15319 (2) I .
l POST THIS CARD NEAR FRONT OF BUILDING
'" / CERMIT NUMBER
CITY OF CUPERTINO 15319
INSPECTION DIVISION
JOB INSPECTION EC RD
PERMIT EXPIRATION
,JOB ADDRESS 1 0� NIT# _LOT#
" PERMIT EXPIRES IF WORK
OWNER-- coNTRACTo ,IS NOT STARTED WITHIN
C',' INSPECTION DATE IMPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. -
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED % ID
UNDERGROUND /SLAB
PLUMBING 11989 .
ELECTRICAL - ISSUANCE DATE -
MECHANICAL - Cr I PLG. - MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
'WOOD FLOOR VALUATION SIFT,
PLUMBING ,
MECHANICALL'
ELECTRICAL PERMIT TO
FRAMING t ✓
INSULATION _ STORIES TYPE CONSTR
I�
UCC.GROUP 'RES.UNITS
�.
FEL AC_EN O SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NO N I L SP. LL BE MADE BEFORE SO.FT FLUOR AREA TOTAL ACREAGE
�I"
DIAPHRAGM - THEC ST TA AI
BUILDING USE
ROOF SHEATHING RES IND CON PB OILr'
C'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Q El 0 0 0
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY
.. TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY
_ ACC DATE ACC FILE NO
ELECTRICAL - BUILDING ENERGY -
FRAMING" ELECT.FINAL TEST
INSULATION - PLUMBING ZONING ENG SITE,NO
GAS TEST. - GAS -
MECHANICAL FIRE SPRINK ENERGY T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED` HEATING MED El "0.
F LDDD ZONE A.L.U,C.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR.SHEAR FIRE DEPT. Y ❑ N[0] Y 0 No'
_. SHEETROCK - GRADE - FEESUMMARY
.EXTERIOR LATH BUILDING
INTERIOR "LATHTEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
IND TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
°ARRANGE FOR'INSPECTION BY =DATE —
IC
ELECTRIC
e til ONE WORKING DAY BEFORE REPLUMBING
- PLEASE JOB ADDRESS WHE
w2 — SEE PERMIT FOR EXPIRMECHANICALIMPORTANTIby"sT.TAX
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
BUILDING PROJECT IDENTIFICATION YERMITNUMBER I
BUILDING APPLICATION & PERMIT 9
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
E CITY. ELECTRIC PERMIT FEE
PHONE '07i
COrvTRac\*oR �'^ OUTLETS-SWITCHES-RECEP 10.00/1.00
VAPOE
11 1►'��uc.NDsfIJ LIGHTING FIXTURES 10.00/1.00
CONTRACTOR' 30 pp (� ��+h CI CJ PPLIANCES-RESIDENTIAL' 4.00
CS
' Ao a l• -
PHOry PANELS 10.00 DATE OF APPLICATION
ARCHITEC PANELS (OVER 200 AMP)
ENGINEEfl 20,00 PLAN CHECK FEE P.C.NO.
on
- uc.No. � SIGNS TRANS. 3.00
AARCH.OR
DDRESS ENG. SPECIAL CIRCUIT 5,00 TPERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 U. AN'I'a•�v�` I
APPLICANTS MOTORS - SEE FEE SCH. -
ADDRESS
SERVICE CHANGE 20.00 D 9 I I /89
w o o LICENSED CONTRACTORS DECLARATION 1M '
a v -
I hereby affirm that I am licensed under provisions of Chapter 9 I DANCE DATE
m a N (commencing with Section 7000)of Division 3 of the,Business and BLDG. ELECT. PLG. MECH.
H o z Professions Co f,�andan se is in full f ❑
z o y- Lice n lac Lic.Numb rNew ED
9 m H w Dia Contractor
a m f BUILDING PERMIT
¢ a, ¢ ¢ OWNER-BUILDER DECLARATION
a P.
o W ° MISC.- REFER TO ORD INFORMATION
X ;LL N I hereby uffirm that 1 am exempt from the Contractor's License VALUATION S/FT.-
F ICN , Law for the following reason. 7031.5,Business and Professions PERMIT ISSUANCE 10.00
sy Code:Any city or county which requiresa permit to construct,alter.
<a improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
w -o u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
o. •m he is licensed pursuant to the provisions of the Contractor's License - �/� /�,-s 1
1 rii Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe Mr-LNII-PNV
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
Ic H the basis for the alleged exemption.Any violation o(Sec[ion 7031.5 STORIES TYPE CONSTR.
n; � by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 DCC.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,AR EA,COND. 5.00 '
Code:The Contractor's License Law does not apply to an owner of
�r property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP S.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-I1NC.40UTLETS 6.00 .
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Omer
prove for purpose of sale.). , INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I 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 SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a ecturactm(s)licensed pursuant to SEWER-SAN ITARV-STORM EA.200ft/10.00 -TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ lam exempt under Sec..,BAPC.for this WATER HEATER W/VENT 6.00 ,
reason
Owner Date WATER SYSTEM '5.00 - ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECCARATION WATER TREATING EQUIP. 5.00
I hereby affirm [hat I have a certificate of consent to self-iname, ZONING ENG.SITE NO.
or a certificaterkers'CmnlrcnsatioG,serine�y�lor a ertificd
copy[hc Lab.C.r(]]�KK.�..r l-��
Policy N any
0 ❑❑� rtIII eit copy is herebm
y uished FIRE SPRINK ENERGY T-20
Lpe1
Z Z ✓ `erY re u� '. s 'EI mschon division.
0 Applkam �l�d4 ,,;,,, •I,. ..YyjT MISC.- REFER TO ORD. Y N❑ Y E-1PERMITL4 CERTIFICAI'170 EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU >_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. DLG.
CL (This section'need not be completed if the permit is for one TOTAL Y❑ NE] Y❑ N❑
Z) Z hundred dollars IS 100)or less.)
U 0 1 certify that in the performance of the work for which this per, DTV. MECHANICAL PERMIT ' FEE FEE SUMMARY
IL H mit is issued,I shall not employ any person in any Donner so as to
U become subject to the Workers'Compensation Laws of California.
D.M Date Applicant ALTER OR ADD TO MECH. - '5.00 BUILDING
} Ul NOTICE TO APPLICANT: If,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
V such provisions or this permit shall be 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
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. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address - HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that 1 have read this application and store that the above VENTILATION FAN (SINGLE) 4.00
inforintiun is correct.I agree to comply with all city and county PLUMBING
4, ✓ ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city.to enter upon the BOI LER-COMP Mae,100,000 BTUI SEE FEE SCH. MECHANICAL 21
above-mentioned property for inspection purposes.
4.(�W�S) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
ino against liabilities,judgments, costs and expenses which T.TAX
in any way accrue against'said City.in consequence of the PERMIT ISSUANCE 49-00 ' i
f this permit. E ONT. LIC.NO. MECH.
� TOT° TOTAL 0021
reof pplicanl ontrclor Date •'
li OFFICE COPY