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NO PERMIT NUMBER PUST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PI"MON Ii''III II INSPECTION DIVISION dOB INSPECTION RECORD PERMIT EXPIRATION JOBADDRESS � UNIT ldLOT#f PERMIT EXPIRES IF WORK OWNER _ l CONIRA:rnN IS NOT STARTED WITHIN INSPECTION E INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU FOUNDATION ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PREGUNITE PTlnln VAI InATON -- POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DA f li MECHANICAL x�Lu'rI. Ft cr Plr, n+r cu L,J ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VAUTAR+N VF T. MECHANICAL ELECTRICAL JJrenl,In rP FRAMING INSULATION SrOIRLS TNIt CONsr+ ur,r, 611111111 - Rls uNlTs PLACE NO SUBFL00 UNTIL ABOVE HAS BEEN SIGNED ROOF SOII IIOpRAIIIA 101AL AC 111A1,L IAPHRAGM RI II I.I II NLS IIS! RFS IND CUN I'll APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ROUGH I� ASSL%SUS PAIICL L NO PLUMBING GAS TEST n1ACI NO - PAa:T_ND MECHANICAL ELECTRICAL --- ACE IIATF ACE PILf NO FINALS DATE INSP. FRAMING _ _ SAN # _ INSULATION )I1NIN6 t I;slII NO PLUMOING _ GAS _ MECHANICAL IIRF SPRINT, TNF, < l r ',n COVER NO WOR UNTIL ABOV HAS BEEN SIGNED HEATING ❑ "❑ ❑ "❑ LATH-INTERIOR1 ELECTRICAL n.00DSONL AIUP. S LATH-EXTERIOR FIRE DEPT. ° ❑ N❑ ` ❑ No SHEETROCK GRADE FEE SUMMARY ;HEAR INTERIOR BUILDING TEAR EXTERIOR TEMPORARY APPROVALS BUILDING i REWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 'CCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL TAX IMPORTANT! CONST. _ 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 BUI LDI NG PROJECT I DENTI FICATION RMIT NUMBER eu U;_1U APPLICATION & PERMIT ADD a / 8 217 S /Pr4[ Ly �� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OW ER'S rvAME _ LANC ALIDATION • •� t, l✓L' 11AJ DTA'• ELECTRIC PERMIT FEE PHONE c LONTRACTOR3 NAME UTLETS-SWITCHES-RECEP 10.00/1.00 LIc.No. CONTRACTOR'S LIGHTING FIXTURES 10.00/1.00 ADDRESS APPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 APCHITECi DATE OF APPLICATION OR ENGINEER PANELS (OVER 200 AMP) .20.00 PLAN CHECK FEE .C.NO. ARCH.OR ENG, CIL.NO, SIGNS TRANS. 3.00 ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION zIP EMP.METER OR POLE INS. 20,00 APPLICANT'S h , ADOREss MOTORS SEE FEE w¢ i SERVICE CHANGE 20.00 .02 LICENSER CONTRACTORS DECLARATION TEMP.POLE 30.00 ri U I hereby affirm that 1 am licensed under provisions of Chapter 9 a 0 (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE r w 2 Professions Code,and my license is in full force and effect. - ELECT. PLG. MECH. zo 0 a W License Class Lie.Number. m H Dale Contractor. 1:1 El EJ axf ¢ ¢w OWNER-BUILDER DECLARATION BUILDING PERMIT w ;' I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION F u O j Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE VALUATION S/FT. n Code:Any city or county which requires.permit totonslrm l,alter, 10.00 ¢ 2 Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. yO LL requires the applicant for such permit to file a signed statement that ELEC. ©O whe is licensed pursuant to the provisions of the Contractors License TOTAL PERM O 5 z a Law(Chapter9(commencing with Section 7000)of Division3 of the Z 4 o Nosiness and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE /✓/s�IYN//v ¢I-$ the basis for the alleged exemption.Any violation of Section 7031.5 n 3 by any applicant for a permit subjects[he applicant[o a civil penaltySTORIES T E CONSTR. Of not more than five hundred dollars(5500).): 'ALTER-DRAIN&VENT-WATER IEA.) 5.00 ❑ 1,as owner of the properly,or my employees with wages as their sale compensation,will do the work,and the structure is not BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business end Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's Liccnu Law does not apply m an owner of property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 IIImsCIf Or Ihrnagh(IIs OWn CnIP0YCC5.pro Vlded that SIICh Improve. SO.FT.FLOOR AREA TOTAL ACREAGE mems are not intended or offered(or sale.IL however.the building GAS-EA.SYSTEM.1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- in r will have the burden of proving that he did not build ar im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE o 1,as ownerose of theJ. INDUSTRIAL WASTE INTER. 30.00 REB IND CON Pe Other I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ ed contractors to construct the project La 7044,Business nd Professions Code:The Contractor's License Law does not apply LAWN SPRINKLERS-11NC5 V.B. 6.00 ASSESSORS PARCEL NO. 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 colorations)licensed pursuant to the Con tract is Licenle Law. SEWER-SANITARY-STORM EA.200ft/10.00 0. In eempl a er S ._-,B.&P.C.for this TRACT NO. PARCEL NO. reason WATER HEATER W/VENT 6.00 Own WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKS RS'CI have aS TIONDECLARATION ofco RATION WATER TREATING EQUIP. 5.00 I hereby affirm that.(have a certificate of consent[G self-insure. or a certificate of Workers'Compensation Insurance,or a certified ZONING Copy thereof(Sec.3800,Lab.CJ. ENG.SITE N0. Policy No. Company _ 0 ❑ Certified copy is hereby furnished. Z Z ❑ Cenified COPY is fled with the City inspection division. FIRE SPRINK ENERGY T-24 p Applicant MISC.- REFER TO ORD, Y N� Y N❑ D- y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 LD COMPENSATION INSURANCE 7Lo00 ZONE A.L.u.C. CL PLG.CONTR. LIC.NO. PLG. Z (This section need not be completed if the permit is for one TOTAL Y E] N� Y 0 N� U O hundred dollars(5100)or less.) I certify that in the performance of the work for which this per- FEE SUMMARY LL I- mit is issued,I shall not employ any person in any mannerso as to CITY, MECHANICAL PERMIT FEE Q W become subject to the Workers'Compensalion Laws of California. y NOT APPLICANT: If, ALTER OR ADD TO MECH. BUILDING } m NOTICE TO APPLICANT: If,after making this Certificate sa ion 5.00 I- 2 eruption,you should become subject to the Workers'Compensation APPLIANCE provisions of the Labor Code, you must forthwith comply with 5.00 PLAN CHECK sha U • such Provisions or this permit ll be deemed revoked. AIR HANDLING UNIT(TO 10pODGF.M.) 4,00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 140WGRM.) 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. 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender,Name Lender's Address HEATINGUNIT(OVER100,000B.T.U.)9.50 ELECTRIC I certify that 1 have read this application and state(hat ,a above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to coat P1Y with all city and county on inances and state laws relating to building construction, and BOILER-COMP(3H.Rorli08.T.U.) 6.001 PLUMBING hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE,FEE SCR. MECHANICAL (We) agreeto save, indemnify and keep harmless the City of MISC.- REFERTO ORD Cupe ' agamM bilines,judgments,costs and expenses which . ma any way ecru,howInst City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX g g o(this sa' �yS ECH.CONT. LIC.NO.. MECH. �Sg (- n Signature of Applicant/Contractor/ Date r TOTAL TOTAL i5 3- OFFICE COPY - ///