8648 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
v CITY OF CUPERTINO QQ /{
INSPECTION DIVISION V '# i
JOB INSPECTION RECORD .
. //n^C n �'/ �J PERMIT EXPIRATION
JOB ADDRESS lQ56'.'C �quI'a, UNIT# - LOT#
PERMIT EXPIRES IF WORK
OWNER e. CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR IUSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
LAST CALL E DI NSPECTION:
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
ISSUANCE DATE
MECHANICAL SLOG. ELECT. PLG. MEER.
r ❑ El ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - �I BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING
VALUATION $/FT.
// ,
MECHANICAL Vz; .' -
ELECTRICALPERMIT TO
FRAMING Q 1LJ4- mu,
INSULATION STORIES TYPE CONSTR,
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO FT FLOOR ARLA TOTAL ACREAGE
. DIAPHRAGM
BUILDING USE
RES IND CON PB OB,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED O! ❑ ❑ ❑ ❑
ROUGH I
'ASSESSORS PARCEL NO.
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.DATE I ACC,FILE NO.
FRAMING SAN #
INSULATION - PLUMBING ZONING ENG.SITE NO.
GAS
MECHANICAL FIRE SPRINK ENERGY A24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ .N❑ Y ❑ No
LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C.
LATH-EXTERIOR FIRE DEPT. Y❑ N❑ YO NO
SHEETROCK GRADE
SHEAR INTERIOR FEE SUMMARY
BUILDING
SHEAR EXTERIORTEMPORARY APPROVALS' BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEES
OCCUPANCY OF BUILDING ISNOT PE RMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
ZMECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL 4
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
+ - BUILDING PROJECT IDENTIFICATION PERMI NUMBER
BUILDING /^) APPLICATION & PERMIT 8648
�(
ADDRESS O V r
�J-2 BUILDING-ELECTRICAL-PLUMBING-MECHANICA
OWNERS PLAN CHECK VALIDATION
aN
• O�� ,, / DTV. ELECTRIC PERMIT FEE
1..N1 7,32-4T
COW EFACTOR S UTLETS-SWITCHES-RECEP 10.00/1.00
PM LIC,NO, LIGHTING FIXTURES 10.00/1.00
ADDcDRESSroR's APPLIANCES-RESIDENTIAL 4.00
CONTRACTORS
PHONE PANELS 10.00 DATE OF APPLICATION
RRCHITECr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
uc.No. SIGNS TRANS. 3.00
ADDRRESS esa. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP rrEMP.METER OR POLE INS. 20.00
APPLICANTS
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 y �
8'p-L 1
o W O LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
a o 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
H Gw (commencing with Section 7000)of Division 3 of the Business and B D ELECT.
PLG. MECH.
oro z Professions Code,and my license is in full force and effect - ❑ E] ❑
0 m License Class Lic.Number
o
< Y E W J Date Contractor (� ((��
¢ ¢w a OWNFR-BUILDER-R DECLARATION G - BUILDING PERMIT
F.
u. LL I hereby affirm that I am exempt from the Contractors License MISC.- REFER TO ORD
NFORMATION
ALUATION
.. o¢ Law for the following reason.(Sec air L5.permit
to c and Professions ' $/FT
w• - � PERMIT ISSUANCE 10.00
Code:Any city or county which requirese permit to construct,alter, /` �y O
2 2 Q improve,demolish.or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. V V
D¢ requires the applicant for such permit to file a Signed statement that TOTAL PER TO
d w m he is licensed Pursuant to the provisions of the Contractors License
Hzi
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe /N•�J
4 o Business and Professions Code)or that he is exempt therefrom andDTV. PLUMBING PERMIT FEE
¢ H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d3 _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(S500).):
❑ 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 OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 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 F IXTUR ES-PER TRAP 5.00 50,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 budding GAS-EA.SYSTEM-11NC.4OUTLETS 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 for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 IND o0N PB Omer
❑ I,as owner of the property,ata exclusively contracting with
licensed contractors to construct the project(Sec 7044,BusinessLAWN SPRINKLERS- 1 INC 5 VB600 ASSESSORS PARCEL NO.
and Professions Coda The Contractor's License Law does not apply V.B. .
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 contractod s)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITARV-STORM EA.200tt/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec..,BAP.C.for is WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
OR K E RS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 mraby affum that I hove a certificate of cons....to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C,).
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPANK ENERGY T-1a
Z 2 ❑ Certified copy is fled with the city inspection division.
F 0 Applicant MISC.- REFER TO ORD. Y❑ N❑ v ❑ No
y CERTIFICATE 01'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A..L.u.c.
W > COh1PF.NSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
(L o (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
::) Z hundred dollars IS 100)or less.)
U O 1 certify that in.he performance of the work for which this per- OTY MECHANICAL PERMIT FEE
FEESUMMARY
LL H mit is issued, I shall not employ any person in any manner so as to
O become subject to the Workers'Compensation Laws of California.
U n Data Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT': II',after making this Certificate of Ex-
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 FEE (p
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOWCF.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT)MNO.
5.00
the performance of the work for which.his permit is issued(Sec. MICROFILM
3097,Civ.C.). NG UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address GUNIT(OVER l00,000B.T.LL)9.50 ELECTRIC
1 certify that 1 have real this application and stale that.he aboveLATION FAN (SINGLE) 4.00
. information is correct. I agree.o comply with all city and countyPLUMBING
ordinances and state laws relating to building construction, and -COMP H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the -COMP (Over 100,000 BTU(SEE FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of REFER TO ORD.
Geertino against liabilities,judgments, costs and expenses whichCONST.TAX
May in any way accrue against said City in consequence of the ISSUANCE 10.00
gran tin of this peon' . .n LIC.NO. MECH,pOTAL TOTAL
tore of Applicant/Contractor ate O
OFFICE COPY