17300 POST THIS CARD NEAR FRONT,OF BUILDING
_ PERMIT�NUMBER
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CITY OF CUPERTINO '
'INSPECTION DIVISION
RB INSPECTON R
IECORD .
. ® 4 ✓ham
/�,^� • 'e`�£ o\ PERMIT EXPIRATION
JOB ADDRESS l W 4L� UNIT# `_LOT# I ,)pERM1T EXPIRES IF WORK
OWNER CONTRACTOR - IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD )'780 DAYS OF PERMIT iSSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: -•-LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIT/OF PERMIT VALIDATION
GARAGE SLABS - CUPERTINO STANDARDS. !�1 ,. { ♦
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - -
UNDERGROUND-
/SLAB, - -
PLUMBING
. ELECTRICAL - SCI ISSUANCE LATE
MECHANICAL G Itm ELECT PLc. MECR.
❑ ; ! 1, ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BOILDIN,O PERMIT
WOOD FLOOR INFO ATION
VALUATION
PLUMBING - -
MECHANICAL -
ELECTRICAL - PERMIT TOO. 1 '
FRAMING - I !-
STORIES TYPE CONSTH,
INSULATION
OCC GROUP RES-UNITS
y
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.F. FLOOR AREA TOTAL ncREAcg.
i' DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
-
ROOFSHEATHING -FITS IND CON P9 ow.,
' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.N ASSESSORS PARCEL NO.
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT No. PARCEL NO
MECHANICAL MECH.ENERGY
-
ELECTRICAL � .. y� BUILDING ENERGY ACC,DATEACC.FILE NO
FRAMING - ELECT.FINAL TEST -
ZONING ENG SITE NO,
INSULATION PLUMBING �GAS TEST - GAS
MECHANICAL - FIRE SPR INK ENERcv T.zA
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ - No
EXTERIOR SHEAR
ELECTRICAL RELEASE ^ FLOOD ZONE A.L,Uc.
INTERIOR-SHEAR - FIRE DEPT. Y ❑ N❑ '° ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH -- BUILDING
INTERIOR.LATH - TEMPORARY APPROVALS BUILDING
SCRATCH COAT JELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDINGFINAL IS SIGNED.BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION-BY PHONING 252-4505, ELECTRIC
• LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING:
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!
CONST.rqx
PLEASE READ REVERSE SIDE BEFORE . TOTAL
CALLING FOR FINAL INSPECTION. .1
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATI ON -PERMIT NUMBER
BUILDING APPLICATION & PERMIT x 7300
AOORBE,'J '+ ` _ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL y
OWNERS
NAME /" I PLAN CHECK VALIDATION
d / DTV. ELECTRIC PERMIT r FEE
C L(�ytc!' PHONE s
NOMERacrDR's `O Q UTLETS-SWITCHES-RECEP 10.00/1.00 13,0
LIGHTING FIXTURES 10.00/1.00 Z
CONTRACTOR's
ADDRESS e
� APPLIANCES-RESIDENTIAL 4.00
pN),q
M - PHONE 7 -f99 PANELS 10.00 I , DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.N0. '
OR PANELS (OVER 200 AMP) 20.00 ,
ENGINEER
' LIC.No. ISIGNS TRANS. 3.00
ADDRESS ENG SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
21P EMP.METER OR POLE INS. 20.00 �,�fl L�'f11�1L r-CA
ADDRESS - MOTORS SEE FEE SCH. a\r)(l.il�}�..��J
ADDRESS
'/ JJ'sSs SERVICE CHANGE 20.00
Woo LICENSED CONTRACTORS DECLARATION
W, wow I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
F (commencing with Section 7000)of Division 3 of the Business and
w a y BLDG. ELECT. PLG. MECH.
F z Professions Code,and my license is in In force' Y
z o - License Class Lic.Nor
be _ VEl E
D Date =G2 Contractor CI W
a m a - BUILDING PERMIT
¢ a OWNER-BUILDER DEC RATION -
o d o - - INFORMATION
aaser ; a y I hereby affirm that I so exempt from the ConNactnr's License MISC.- REFER TO ORD VALUATION $/FT.
Foo J Law torthe following reason.(Sec.7031.5,Business:rad Professions PERMIT ISSUANCE i8:'fiB 12 40
Code:Any city or county which requires a permit to construct,alter,
Krt ¢ improve,demolish,Or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. - ELEC. I�O
wO LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
$ he is licensed pursuant to the provisions of the Contractor's License .,.,r
F Z i Law(Chapter 9(commencing with Section 7000)of Division 3 critic i'.-.-.11
a Business and Professions Cade)Or that he isexompl therefrom and DTV. PLUMBING PERMIT FEE
f i O
It F the basis for the alleged exemption.Any violation of Section 7031.5 STORIES - TYPE CONSTR.
a ; '? by any applicant for a permit subjects the applicant to a civil penally
of not more than live hundred dollars(45001.): ALTER-DRAIN&VENT-WATER (EA.) AO
❑ 1,as owner of the property,or my employees with wages as BACKFLOW 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,CO D. 5.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds Or improves thereon,and who floe's Such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
merits are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INCA TLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OV E 4 IEA.) 2.00
builder will have The burden of proving that he did not build or im. BUILDING USE
prove for purpose of sale.).- INDUSTRIAL WASTEI TER , 3000 RES IND CON PB Omer
❑ I,as owner of the property,ons exclusively contracting with . . ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec 7044,Business LAWN SPRINKLER -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 SPRINKL S-OVER 5 IEA.) 1.00
contracts for such projects with a conlraclons)licensed pursuant to SEWER-SANIT RY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec,-,IL&P.C.for this WATER HE ERW/VENT 6.00
reason
Owner Date WATERS STEM - 5.00 -
ACC.DATE ACG FILE N0.
WORKERS'COMPENSATION DECLARATION WATE REATING EQUIP. 5.00 -
1 hereby affirm that I have a certificate orconsent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. t FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with Om,city inspection division. MISC.- REFER TO ORD. .
O Applicant Y ❑ N❑ Y ❑ N❑
LU
T) CERTIFICATE PERMIT ISSUANCE 10.00 FLOOD-ZONE A.L.U.C.ION INSURANCE
FROM WORKERS'
W ? COMPEIiEXEMPTION PLG.CONTR. LIC.NO. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL Y E] N❑ Y C] NE]N
hundred dollars(8100)or less.)
U O 1 certify that in the performance of R • o forrich
this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued.I shall not employ any pe an rine,so as to
U hecom•su Io WOrke ompc s of£alil'ornin.
O ED - BUILDING
C. Dat Pelican ALTER OR ADD TO MECH. 5.00
} Us NOTICE. TO APPLICAN r I a ter ma ing this Certificate of Ex-
f- 2 emption,you shoulJ became jec to the Workers'Compensation APPLIANCE 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(TO346011FAI 4.00
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNITI R 10000.RM.) 6.00 SEISMIC FEE
I hereby-affnm that there is a construction lending agency for EXHAUST HOOD ITH DUCT) 5.00
the 30971CiLorcance of the work for which this permit is issued(See.j. HEATING UN (TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name HEATING 1T(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I C
I certify that I have read This application and state that the above VENTILXTION FAN (SINGLE) 4.00
• infuriation is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOIL -CC)MP(3.H.P.or100,000B.T.U.I 6.00
hereby authorize representatives of this city to enter upon the B LER-COMP (Over 100,000 BTU)SEE FEE SCM. i MECHANICAL
above-mentioned property for inspection purposes.
(Wepagrce to save, indemnify and keep harmless The City of ISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
Ice ing of This permit. MECH.CONT. LIC.NO. MECH.
aj TOTAL TOTAL 't'�•
S' aure of Applic t/Contractor Date
OFFICE COPY