18777 POST THIS CARD NEAR FRONT OF BUILDING PERM ITNUMBE13
'CITY 01 " CUPERTINO 18777
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS UNIT# LOT# _ PERMIT EXPIRES IF WORK
OWNER CONTRACTOR - IS NOT STARTED WITHIN
-INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - - - ANCE OR 180 DAYS FROM
.NOTE:
UFER � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLE D INSPECTION.
PREGUNITE TO COMPLYIWITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS... .
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB OCT 1
PLUMBING' ♦ J
ELECTRICAL CIaT of.CItDBIt107 ,issuANCE DATE• V
MECHANICAL ELDG. ELECT. .PLG, MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING (J
MECHANICAL - / dO ~
'ELECTRICAL PERMIT To
FRAMING.
INSULATION STOWES TYPO CONSTR,
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO,FT FLOORAREA TOTALACREAGE
DIAPHRAGM. THE CONSTRUCTION TAX IS PAID ,�"
6uI LUI USE
fl00F SHEATHING � � HES IND CON PE Um..
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El El El ❑
ASSESSORSPAHCEL NO.
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL - BUILDING ENERG ..ACC,DATE ACC FILE No
FRAMING• _ - ELECT.FINAL TAW
ZONING END SITE N0.
INSULATION - � � PLUMBING
GAS TEST' - - GAS
MECHANICAL FIRE SPRINK ENERGY 724
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING' ` "� "o
EXTERIOR SHEARELECTRICAL RELEASE FLOOD ZONE AL U.0
N� L �
• INTERIOR SHEAR N
- FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING SS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE,OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ' �J co O
��. ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING �'
o PLEASE GIVE JOB ADDRESSWHEN PHONING. G
z - SEE PERMIT FOR EXPIRATION DATE - MECHANicAL
IMPORTANT! CONST.TAX '
PLEASE READ REVERSE SIDE BEFORE TOTAL Sa
CALLING FOR FINAL INSPECTION.' 2
' - OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
1 ' BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER
0 LDING APPLICATION & PERMIT O'f
ADDRESS ry ,•' ,'! O II 1
(0072 )IL yy Q� LTJ BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
I OWNER'S
NAME y1 q PLAN CHECK VALIDATION
TION
/,( 253�ID9U DTV. ELECTRIC PERMIT FEE
L RS (/JPHONE
NorvrR Tons OUTLETS-SWITCHES-AECEP 10.00/1.00
LIC.NO, LIGHTING FIXTURES .10.00/1.00
RRADroRs
ADDRESS PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS - 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO
OR PANELS (OVER 200 AMP) 20.00 ENGINEER ENGINEER -LIC.NO, ISIGNS TRANS. 3.00
ADDRESS ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20,00 I V—1 6
ASMOTORS SEE FEE SCH.
Erc
ADDRESS
SERVICE CHANGE ss�20.00
O o LICENSED CONTRACTORS DECLARATION
a U I hemby ff,.stmt 1 am licensed under provisions of Chapter 9 .ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and
¢ A g BLDG. ELECT. PLG. MECH.
F 7 i Professions Code,and my license is in full force and effect. s .- ❑
o 0'�, G License Class Lic.Number
H m H j Dale Contractor y��
rc m ¢ ¢ OWNER-BUILDER DECLARATION CITY 0f CUOBd�110 BUILDING PERMIT
. o it u INFORMATION
w g LL H 1 hereby affirm that 1 on exempt from the Contractor's License MISC.— REFER'TO ORD
✓+ VALUATION $/FT.
H u o¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 ,�Q
Www Code:Any city or county which requiresa permit toconstrucl,alter, I
rc La¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
i 0 M requires Ilse applicant for such permit to file a signed statement that TOTAL. .�3
La w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
HZ > Law(Chapter 9(commencing with Section 7000)of Division 3 of the
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
6 H g lire basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE ONSTR.
i by anyappticant fora permit subjects rhe applicant tGaCivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5,00 7 Cb
more
ohms five bund«d property,
s 1my employees
I,as owner at the property,or my employees with wages us BACK FLOW PROTECT.DEVICE 4.00 OCC,GROUP RES.UNITS
Ih sole compensation,will(S the work,and the structure Is not -
m ended or offered for role (Sec. do nosiness and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not who to an owner of -
himspro,elfy who orthlughhisrlmnemplNees,pr andwhotat oes such im work FIXTURES-PER TRAP S.OD QO SO.FT.FLOOR AREA TOTAL ACREAGE
himself m through his own employees,fors provided that such improve-
orim am not or within
year
If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sob within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or am. BUILDING USE
Prove for purpose.1 SWC.). RES IND CON PB' Orhe,
O 1,as owner off the property,am exclusively contracting with INDUSTRIAL WASTE INTER. - 30.00
licensed contractors to Cm.H,CCI the prolem(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. .6.00 ASSESSORS PARFE—LNo-
and Professions Code:I'he Contractors 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 contractonst licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200t1/10.00 TRACT NO. PARCEL NO.
❑ la ns exempt under Sec. ,B.&P.C.I' r0is WATER HEATER W/VENT 6.00
reason
�( Owner )ate/ / WATER SYSTEM 5.00
ACC.GATE- ACC FILE NO.
W KERS'COMPENSATI NDECLARATION WATER TREATING EQUIP. 5.00
I herchy affirm that I have a certificate of consent to lel Glns'uro,
or a certificate of Workers Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thercof(Sce.3800,Lah.CJ. "
Policy No. Company
0 ❑ Certified Copy is hereby furnished. _ FIRE gPRINK ENERGY T-24
Z C) ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. � ❑
O Applicant v N Y N
W CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00y.2,00 tFLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. /
fL Z (This section need not he completed if the permit Is for one TOTAL �p �� Y ED N� Y E) No
hundred dollars IS 100)or IcsaJ
U O 1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
IL mit is issued,I Shall not employ any person in any manner so as to
O W become sCh,iCCt to the Workers'Compensation Laws of Californ ia.
n Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING D3
} m NOTICE. '(O APPLICANT: If,atter making this Certificate of fix. .7
? emption,you should become subject to the Workers'Conmensation APPLIANCE 5,00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or This pennit Shull he deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lendiag 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 ITO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC ` to CO
Icerlify lhatlhave read this applicmion and state that the above VENTILATION FAN (SINGLE)' 4.00
11
information is correct. I agree to comply with all city and county PLUMBING
ordinances and slate laws relating to building Construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 (V
herchy tunentiofifted representativesec this city es enter upon the BOILER-COM P(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly forinsp of
purposes.
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, cost and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City consequence of th•
[Ingot Iispermil' MECH.CONT. LIC.NO. MECH.
TOTAL
'TOTAL
Signal Applicant/Contractor Dme
OFFICE COPY