9490 (2) POST THIS CARD NEAR FRONT OF BUILDING
T I PFRMIT'NUMBER
CITY OF CUPERTINO '`� . :`
INSPECTION DIVISION v
JOB INSPECTION RECORD Q�vL"
� � kW UNIT# LOT# - r PERMIT EXPIRATION
JOB ADDRESS I,G PERMIT EXPIRES IF WORK
'OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTI N - DATE INSPECTOR INSPECTI N RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONeft NCE OR 180 DAYS FROM
/
�— -,1' '-LAST CALLED INSPECTION.
UFER _ to
PREGUNITE - PERMIT VALIDATION "
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ''�"� 'ISSUANCE DATE
MECHANICAL -BUOG ELECT. PLG, MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT.
,k,,,
INFORMATION
WOOD FLOOR I*•
VALUATION 'SIFT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING
INSULATION STORIES, T PE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.FT:FLOOR AREA TOTAL AFH FACE
DIAPHRAGM
euILDINc USE
-
RES IND C 'PB Olner
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑, ❑
ASSESS ARCEL NO.
ROUGH
PLUMBING
GAS TEST
TRACT NO. P'ARCEL NO.
� - �
MECHANICA / 3-• ' -
ACC.GATE
ELECTRICAL FINALS DATE INSP. o ACC.FILE NO.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING,
GAS
FIRE SPRINK ENERGY T 24
• MECHANICAL • — Y E] N v ❑ N '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH—INTERIOR - - ELECTRICAL - ,�6 FLooD zome AIL.U.C,
LATH—EXTERIOR FIRE DEPT. - v ❑ N❑ Y Q N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING3e
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING `,, ..•
FIREWALLS ELECTRIC - - PLAN CHECK "
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
UCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILMuJ `
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIREDINSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING'.
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. 't
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBERBUILDING APPLICATION & PERMIT
ADDRESS �l_!jl �JJ
BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
OWNER, P PLAN CHECK LIDATION
N(,NE OTY• ELECTRIC PERMIT 'FEE Syf 1
D -//o P-ONE �O
NAME
CONTRACTORS UTLETS-SWITCHES-RECEP 10,00/1.00 90 q� )/4/
uC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
///�V/�`�/OV/� APPLIANCES-RESIDENTIAL 4.00
w PHONE �4 PANELS 10.00 DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO.
ofl PANELS (OVER 200 AMP) 20.00
ENGINEER / _/I.
n Llc.No SIGNS TRANS. 3.00
ADDRESS ENG. �• M _, PERMIT VALIDATION
ARCH OR /F- /�/C SPECIAL CIRCUIT 5.00
6 zIP EMP.METER OR POLE INS. 20.00
APPLICANT rs MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
, 02 LICENSED CONTRA ORS DECLARATION TEMP.POLE 30.00
< u I hereby affirm that I am licensed under provisions of Chapter 9 U ATE
w re t (commencing with Section 7000)of Division 3 of the Business and G. ELECT. PLG. MECH.
H �i Professions Code,and my license is in full force and effect.
o 0= o License ClassLic.Number �e 1n� 0
Dale Contractor ver
a y f` BUILDING PERMIT
¢ a ¢ OWNER-BUILDER DECLARATION
o i Li INFORMATION
w ; a.mI hereby al'firm.[hnt I am exempt from the Contractor's License REFER TO ORD
MISC.-
H u o j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION E/FT.
Code:Any city or county whichrequiresa permit to construct,alter, 9., .. ��y„�
X a ci improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. d(J'V 0, s+
In C a, requires the applicant for such permit to file a signed statement that - TOTAL
w 8 he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Hzi
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �A ��
a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE 7T_'"', / �Or
] i D
¢ H$ the basis for the alleged exemption.Any violation of Section malty STORIES TYPE CONSTR.
a ;
by any applicant for apermit subjects $500o.applicant loacivilpcnahy ALTER-DRAIN&VENT-WATER IEA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sale compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 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-
prXforpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PS other
4 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 does not apply
to an owner of property who builds or improves(hereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
colorantsactorLicense
L A200f /1000 rfsl licensed pursuant to
SEWER-SANITARY-STORM E . t .
the Contractor's
for s f h h projects
with a contraclow. TRACT NO. PARCEL NO.
/ ❑ lam exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
�( reason
Owner Dute - WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
wORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.CJ.
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division.
p TO ORD.
O Applicant MISC- REFERY ❑ N❑ Y ❑ NE]y - PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.L.
LU CER'I'IPICCOMPE EXEMPTION FROM WORKERS'
IU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y❑ N
D ❑
e section need not be Completed if the permit is for one TOTAL
Z hundred dollars IS WO)or less.)
U O 1 certify that in the performance of the work for which this per. CITY, MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mit is issued,1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
w Date I Applicant Ps BUILDING � .? c
D. ALTER OR ADD TO MECH. 5.00
} W NOTICE: TO APPLICANT: IL after making this rs'Compe sa Ex
F ? em vision you should become subject m the Workers'Compensation with gppLIANCE 5.00 PLAN CHECK
provisions io the labor Cade, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 CF.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE B9
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the wk for which this permit is issued(Sec. MICROFILM
3077,Civ.C.). E HEATING UNIT(TO 100,0008.T.U.) 8.00
Lender's am
Lender's NamAddress
Ne_ HEAT]NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and ,are Ihaf the above VENTILATION FAN (SINGLE) 4.00
information n correct.I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000BTU)SEEFEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in a way accrue against said City in consequence of the
Bomb o this par '. MECH.CONT. LIC.NO. MECH.
\/ TOTAL TOTAL 04
7nature of Applica o actor Dare
OFFICE COPY