C 8357 (2) POST THIS CARD NEAR FRONT OF BUILDING aERMIrrvuMBER
CITY OF . CUPERTINO X357
INSPECTION DIVISION
B•INSPECTION RECORD
PERMIT EXPIRATION%
JOB ADDRE �`�v UNI - LOT#
- PERMIT EXPIRES IF WORK
OWNER CONTRACTOR ' IS NOT STARTED WITHIN
E i80DAYS OFPERMIT ISSU-
S CTION _ ANCE OR 180 DAYS FROM
FOUNDATION i q-Yr"PI .� LAST CALLED INSPECTION.
UFER
PREGUNITE - v,� •� PERMIT vALmnn ON . ,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB yy-
PLUMBING 5-3(-fCr 8011"1'GSt. ZZ-rdf• JA.CE
��ELECTRICAL `. � ATE J
MECHANICAL BLDG. E .cr: aw. 'MECH,
❑ , ❑ o
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT
INFORMATION
- WOOD FLOOR � vnwnnoN, SIFT.
PLUMBING
MECHANICAL
ELECTRICAL ° PERM iT TO
FRAMING -
INSULATION TORTE ..Tv ECONSTR.
OCC.GROUP HES.UNITS'
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,FT.FLOOR AREA TOTAL ACREAGE
. DIAPHRAGM -
WLDING USE
HES NO CON PB O,ne,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑• ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH,
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL '
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN # '
ZONING ENG,SITE N0.
INSULATION � PLUMBING
GAS
" FIRE SPANK ENERGY T2
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - ° HO. " "0
LATH-INTERIOR � ELECTRICAL -
FLOOD ZONE
LATH-EXTERIOR - FIRE DEPT. - Y❑ N[] °AL.U,C
❑ N❑
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 NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. 'A
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
D ONEMORKING DAY BEFORE REQUIRED INSPECTION. 'PLUMBING
(D PLEASE GIVE JOB ADDRESS.WHEN PHONING. '
GZ
Z . 1 MECHANICAL '
- SEE PERMIT FOR EXPIRATION DATE -
• ' CONST.TAX
"6MPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. y .
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
,240 LD1 NO PROJECT I DENTI FICATION PERMIT NUMBER
6UTLDING APPLICATION & PERMIT g 357
TADDRESs
Z Z � -� r BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'$
NAME PLAN CHECK VALIDATION
.
L� 3�� 3 ELECTRIC PERMIT FEE
PHONE
NAMEnncTORs - OUTLETS-SWITCHES-RECEP 10.00/1.00 "
LC.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10,00 DATE OF APPLICATION
ARCHITECT ,A`-/ PLAN CHECK FEE P.C.N0.
OR /6P C.k PANELS (OVER 200 AMP) 20.00
ENGINEER
Lt..NQ. SIGNS TRANS. 3.00
ANDRESS ENG' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
AEMOTORS
ADDRDDRESSSS SEE FEE SCH. S
SERVICE CHANGE 20.00 � Zf/
o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 7 Y
Ar v I hereby affirm that I am licensed'under provisions of Chapler'J IBSUANC GATE
yaw (commencing with Section 7000)of Division 3 of the Business:md BLDG. ELECT. PLG. MECH.
H m z Professions Code,and my license is in fall force and effect ❑ ❑ ❑ ❑
O 0 n W License Class Lie.Number
Dale Contractor
N F J
BUILDING PERMIT.
rt 0 w OWNIi R-BUILUIiR DECLARATION .x9
'x ;LL H I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD 'INFORMATION r;
w a_ o a Law for the following reason.(Sec.7031.5,Business and Professions VALUATION S/FT.
H - PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
acw¢ 2 improve, or repair any structure,prior to its issuance,also ELECCONTR. LIC.NO.
R ¢ O ELEC. !/,14
n wDLL requires the applicant for such permit ID OIc a signed statement that TOTAL
8 y he is licensed pursuant to the provisions ol'the Contractor's License PERMIT TO
I- za Law,(Chapter9(commencing with Section 7000)of Division 3 of the _ I ''d
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT ' 'FEE �AS�r 1.�/� L-
Ixo
C H$ the basis for the alleged exemption.Any violation oto action 703L5 STORIES TYPE CONSTR.
n ; _ by any ore cantthan forfive
a permit subjects $500).he licam lnacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five h e dredprop dollars($500).):employees
tY Of Ca
❑ I,as owner at the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
pertin
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,AR EA,COND. 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 FIXTURES-PER TRAP 5.00 SQ.FT.FLOOR AREA TOTAL ACREAGE
himself m through his own fiend foremployees,sale.provided that such improve.
ments improvmennot tRen old or withinrone year If,hawetion the the o ne, GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement will have
is e b within one year of completion, the o r in GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or inn- BUILDING USE
prove for purpose Dl'Sale.). RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting will) INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsuch projects with a contractor(s)licensed personal to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10,00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&RC.fur,this WATER HEATER W/VENT 6.00
reason
caner Date ATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSA1 ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofamsent to self-insum,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(See.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T@4
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. C-] N❑ v F] N[:]
P O Applicant y
CC LO -
OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.LLC.
W > COMPENSATION INSURANCE PLG.CONTH. ILIC.NO. PLG.
LL o ('Phis section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑, ry❑
Z hundred dollars IS TOO)or less.)
U O I certify that in the performance of the work for which this per- DTV. '.MECHANICAL PERMIT FEE FE SUMMARY
LL U mit is issued,1 shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California. G
W Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} run NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F ?
irruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit Shall be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 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 UN IT 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify-that l have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information n correct. 1 agree to comply with all city and county PLUMBING
ordinances formatio and state laws relating to building construction, and BOILER-COMP(3 H.P.Dr 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against sa' City in consequence of the PERMIT ISSUANCE 10.00
gratin o(this permit. MECH.CONT. LIC.NO. MECH.
y y TOTAL TOTAL /,4,776
Signature of Applicant/Contmcto Date
OFFICE COPY