11475 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 11475
INSPECTION DIVISION
i JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB AD IDRE�SS\\ yD� J.(/ L F`—„� UNIT#J�=-'C�77Yf' PERMIT EXPIRES IF WORK
OWNER I L1-.W Pill CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
UFER LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
i
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING (((
ELECTRICAL ISSUANCE DATE
MECHANICAL 'Bu ELEcr. G. MECH.
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING 3iD/�O
MECHANICAL
Ry 1 TO
ELECTRICAL IrvT.
FRAMINGSTORv, CIES TYPEECOO
NSTR.
INSULATION ,
C.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO IT 1.10011 AREA TOTAL ACREAGE
ROOF
DIAPHRAGM BUILDING USE
RES IND CON PR UP.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED -
ASSESSORSPARCELND.
ROUGH
PLUMBING
TRACT NO. PARCEL NO,
GAS TEST
MECHANICAL
ACC DATE ACC FILE NO
ELECTRICAL FINALS DATE INSP.
FRAMING SAN #
zoNlNc ENc,SITE No.
INSULATION PLUMBING
GAS
FIRE BPRINK ENERGY D24
MECHANICAL Y N ❑ NC]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE 4.L.0 C.
LATH—INTERIOR ELECTRICAL
LATH—EXTERIOR FIRE DEPEXP
v N� v I] NE]
SHEETROCK GRADE M 16.IIIIf FEE SUMMARY
SHEAR INTERIOR BUILDING
BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
IIlwO� PLEASE GIVE JOB ADDRESS WHEN PHONING.
z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL i
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUILDING PROJECT IDENT FICATION PERMIT NUMBER
BUILDING Q APPLICATION & PERMIT 11475
A611 / far
(d/ (,Yv BUILDING — ELECTRICAL—PLUMBING—MECHANICAL
' -2 '7J� PLAN CHECK VALIDATION
WNE o'er/-7
"AME �//]J� DTV. ELECTRIC PERMIT FEE
.' V ' h HONE 1[
CONTRACTORSOUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
LIC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT
PANELS (OVER 200 AMP) 20,00 NCHECKFEE
PLAP.C.NO.
OR
ENGINEER
LIC,No, SIGNS TRANS. 3.00
ARCH,OR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
ZIP rrEMP.METER OR POLE INS. 20.00
APPLICANT MOTORS SEE FEE SCH.
ADDRESS Ess
SERVICE CHANGE 20.00
wa o LICENSED CONTRACTORS DECLARATION D l( p
u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
H Q m (commencing witls Section 7000)of Division 3 of the Business and BTLDGI SELECT. PLG. MECH.
H w z Professions Coda and my license is in full force and effect r(' El
o w— License Class Lie.Number \ El ❑
Q H w Date—
Contractor. p
\� a w ¢ OWNER-BUILDER DECLARATION \ CUQB ING PERMIT
O REFER TO ORD INFORMATION
re 3 u I- I herebyaffou that 1 am exempt from the Contractors License MISC.—
p VALUATION •$/FT.
anoa Law for the following reason.(Sec.7031.5,Businessind Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires permit to construct,alter,
)w Q 0 Improve,demolish,or repair any Structure,prior to Its issuance,alio ELEC.CONTE. LIC.NO. ELEC.
— O u requires the applicant for such permit to file a signed Statement that TOTAL PERMIT TO
e. w m he is licensed pursuant to the provisions of the Contractor's License
FZi Law(Chapter 9(commencing with Section 7000)ofDlvision 3 of the
��{/� l/LQ[�
a Business and Professions Code)or That he is exempt therefrom and DTV. PLUMBING PERMIT FEE
E 2 O STORIES TYPE CONSTR.
I_$ the basis for tam alleged exemption.Any violation u(Sectiun malty
La ; _ by any applicant fora permit subjects tha applicant toa civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500L)'.
❑ Lmyemployees owner of the properly,or my with wages as BACK FLOW PROTECT.DEVICE 4.00 --FCC.GROUP RES,UNITS
their sole r offered
fo,will(S the work,and the structure is not
intended air Contractor's
for sale seta 7044, Business and it owner
DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:'fhe Contractor's Lin:nse Law docs not apply to an owner of
IJ property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-11NC.40UTLET$ 6.00
marts are not intended or offered for sale.IC however,the building
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have it,,it,,burden of proving that h .e did not build or im- RES IND CON PR Other
prove lot purpose of sale.). INDUSTRIAL WASTE INTER. h 30.00 ❑ ❑ ❑ ❑ ❑
❑ I,as owner of the property,am exclusively contracting with
licensed 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 docs not apply
to an oAta
open, wbuil it improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracforproj$vrs th c ntructons)licensed pursuant to
the CoSEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ l ,B.&P.C.for this WATER HEATER W/VENT 6.00
ason
OwnerUa[e WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSAT) D- RATION WATER TREATING EQUIP, " ., 5.00
I hereby allinn that 1 have ay�ti Irate of consent to sell=insure, ZONING ENG.SITE NO.
or a certificate of Workers'Corllfrensalion Insurance,or a cerlified
copy thereof(Sec.3800,Lah.C.).
Policy No- Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z_ Z ❑ Ccrlificd copy is Filed with the city inspection division. MISC.- REFER TO ORD, v ❑ N❑ v ❑ N❑
I--' oApplicant
PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W — CERTIFICATE 017 EXEMPTION FRONT WORKERS'
UJ > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. v❑ N❑ Y ❑ N❑
CL o This Section need not be completed if the permit is fur one TOTAL
D Z hundred dollars IS 100)or leer)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
EL P- mit is issued, I shall not employ any person in any manner so as to /
OL) become Subject lO the Worker.,''Compensation Laws of Calitilrn ia. BUILDING
Dale Applicenl ALTER OR ADD TO MECH. 5.00 KKK///vi
} ran NOTICE TO APPLICANT: 11,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 10SWC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOWC.F.M.) 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,CIv.CJ.
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws retailing to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP(Owr 100,000 BTU)SEE FEESCH. MECHANICAL
A4r
property rinspection purposes.
save, ' on andkeephurndess the Cityof MISC.- REFER TO ORD.
halt If s, ' gmenis, costs and expenses which PERMIT ISSUANCE 10.00CONST.TAX
a stsaid City is conseque ce o ther t MECH.CONT. LIC.NO. MECH.7 16 TOTAL TOTALHeNot/ antro or 1 Te
OFFICE COPY