13024 (2) POST THIS CARD NEAR FRONT OF BUILDING
PFRNIi NUMBER '
CITY OF CUPERTINO 13024
INSPECTION DIVISION
• JOB INSPECTION RECORD
PERMIT EXPIRATION
I JOB ADDRESS O 0. /Y'� �/J��W - UNIT# _LOT#
PERMIT EXPIRES IF WORK
owrvER T p//J. CONTRACTOR D,QJ �D" L IS NOT STARTED WITHIN
NSPE TION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
LAST CALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
' ELECTRICAL
ISSUANCE DATE
ME HANICAL BLDc, ELECT. PLG. MECH.
e� O7W ❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING 15ERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION SIFT.
MECHANICAL- -
ELECTRICAL „y PERMITTD
FRAMING A7/II
INSULATION STORIES TYPE CONSTR.
�l
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF _ ! SO.FLFLOORAREA TOTALACREAGE
•. DIAPHRAGM
I BUILDING USE
RES IND CON PB 00...
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - - MAY E• El ❑ ❑ 1:1 1:1ASSESSORS PAR CEL NO.
ROUGH ""'
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL -
ACC.DATE ACC.FILE NO,
ELECTRICAL FINALS DATE INSP.
FRAMING SAN # -
INSULATION PLUMBING '
ZONING ENG.SITE NO.
-
GAS
MECHANICAL FIRE SPRINK ENERGY T 24
' •
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED' 'S, HEATING Y ❑ N❑ Y ❑ N❑ "
.
LATH—INTERIOR ELECTRICAL FLOOD20NE A.LU.C.
LATH—EXTERIOR FIRE DEPT. v❑ N❑ 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
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
. z ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.. '
. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL.
CONST.ONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
a , OFFICECOPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION & PERMIT 13024
O 1rJbOL(J 1K BUILDING-ELECTRICAL-PLUMBING.-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
. "AM OTY. ELECTRIC PERMIT FEE
Q (f PHONE
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
NAME // �/ �p
IPO l�7 Cp LIC.No IK/ (0 LIGHTING FIXTURES 10.00/1.00 '
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
,O, (o09G J PHONE o? PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK
OR FEE P.C.NO.
'
ENGINEER ,
LIC.rv0, SIGNS TRANS, 3.00
ARCH,OR ENG. PERMIT VALIDATION
ADO
HESS SPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00 PAID
ADDRESS
r'$
AMOTORS SEE FEE SCH.
OREss
SERVICE CHANGE 20.00 MAY 2 01987
wO O LICENSED CONTRACTORS DECLARATION ` pp��
a 0 w 1 hereby affirm that I am licensed under provisions of Chapter 9 CI SOi`Nlttl •n0
y<N (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH.
H N z Professions Code,a I' case is in full force a of eel F-1
❑ ❑
z O m- License Class_ - Lic.Number�J_'f.
0� � w Date - Contractor
a y s r BUILDING PERMIT
le ¢ OWNER-BUILDER DEChA RA ON
a o a- D INFORMATION
X g w I for
affirm that Pose exempt from the Contractor's License MISC.- REFER TO ORD
u D¢ Law for the following reason(Sec.7031.5,Business and Professions PERMIT ISSUANCE VALUATION $/FT.
y Code:Any city or county which requires permit to construct,alter, 10.00
ELEC.CONTR. LIC.NO.
m ¢ 0 improve,demolish,or repair any structure,prior to its issuuncu,also ELEC.
w0 u requires(lie applicant for such permit to Elle u signed statement that TOTAL PERMIT TO
re w he is licensed pursuant to the provisions of the Contractor's License 1OI/
Fir
Low(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe
¢ Business and Professions Code)or that he is exempt therefrom and QTY. - r PLUMBING PERMIT FEE
Fi0
R F$ the basis for the alleged exemption.Any violation of$eclion 7031.5 STORIES TYPE CONSTR.
a ; -. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DflAIN& 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 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 does not apply to an owner of
properly who builds or improves thereon,and who does such workYW FIXTURES-PER TRAP 5.00O 5Q.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve
-
memsarenotintendedoroffered for sale.If,however,the buildingGAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 0,6
or improvement is sold within one year of completion, the ow -
builder will have the burden of proving that he did not build ornerim- GAS-EA.SYSTEM-OVER 4 (EA,) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Olhar
❑ I,as owner of the property,am exclusively comani ing with ❑ [:] E] ❑ ❑
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 IEA.) 1,00confir ..
the Cons l'orsuch License
eLwith oconlmctor(sl licensed Pursunnl to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. ® TRACT NO, PARCEL NO.
❑ Iamexempt under Sec. ,BAP.C.IbrThis WATER HEATERW/VENT 6.00 QO
reason
Owner Date �' WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUI 5.00
1 hereby affirm that I have a certificate of consent to selGinsme, O ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insura''c,.,or a c ed
copy lherficate f Work rs'Com. e7/ef/Insure
Y!{
Policy No. Company
Q ❑ Certified copy i5 hereby furnished. rifvFIRE SPRINK ENERGY T24
Z Z ewdizv fir c IS (led itl t city inspection division.
FApplicant MISC.- CUPORTO ORD.
O Y ❑ N❑ Y ❑ N❑
LU CERTIFICATE
T PERMIT ISSUANCE 10.00 /e1 FLOOD ZONE A.L.U.c.
W > COMPENSATION
EXEMPTION FROM WORKERS'NSATION INSURANCIi PLG.co"rR. LIC.NO. PLG. CJS '
Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
hundred doIhas($100)orlessJ
U O 1 certify that in the performance of the work for which this per- DTV. :MECHANICAL PERMIT FEE FEE SUMMARY
W P mil is issued,1 shall not employ any person in any Runner so as to
O w become Subject to the Workers'Compensation Laws of California.
Dale A> licant OBUILDING
a Ip ALTER R ADD TO MECH. 5.00
} N NOl'ICIi TO APPLICANT: If,after making this Certificate allix-
F Z emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith cmnply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10000GFM.) 6.00 SEISMIC FEE
I 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
Lender's Address ELECTRIC
• I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING ov
ordinances and state laws relating to building construction, unJ BOILER-OOMP(3 H.P.Or 100,0008.T.U.) 6.00
hereby authorize representatives of this city to enter upon lite BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmdess the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and experees which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
granting of this permit, MECH.CONT. - LIC.N0, MECH,
TOTAL TOTAL
Signature of Applicant/Contractor Date -
OFFICE COPY