C 8337 (2) POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO - PF RM1IIT NUMBER
INSPECTION DIVISION 8337
JOB IN PECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS U LOT
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
r%fiINSPECTION D TE IN COR INSPECTION REtORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANC OR 180 DAYS FROM
UFER LASTCALLED INSPECTION.
� .
PREGUNITE •�. -} Pf�VMIT VAuognoN
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB •� / �
PLUMBING (/
ELECTRICAL ISSUANCE uri?
MECHANICAL BLDG. ELECT. PLG. MECR.
❑ ❑ 1 ❑ I ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VgLUATION $SFT.
MECHANICAL ll
ELECTRICAL PERMIT TO
FRAMING
INSULATION - STORES YECorvsrR.
OCG GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,ET,FLOOR AREA TOTALACREAGE
. DIAPHRAGM
BWLDWuse
' RES IND CONNPR 'Olnxr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH
ASSESSOR-PARCEL NO.
�/oQZs��
PLUMBING
GAS TEST rggcT rvo. PARCEL NO.
MECHANICAL
ELECTRICAL FINDATE ACC.DATE Acc.FaE No.
INSP.
FRAMING SAN #
INSULATION PLUMBING zoNlNc ENG.SITE NO.
GAS
MECHANICAL] FARE SPRINK ENEROV T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v ❑ N❑ v ❑ N❑
LATH-INTERIOR ELECTRICFLOOD ZONE A.L.U.C.
LATH-EXTERIOR FIRE DEPTv❑ N Y ❑ N❑
SHEETROCK - GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY,APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED 10CCUPANCY SEISMIC FEE
UCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. -MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z'
PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANTI CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATI ON I PERMITINMBER
BUILDING APPLICATION & PERMIT
ADDRESS
iv 1, - 3 7
-1 G IhnS FDIf� � � BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'$ (9::�?3
N CHECK VALIDATION
AME
MQ1,�,V1fy � aISi4 DTV. ELECTRIC PERMIT FEE
h YvRorve
croR
NAME s•'0 ern L UTLETS-SWITCHES-RECEP 10.00/1.00
NAME N
AqJ NO LIGHTING FIXTURES 10.00/1.00
ADDRESS APPLIANCES
CONTRACTOR L��/!/.,,. /I / PPLIANCES-RESIDENTIAL 4.00
1OZvL�j IV1 �((( ONE �L/{i PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP 20.00
ENGINEER
LIC,NO. SIGNS TRANS. 3.00
ADDRESS ENG, PERMIT CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 20.00 _ J�
APPLICANT'S
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
a U w I hereby affirm 'hat I am licensed under provisions of Chapter 9
w a (commencing with Section 7000)of Division 3 of the Business and I UANC GATE
F w 2 rofessions Co pp�aI��m g�1��is in full for rad f[� BLDG. ELECT. PL❑G. MECH.
O z m D License-G-s 'GIfiFlLic.Numher �53
w F Uatc -F3-Contractor
w a OWNER-BUILUF,R DECLARATION BUILDING PERMIT
`
o a eJ _ INFORMATION
xa ; u_y 1 hereby al firm that I am t from the Contractor's License MISC.- REFER TO ORD
a-o 4 Law for the following reason.(Sec.703[.S,Business and Professions r VALUATION $/FT.
L - PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit f o construct,alteq [
or o
G improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. n 3�ta(L,};')
LL requires the applicant for such permit to file a signed statement that TOTAL MFt V
w m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
F z a Law(Chapter 9(commencing with Section 7000)of Uivision3 ofthe
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE .P uu- t•'10 �y4 -`
I- $ the basis for the alleged exemption.Any violation of Section 7031.5
by any applicant for a permit subjects the applicant toa civil penalty GTO ES TYPE CONSTR.
Of not more than five hundred dollars($500b.): ALTER-DRAIN&VENT-WATER (EA.) 5.00
O 1,as owner of the property,or my employeeswith wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP HES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 S0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
Tentsarenotintendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is Sold'within one year of completion,the owner-
builder will have the burden of proving that he did not build or int- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove 1,as ownerose
off the
INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑N ❑ Other❑
O Las owner of the property,am exclusively contracting with
RES IND
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Cm-Hactor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractos(s)licensed pursuant to
Ute Contractor's License Law. SEWER-SANITARY-STORM EA.2001ft/10.00 TRACT NO. PARCEL NO.
❑ l am exempt under See. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE No.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers Compensation Insurance,or a Certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ.
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE$PRINK ENERGY T-24
Z Z O Certified copy is tiled with the city inspection division.
FO Applicant MISC.- REFER TO ORD. yF] N0 vE] NE]
m CERT'IF'ICAT Ii of EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.Lu.C.
W > COMPFNSATION INSURANCE PLG.CONTR. LIC.No. PLG. '
EL O (This section need not be completed if the permit is for one TOTAL Y N V [:] N
VZO hundred dollars(5100)or less.)
I eery y that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is r tied, Shall not employ an person' ny manner so as to
O W bccu m Workc,��y I a sa t ifornia.
Da Applicantc']ld4' - ALTER OR ADD TO MECH. 5.00 BUILDING Jv
} N N C T APPLICANT: If,after making this Certificate of Ex-
F ? emption,you should become subject TO the Workers Compensation APPLIANCE 5.00 PLAN CHECK
P,ovisions of the Labor Code, you most forthwith comply with
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT ITO 10000C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.FM.) 6.00 SEISMIC FEE Ja
1 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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OV E R 100,000 B.T.U.)9,50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
• information a estate. I agree to comply with all city and county PLUMBING
ordinances and state laws relating m is building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city es anter upon the BOILER-COMP (Over 100,0006TUISEE FEESCH.
abovo-m ' nod properl for inspection purposes
MECHANICAL
(W agree to save in Offy and keep harmless the City of MISC.. REFER TO ORD.
o agai st liu lilies, en is, coslS and expenus which CONST.TAX
ac a said City in co uque a of the PERMIT ISSUANCE 10.00
gran o MECH.CONT. LIF NO. MECH.
TOTAL TOTAL
Signature of pplicant ontracmr Date
OFFICE COPY