C 8164 POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO RnnT NDMBEry
s:
r INSPECTION DIVISION, 8164
JOB INSPECTION RECORD
I PERMIT EXPIRATION
JOB ADDRE UN LOT# PERMIT EXPIRES IF WORK
OWNER ONTRACTOR I IS NOT STARTED WITHIN
INSPPCTION I DATE INSPECTOR I INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION k ANCE OR 180 DAYS FROM
UFER
LASTCALLED INSPECTION.
PREGUNI TE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB /�CI
PLUMBING
ELECTRICAL
IS UANCE OATE
MECHANICAL - - BLDG. ELECT. PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - -BUILDING PERMIT"
WOOD FLOOR INFORMATION
PLUMBING VALUATION $�FT.
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING
INSULATION sT0 Bs TYPEDo STR.
c.GITOUP ES.UNITS
4
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50.GT.fL0(IH AREA TOTAL ACREAGE
ROOF '
DIAPHRAGM . BUILOI NG USE
RES IND CON PB O,ha,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING
GAS TEST TRAGI NO. PARCEL NO.
MECHANICAL
'
ELECTRICAL FINALS DATE INSP. ACC.DATEACC.FILE NO.
FRAMING SAN #
INSULATION PLUMBING r
ZONING ENG.SITE NO.
GAS
MECHANICAL FIRE SPRINK ENERGY T Y<
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� Y "o
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.U.c.
LATH—EXTERIOR FIRE DEPT. Y❑ NE] Y 0 N❑
SHEETROCK GRADE - FEESUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
"- GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
J.0 PLEASE PLEASE GIVE JOB ADDRESS WHEN PHONING.
I,
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! coNsr.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. f" j
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATIONPERMIT NUMBER
BUILDING APPLICATION & PERMIT . ' .
IT REBB W0 6 4
s -BUILDING-ELECTRICAL-PLUMBING -MECHANICA
INNER'S PLAN ECK VALIDATION
ME QTY. ELECTRIC PERMIT FEE
CIDB�bv E
ACTOR S
OUTLETS-SWITCHES-RECEP 10.00/1.00
\IL--•tnJ I.IC.NO. LIGHTING FIXTURES 10.00/1.00
C TRBET Rs PPLIANCES-RESIDENTIAL 4.00
a ESS
\ PHONE PANELS 10.00 DATE OF APPLICATION
ORRCRI CT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
ENGINEER
LIc.No, SIGNS TRANS. 3.00
A.CREb E� SPECIALCIRCUIT 5,00 PERMIT VALIDATION
EMP.METER OR POLE INS. 20.00
ADDRESS is
a PPLICA MOTORS SEE FEE SCH. J
SERVICECHANGE 20.00q
Be O LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 3��
a i w I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSU NCE DATE
v, a N (crunu cmg w h 00)of Division 3 of the Busine and BLD ELECT. PLG. MECH.
E. w z Prot essla s C license is in full f
z O m License a Lic.Numb
o 1- )a Contractor
`a Y s , O BUILDING PERMIT
BE o i NER-BUILDER DECLARATION INFORMATION
Z
; m 1 hereby at that I am exempt from the Contractor's License MISC.- REFER TO ORD
F LL o J Law for the following reason.(See.703 L5.Businessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
op Code:Any city or county%fact:requires peanut locnnstaAf al«r,
BE
¢ ¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
A w .4 req WleS IIIc apphCJul far SIICh permit to IIIc L signed sfJICmCN that TOTAL - PERMIT O
m he is licensed pursuant to the provisions of the Contractor's License
1- reA Law Chapter 9(commencing with Section 700()of Division Toll the
4 D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
Ee I a the basis for the alleged exemption.Any violation of Section 7031.5 ST Ed T PE OrvSTR.
s ; _ by any applicant fore permit Subjects(S500 licam toacivil penally ALTER-DRAIN -WATER (EA.) 5.00 A �-
of not more than five hundred dollars ISSOO7J:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not DCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 J/-t1
Code:The Contractor's License Law does not apply to on owner of Of Cu e
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00
SO.Fr.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
x ments are not intended or offered for sale.If.however.the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that be did not build or an BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
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 does not apply
to as owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts fur such projects with a contrectorlsl licensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,B&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a cert. cafe ofconsent to self-insure. ZONING
Or a certificate of Workers'Compere ling Insur nee,ar a ce reified ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.) �V 1y
'T Pohc o. Cnm any
O rtifood cop isl ref furnis FIRESPRINK ENERGYT24
z Z Certified file wi h he a pex I n MISC.- REFER TO ORD.
- Applicant 11' Y ❑ N❑ Y ❑ N❑
� �' cF:RT1F AT ser ExEMP O 'OR ERS. PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
LU C PENSAI'ION IN URANC: PLG.CONTR. LIC.NO. PLG. Y E] N❑ v C3 N❑
CL Z (This section need not be completed if the per Fit is for one TOTAL
hundred dollars IS 100)or IessJ
U O 1 certily that in the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued, 1 shrill not clmplay any person in any manner r,as to
U
U become subject to the Worker:Compensation Laws of California. BUILDING
y Date Applicant ALTER OR ADD TO MECH. 5.00 �3
} N NOTICE TO APPLICANT: IC after making this Certificate of Ex-
F ? ecoption.you should become subject to the Workerh Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE o p/
U Inch provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=r-F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 4"
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the purfnrmance of the work for which this permit is issued(See. MICROFILM
3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 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-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
mdurances and state laws relating to building construction, and
hereby authorize representatives o1' this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agr a to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupe tiro gains) liab" 'es judgments, cap and exp ses which PERMIT ISSUANCE 10.00 CONST.TAX
BID LF y way a i st said Cit in consequ ace o the
a Of 11115 II. MECH.CONT. LIC.NO. TOETAL jlts
TOTAL 7
i re PPI 'an or a
OFFICE COPY /