14003 (2) POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO L,R1 NO
Il .. JOB INSPECTION RORD ,�0 o�
DIVISION'INSPECTION
C
PERMIT EXPIRATION
JOBADDRESS 847 SEPTEMBER UNIT# Lor#
PERMIT EXPIRES IF WORK
OWNER CHENG CONTRACTOR MY. YARD LANDSCAPING IS NOT STARTED WITHIN
INSPECTION DATEINSPE TOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION LASTCALLED�INSPECTION.
LIFER _
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTILABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
r �..
PLUMBING peoNvo
_ ELECTRICAL C�XUANCE OATS
MECHANICAL - ELECT. PLG. MECH. -
El `0 El
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALE,
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO� `N �
FRAMING
STORIES TYPE CONSTR.
INSULATION
OCC GROUP RES.UNITS
�:,P,LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED f
- SO,FT.GLOOH AREA TOTAL ACREAGE
ROOF
DIAPHRAGM
-
BUILDING USE
RESIND CON PB 00'."APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 0 ❑ ❑ El
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST _ TRACT N0. PARCEL NO.
MECHANICAL
ACC.DATE ACG FILE NO.
ELECTRICAL FINALS ,'DATE INSP.
FRAMING SAN 7t -
ZONING ENG SITE N0.
INSULATION PLUMBING '
GAS
FIRE SPRINK ENERGY T 24
MECHANICAL vN� v NE]WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
.
LATH-INTERIOR ELECTRICAL . FLOOD ZONE A.L.0C,_
LATH-EXTERIOR WGRADE ' .
Y❑ NEI Y0 N❑
SHEETROCK : FEE SUMMARY
SHEAR INTERIOR :_ZSHEAR EXTERIOR APPRO ALS FIREWALLS PLANCHECK
kk NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED SEISMIC FEE S U
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDINGFINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
oONE WORKING DAY BEFORE REQUIRED,INSPECTION. „ " PLUMBING
z PLEASE GIVE'JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!
CONST.rnx '
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
i
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDING PROJECT IDENTIFICATION , PERMITNUMBER
. a01 GING 5� APPLICATION PERMITA.aamysa 1 4003
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S,r - � PLAN CHECK VALIDATION
NAMFOTY. ELECTRIC PERMIT FEE
• r PHON -
CONTRACTOR S
UTLETS-SWITCHES-RECEP 10.00/1.00
NAMF ) 48(? '� '
- '�lp 7_ LIGHTING FIXTURES 10,00/1.00 -
coRAAC Ov'S r PPLIANCES-RESIDENTIAL 4.00
sNJN PHOrvE PANELS
10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR j
ENGINEER - ` 5 . O Z
LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG. - SPECIAL CIRCUIT S.00 PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00
ADORE rs MOTORS SEE FEE SCH.
ADDRESS S&
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION
v I hereby affirm that I am licensed under provisions of Chapter 9 ySUANCE IS
a vTE
wto (commencing with Section 7000)of Division 3 of the Business and
G A ELECT. PLG. MECH,
F D i Professions Code,and my license is in full force and effect.
t
�' ❑ ❑ ❑
o'� License Class Lie,Number
O m Dale Contractor
a x re - BUILDING PERMIT
¢ a T OWNER-BUILDER DECLARATION INF ATION
w ; LL r I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
H u O 4 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE CAN S/FT.
aO1 Code:Any city or county which requires a permit to construct,a ter, 10.00
ceo 3 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO. ELEC.
U,
wc LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
m he is licensed pursuant to the provisions of the Contractor's License
H z r
Law(Chapter 9(commenciagwlth Section 7000)of Olvision3 oftlic �RBn.e
a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
le =$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ; by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S500).):
❑ I,as owner of the properly,or my employees with wagesas BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will an 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 docs not apply to an owner of
property who buildsorimproves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOD AREA TOTAL ACREAGE
himself
ate not
hde ownemployees,for sale.if,ed however,tire
improve- GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
me cls are not intended or offered for sale.If,however,d h holding
or improvement is sold within one year of completion,the owner-
bidder
wner GAS EASYSTEM-OVER 4(EA) 200
builder will have the - . . .
burden of proving that he did not build or im- BUILDING USE
preve for purpose of sale.). RES IND CON PB Other
Rl I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 C3 0 El 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:Tio,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 with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
4 reason _ _
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORKERS'COMPENSAT10N YFCLARAI'1ON WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofcousent to self-insure,
or a certificate of Workers'Compensation Insurance,or a cerlil icd ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is herchy furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant - Y C] N Y ❑ N[]
CC T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD20NE A.L.0 C.
LL > CC IPENSATION INSURANCE PLG.CONTR. E.C.NO. PLG.
d (This Section need not be completed if the permit is for one TOTAL Y❑ N E] Y❑ N
Z hundred dollars IS 100)or less)
0 O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
ED Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 3e
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex
? caption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE -
(.7 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 10=C.FM.) 6.00 SEISMIC FEE S�
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5,00
3he performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 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
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 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 inspectlon,purpows.
(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 a y way accrue
-again sad C in consequence of the gra ti fthis permit MECH.CONT. LIC.NO. MECH.
6TOTAL TOTAL 3y
Signature of Appacan l/ on tractor Dale
OFFICE COPY ,