calimmis.
y Date Applicant " ALTER OR ADD TO MECH'. 5.00 BUILDING
} rn NOTICE TO APPLICANT: If,after making this Certificate of fix-
Z cmption,you should become subject to the Workers'Compensation APPLIANCE • 5.00 PLAN CHECK
provisions of the Labor Code, you must.fonhwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1000QflM.) 6.00 SEISMIC FEE
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
Lender's Address 'HEATING UNIT(OVER 100,000 B.T.U.)9,50 ELECTRIC
O I certify that I have read this application and Elute that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to con.ply with all city and county PLUMBING
ordinances and state laws relating to btulding,construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city Ib'vnler upon the BOILER-COMP love,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 whichCONST.TAX
may in any way accrue agairist,said City in consequence of the PERMIT ISSUANCE 10.00
Stmt hg of this perm). • MECH.CONT. LIC.NO. MECH.
�7M! �5 TOTAL TOTAL
SignalureofApphcant/Conractor �atd
OFFICE COPY - -