11370 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 11370
INSPECTION DIVISION
• JOB INSPECTION RECORD
M `l PERMIT EXPIRATION
JOB ADDRESS �! ' •e �r `�� UNIT# LOT#
'^ - PERMIT EXPIRES IF WORK
/l
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPEOTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION LASTCALLED INSPECTION.
UFER
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB -
PLUMBING
ELECTRICAL - ISSUANCE DATE
BLDG. ELECT. PLG. ME H.
MECHANICAL ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUAn ON $TFT.
PLUMBING
MECHANICAL E
INAL _ PERMIT TO
ELECTRICAL Ir
FRAMING IT- � BG
$TORTE'S TYPE CONSTR.
INSULATION cn r
�'('� I� OCC,GROUP NES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED l DATE 311111114---
SQ FT FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM BUILDINGuse
R[5 IND CON PB 011.i•.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ASSESSORS PARCEL NO
ROUGH
PLUMBING TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL
ACC.GATE ACG FILE NO
ELECTRICAL FINALS DATE INSP.
FRAMING SAN # ZONING ENG,SITE NO,
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY T44
MECHANICAL Y ❑ NE] Y El N1
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L c.
LATH-INTERIOR ELECTRICAL
FIRE DEPT. YE] No YoN❑
LATH-EXTERIOR - -
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN :F
CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCv SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING.
�I O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
CONST.TAX
IMPORTANT!
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
BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER
BUILDING C APPLICATION & PERMIT 11370
-•�� !-'t-_Y1 BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
ERaa � 19) �, _g PLAN CHECK VALIDATION
" ME TY. ELECTRIC PERMIT FEE
CONTRACTOR I OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
LIC.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
ADDRESS
pPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT
PLAN
PANELS (OVER 200 AMP) 20.00 CHECK FEE P.C.NO.
OR
ENGINEER
uc.No. SIGNS TRANS. 3.00
.OR ENG. 5.00 PERMIT VALIDATION
ARCH
ADDRESS
SPECIAL CIRCUIT
ZIP, ��L7EMP.METER OR POLE INS. 20.00 eLR _ /�`f -M' -
R, "__
avvuCANrs MOTORS SEE FEE SCH.
ADDRESS /
SERVICE CHANGE 20.00 z ( 1,�98- /�
0Tz //�
r 00 LICENSED CON'T'RACTORS DECLARATION
a t I hereby Al'inn that I am licensed under provisions ol'Chapler 9 IS DANCE DATE
y a w (commencing with Section 7000)of Division 3 of the Business and I PLG. MECH.
H N z Professions Coda and my license is in full force and effect. rT ❑ El
❑
z o w - License Class Lic.Number-
2
umber O zywD Date.Contractor
r
BUILDING PERMIT
¢ a w¢ OWNER-BUILDER DECLARATION INFORMATION
ca> u MISC.- REFER TO ORD
X g: u- H I hereby affirm that I am exempt from the Contractors License VALUATION S/FT.
F ¢O 4 Law for the following reason.(Sec.7031.5,Businessmld Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
¢ Q Q 0 improve,demolish,or repair any sle,",prior to its issuance,also FLED.CONTE, LIC,NO, ELEC.
O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO EAYP-il /
a w m he is licensed pursuant to the provisions of the Contractor's License n�
r z i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR.
�-
¢ H m the basis for the alleged exemption.Any violation ol'Section 7031.5
¢ ; - of not more than five hundrled do)ects the llars($500j jcanuaacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ h as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.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,AREA,COND. 5.00
Code The Contractor's License Law dues or apply to an owner of
. properly who builds or improves thereon,and who does such walk F IXTUR ES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve GAS-EA.SVSTEM-11NC.40UTLETS 6.00
mems are not intended or offered for sale.If,however,the building
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 Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ 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 ASSE550RSPARCELNO.
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 wilhacontrucWrts)licensed pursuant to
gEWER-SANITARY-STORMEA.200f1/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ n c ndc S B.&�'C� 's WgTER HEATER W/VENT 6.00
reason qq /''°a-v's-
Owner�1� - Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sce.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T44
Z_ Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. Y N❑ Y ❑ No
Applicant
F PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
CC - CERTIFICATE OP EXEMPTION FROM WORKERS'
UJ > COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG. Y❑ N❑ V ❑ N❑
1 O (This section need not be completed if the permit is for one TOTAL
0 Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued.I shall not employ any person in any manner so as to
OW become subject to the Workers Compensution Laws of California. BUILDING IN
Dam Applicant ALTER OR ADD TO MECH. 5.00
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex
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
C.1 such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE f D
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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097-Civ.C.).
Lender's Namc HEATING UNIT(OVER l00,000B.T.U.)9.50 ELECTRIC
Lender's Address
1 certify 11411 have read this application and slate that the above V ENTILAT ION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county BOILER-CONP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and slate laws relating to building construction, and
hereby authorize mprcxvr atives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
agree to save, indemnif and keep harmless the City of MISC.- REFER TO ORD.
Cu{ ino against liabilities, ' d sols, costs and expenses which CONST.TAX
T.I an wa accrue v s Yid City in consequence of the PERMIT ISSUANCE 10.00
gmI ing t is .trait. �� /y MECH.CONT. LIC.NO. MECH.
\/ f`7(jL,/ TOTAL TOTAL o2L.S
I` Sig alumIT Ap i Con actor Date
OFFICE COPY