13014 (2) POST THIS CARD NEAR FRONT OF BUILDING-
Y CITY OF CUPERTINO Rn,IT NUMBER
14
INSPECTION DIVISION • �O
JOB INSPECTION RECORD
r JOB ADDRESS � I w ' ✓ �' - UNIT# LOT
,4f# 'PERMIT EXPIRATION
n PERMIT EXPIRES IF WORK
OWNER CONTRACTOR 2T �i3O ALJ �LM IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
LIFER
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND / LAB -
PLUMBING
ELECTRICAL - ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLD. MECH.
❑. . ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT-
WOOD FLOOR VALUATION SIFT.
` PLUMBING. -
MECHANICAL .
ELECTRICAL //, rvMrt To
FRAMING Y
INSULATION �-� STORIES TYPE CONSTR,
ti
j OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF 50.FT.FLOORAREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
� -
RES IND CON PB Olner '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
pma ASSESSORS PARCEL NO.
ROUGH
PLUMBING }' O.NT 2_
nn� TRACT NO. PARCEL NO.
GAS TEST - t ' IIJV
MECHANICAL I ACC,DATE ACC.PILE NO,
ELECTRICAL FINmtysui ATE INSP.
FRAMING SAN #
20NING ENG.SITE NO.
INSULATION � PLUMBING ,
GAS
MECHANICAL FIRE SPRINK ENERGY L2<
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.uc.
LATH—EXTERIORFIRE DEPT. Y[DN❑ Y ❑ NE]
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 OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
0 .
.ONE WORKING DAY BEFORE,REQUIRED INSPECTION. 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.
OFFICECOPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
♦ '
BSI
BUILDING PROJECT APPLICATION PERMIT PERMIT NUMBER
BUILDING
A /J / �
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL/ O
13 014
OWNERS
PLAN CHECK VALIDATION
OTY. ELECTRIC PERMIT FEE
PHONE
CONTRACTORF OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME / p
q PA LQ LC.NO.lS/9P LIGHTING FIXTURES 10.00/1.00
CONTRACTORSAPPLIANCES-RESIDENTIAL 4.00
ADDR Ess
A Q PHONE .a/vim PANELS 10.00 DATE OF APPLICATION
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ORCH]TECT
OR
ENGINEER
LIG.no. SIGNS TRANS. 3.00
ARCH.Ess ENa SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 PAID
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS MAY
((�� q(y y
SERVICE CHANGE 20.00 MAY 2 U I�f�(
O o )LICENSED CONI RACI'ORS DECpLARATION p ^:L- -LAA Q
I bercb nfl'in,that 1 in licensed under rovislousol'Chapter 4l[aVISSDIYi LF
"' (commencing with Section 70001 of Division 3 of the Business and
¢ H BLDG. ELECT. PLG. MECH.
F N z Professions Code,a 'cense is in full force ay
2 D a - License Class Con Number ❑ I El 3K L 0
Number-
2 z H w Date l a•sA-�'7 Contractor
- J �T�
M S, s BUILDING PERMIT
S, w OWNER-BUILDER DECLARATION INFORMATION
wo a MISC.- REFER TO ORD
;u r 1 forth collo that I so exempt tram the Contractor's Liceons
LLD¢ Law for the following reason.(See.7031.5,Business Professions PERMIT ISSUANCE .. VALUATION $/FT.
� - -' Code:Anycity orcounty which requires a permit loconstrom.1ter, 10.00
2La ¢G improve,demolish,or repair any slmcture,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O LL requires the applicant for such permit to file a signed statement that TOTAL MIT TO
ca US or M he is licensed pursuant to the provisions of the Contractor's License
H z r La.,(Chapter 9(commencing with Section 7000)of Division 3 oflhe
¢
Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
M=$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIESTYPE CONSTR.
a ; � by any applicant for a permit subjects the applicant Ina civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4,00
their sole compensation,will d°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,COND. 5.00
Code:The Contractor's License Law does not apply to un owner of p
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 O P 50,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
Humsarenolintended or offered for sale.l f,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 e�
or improvement is sold within one year of contplotion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im. BUILDING USE
prove for purpose ofs.h,.L INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with 11 1:1 E] 1:1 El
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 thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
for ar such projects with a contractorts)licensed pursuant to
the tracts License Law. SEWER-SANITARY-STORM EA.200ft/10.00 .TRACT NO. PARCEL NO.
❑nl am exempt under Sec.-,B.&P.C.for this
reWATER HEATER W/VENT 6.00
' Owner _ Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COAIPENSATION DECLARATION WATER TREATqUUIP. 5.00
1 hereby affirm that I have a certificate of ronsenl to self-insure' ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
PoolicyhNocof(Scc.35Compaoy- 'el4 [ w-P70!'
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGYT2a
Z Z (t Certified pY is f t city inspection division.
p Applicant V , MISC.- MY Of GUPeff1_fJ§FERTO ORD. YC] No Y E] NE]
K y CERTI FICOF EXEMPT ION FROM WORKERS' PERMIT ISSUANCE 10.00 1 FLOOD ZONE A.L.u.O.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Cl (This section need not be completed if the PcRnit is for one TOTAL Y[-] N� V N�
hundred dollars IS 100)or less)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is Issued, 1 shall not employ any person in any planner so as m
become subject to the Worken'Compensation Laws of California.
i nate Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
)..� ? emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of Inc Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he deemed revoked. - AIR HANDLING UNIT(TO 10)000CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 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.). 1 HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 Gently that I hWC read this mplicatlon and staleIhat the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county PLUMBING
ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives forms inspection
this city to ewer upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property forinsp of (his
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 any way accrue against said City in consequence of the
granting of this permit. MECH.CONT. - LIC.NO. MECH.
TOTAL TOTAL
Signature o(Applicanl/Contractor Dale
OFFICE COPY