8985 POST THIS CARD NEAR FRONT OF BUILDING .
CITYNF CUPERTINO ' PERMIT NUMBER
INSPECTION DIVISION
JOB INSP TION RECORD
.. - PERMIT EXPIRATION
IAM-Tl Qk
JOB ADDRESS UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNERoNTRAcroR IS NOT STARTED WITHIN
INSP CTION DATE INSPECTOR INSPECTION RECORD - 180 DAYS OF PERMIT ISSU:
FOUNDATION - ANCE OR 180 DAYS FROM
. - UFER - LAST CALLED INSPECTION.
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLG. MECH.
M4
❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILOING PERMIT
INFORMATION
WOOD FLOOR
,• VALUATION S/FT.
- PLUMBING
MECHANICAL - !�/ / •� ~
ELECTRICAL - / vERMIT ro
FRAMING ; i�7,40 1 -T1, i1
STORIES TYPE CONSTR.
INSULATION •
OCC.GROUP RES.UNITS '
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - - SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
NES IND CON PB OR,el
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ' 11 1-1
ROU H -ASS E SSORS PARCEL NO.
PLUMBING . � •C '
GAS.LEST TRACT NO. PARCEL NO.
MECHANICAL
E LECTRICALpAy�• FINALS DATE INSP. Acc:Gare ACC.FILE No.
FRAMING ,✓4 Af SAN n
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS '
MECHANICAL FIRE SPRINK ENERGY T2
Y El
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N[:1N[]
LATH—INTERIOR ELECTRICALFLOODZONE A.L.Uc.
22-Y�
LATH-EXTERIOR FIRE DEPT. Y : NF] '•• ❑ "❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING •22`YIG
SHEAR EXTERIOR TEMPORARY APPROVAL BUILDING
FIREWALLS ELECTRIC - PLAN CHECK
GAS FEE, •
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCv LSEISMIC FEE'
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAUISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ,
Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL' f J�;
• . CONST.TAX
IMPORTANT!
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
PERMIT NUMBER
guILoBUILDIN OJECT IDE TIFICAT APPLICATION & PE
PrA s l� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 8985
PLAN CHECK VALIDATION
"AME'.ir .-� QTY. ELECTRIC PERMIT FEE
HONE
CONTRACTORS - UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
LIc.N0, LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
ADDRESS APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
PLAN CHECK FEE P.C.NO.
ARCHITECT PANELS (OVER 200 AMPI 20.00
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH,OR ENG. 5.00 PER ION
ADDRESS SPECIAL CIRCUIT
IIP EMP.METER OR POLE INS. 20.00 �1�A
APPLICANTYS MOTORS SEE FEE SCH. I 16 986
ADDRESS
SERVICE CHANGE 20.00 y�� .
D o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 City OIs CIIpBI a tInO
<u it I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
2 w (commencing with Section 7000)of Division 3 of the Business and BLD EL CT. PLG. MECH.
yZ Professions Code,and my license is in full force and effect. ❑
ai u W License Class Lic.Number
T H Date Contactor
tLDING PERMIT
rt ¢w u OWNER-BUILDER DECLARATION INFORMATION
w.3 u w I hereby affirm that 1 am exempt from the Contr.¢tur's License MISC.- REFER TO ORD
ALU TION $/FT.
Ha oa Law forthe following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit lD construct,alter,
QQ Q 40 Improve,demolish,or mpalr any structure,prior to its Issuance,also ELEG CONTE. LIC.NO. ELEC.
O u requires the applicant for such permit to file a signed statement that TOTA PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License 17
Fzi
Law(Chapter 9(commencing with Section 7000)ofDivislon 3 ofthe ' I l�
i Qo Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r v the basis for the alleged exemption.Any violation Of Section 7031.5 STORIES TYPE CONSTR.
!2 by by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER IEA.) 5,00
of not more than five hundred dollars(SSOOM:
❑ 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
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 5 .FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees.Provided that such improve-
mems are not intended or offered for sale.If,however,the balding GAS-EA.SYSTEM-1 INC.4OUTLETS 8.00
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- ES IND CON Pe Other
prfIor purpmeofsale.). INDUSTRIAL WASTE INTER. 30.00
o
I,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑
d 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 as 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
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
l um excmpw er Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00
eawn
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
_ WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.), r (�
Policy No. Company
O ❑ Certified Copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is riled with the city inspection division. MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
QApplicant
KN CERTIFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.LLC.
LEI > . COMPENSATION INSURANCE PLO.CONTR. LIC.NO, PLG. Y❑ N❑ Y ❑ N❑
CL D (This section.need not be completed if the permit is for One TOT
D Z hundred dollars($100)or It..)
U O 1 certify,that in the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued.I shall not employ any person in any manner so as to
Q w become subject to the Workers'Compensation Laws of California. NG
Date Applicant ALTER OR ADD TO MECH. 5.00
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
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 10000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10Mr.RM.) 6.00 SEISMIC FEE
I hereby affirm that (here 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,Ce.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00'
Lender's Name
Lender's Address HEATI NG UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that l 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 BOILER-COMP HP.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and .
hereby authorize representatives of this oily to enter upon the BOILER-COMP(Over 100,000 BTUI 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 NST.TAX
may in any way accrue again sad Ci y in consequence of the
mlynli O this it, MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
/ Signature of ApplicantlConlractor .
OFFICE COPY -