10996 (2) POST THIS CARD NEAR FRONT OF BUILDING
PFRMI F NUMBER
CITY OF CUPERTINO
10996
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRE -11L � • • U IT _ LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR . . IS NOT STARTED WITHIN
IN ECTION DATE INSPECTOR INSPECTI N RECORD 180 DAYS OF PERMIT ISSU-
FOUN DATI N ANCE OR 180 DAYS FROM
LAST CAL LE CTION.
UFER
PREGUNITE PEBryA vauoar
lCW
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED C!(p
UNDERGROUND /SLAB Of cupol*0
PLUMBING
ELECTRICAL ISSUANCE DATE
B U ELECT. PLC,. MECIT
MECHANICAL ❑ F-1D
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - VALUATION $/FT.
PLUMBING ' 11/ 11
MECHANICAL
' PERMIT
ELECTRICAL r
FRAMINGl
INSULATION s II TYPE CONSTR.
C. UP ES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED1 1. ''i
50.FT.F AREA LACNEAGE
ROOF
DIAPHRAGM
BUILDING USE
RE¢ IND CON PB OIFe,
IAPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED �+
IR / ASSESSORS PARCEL NO.
ROUGH
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL
ACC.DATE ACC.FILE NO,
ELECTRICAL FINALS DATE INSP.
l FRAMING _/V—Y6 SAN # ZONING ENG.SITE NO.
r INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY T-IA
MECHANICAL v IN❑ Y N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
F LOOD ZONE AE C.
LATH—INTERIOR ELECTRICAL
LATH—EXTERIOR FIRE DEPT. r N� v I] N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC - PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY
SEISMIC FEE /
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
I
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
IL ONE WORKING DAY BEFORE REQUIRED INSPECTION.
• PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
CONST.TAX
IMPORTANT! /
PLEASE READ REVERSE SIDE BEFORE TOTAL r
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
-,EUI LOI NG PROJECT 1 DENTI FICATION PERMIT NUMBER
X QIUILDING APPLICATION & PERMIT 10996
A0076y 6 rj 14fA / BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S v PLAN CHECK VALIDATION
NP QTY. ELECTRIC PERMIT FEE
7 PMO
CONTRACTOR'S _ UTLETS-SWITCHES-RECEP 10.00/1.00
NPM 7
, r d. HL IZ rIA i'1 LIc.No.� /,doh LIGHTING FIXTURES 10.00/1.00
-� CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
ADDRESS p
� (, /lJ
50/7 L{(7/ ONE -W PANELS 1D.DD DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
UC..O. SIGNS TRANS. 3.00
ARCH.OR ENGSPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS PAID
ZIP EMP.METER OR POLE INS. 20.00 qq yy (�,�(yyL@
APPLICANTS MOTORS SEE FEE SCH. MAR 1 U 1DVU
ADDRESS
SERVICE CHANGE 20.00
w o o LICENSED CONTRACTORS DECLARATION RATION city
I hereby affirm that I am licensed under provisions.1 Chapter 9 city sjJA11EGAYE
wQ& (commencing with Section 7000)of Division 3 of the Business and L G. ELECT. PLG. MECH.
o z Professions Code, d my license is in full force and effect. ❑ ❑ ❑
z o y- icenw Clas Lic.NumM1er` ��
0 z F Date Contractor
Q y F j BUILDING PERMIT
es a w ¢ WNISB-BUILDER UECLAR TION INFORMATION
aoAO MISC.- REFER TO ORD
X
3 LL vHi I hereby al firm Ilial I am exempt tram the Cnnlnetor's License VALUATIO j $/FT.
LLo ¢ Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 r
� - Code'.Any city or county which requires a permit to construct,alter,
¢ ¢Q 0 improve,demolish,or repulr any slruclure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. i
in
-D¢ rnluims the applicant for such permit to file a signed statement that TOTAL PERMIT TO
d w es
Law(Chapter 9(commencing with Section 7000)ofUlvision 3he is licensed Pursuant to the provisions of the Contractor's License
Hi
¢ Business and Professions Code)or that he is exempt therefromoflhe and QTY. PLUMBING PERMIT FEE
¢ F m the basis for the alleged exemption.Any violation of Section 7031.5 ---,To TYPE CONSrR.
n ; _ by any applicant for a perm it subjects the applicant to a civil penally gLTER-DRAIN& VENT-WATER (EA.) 5.00 /I`III///J'I�I I'n' /A�!
of not mare than five hundred dollars(8500).)'.
❑ I,as owner of the property,or my employees with wages as IBACKFLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intcndeJ or offered for sole (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON . 5.00 -�
Code:The Contractor's License Law docs not apply to oriowner of
property who builds or improves thereon,and wlto does such work FIXTURES-PER TRAP 5.00 SD.FT.FLooR AREA Tor L ACREAGE
himself or through his own employees,provided that such improve-
mentsarenot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improveent is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
buim
later will have the burden of proving that he did not build or im- S IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to constructthe project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 A$SESSORSPARCE LAID.
Professions Code:The Contracmr'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 contnctons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec...fl,&P.0 for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate afconwnt to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800.Lab.C.).06MPZa2BZd/FCH
Policy No.
Q ❑ Ceriiedcopy Cis ohmeabnyy_ -#TA(4
FIRE SPRINK ENERGY T44
Z Z ❑ Certilied opy fi I will, tire city inspection division. MISC.- REFER TO ORD.
Applicant .�/�Q'a-._�.d-. Y ❑ "❑ Y ❑ "❑
hNPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
LU -
CERTIFICATE IE EXEMPTION FROM WORKERS'
W > COMP
_ COMPENSATION INSURANCE; PLG.CONTR. LIC.No. PLC.
CL This section need'not he completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
Z hundred dollars($100)or less.)
U O 1 certify that in the perfon..ame of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit Is issued,I shall not employ any person in any nsannerso as to
Ow become subject to the Workeri Compensal ion Lawsof California. BUILDING
Data Applicant ALTER OR ADD TO MECH. 5.00
>_ DO NOTICE TO APPLICANT If,after making this Cenificute of Ex-
F ? mnption,You Should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10AOOGF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE /
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.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
nformation is correct. I agree to comply with all city and county BOILER-COIv1P(3 H.P.or 100,000 B.T.U.) 6,00 PLUMBING
ordinances and stale laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over I00,000BTU)SEE FEESCH. MECHANICAL
above mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino ag But, ties,judgments, costs and expen s w ich CONST.TAX
may in a a e against said Cily in coarse Be
a the PERMIT ISSUANCE 10.00
granlin MECH.CONT. LIC.NO. MECH. /
bg TOTAL TOTAL
Signa r of Applicant/Contractor Ute