11310 (2) C;
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO RMITNUMBER
? INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADESS - — UNIT# LOT# PERMIT EXPIRES IF WORK
D
OWNER -CONTRACTOR - IS NOT STARTED WITHIN
I SECTION DATE INSPECTOR INSPECTION RECORD -18l-
8DAYS OF PERMIT ISSU-
ty ANCE OR 180 DAYS FROM
FOUNDATION '�--LY— 1T� lWJ• #�' LAST CALLEDINSPECTION.
UFER '
PREGUNITE ' - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING �y
ELECTRICAL ISSUANCE DATE
MECHANICAL I BLDG. ELECL PLG. MECH,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
_ INFORMATION
WOOD FLOOR /�VALUATION SIFT.VO
PLUMBING - - i
MECHANICAL - r UVIJ
ERMIT T
ELECTRICAL. /�/��/.PT/ � , WL)
FRAMING
STORIES TYPE CONSTR.
INSULATION -
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF O.FT FLOOR RHEA TOTAL ACREAGE
i DIAPHRAGM -
BUILDING USE
RES IND CON PB Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ 13 0
ROUGH ASSESSORS PARCEL NO.
'
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL 'Z'/2-S' FINALS I DATE INSP. ACC GATE ACC.FILE No.
FRAMING - SAN #
ZONING ENG.SITE NO.
INSULATION - y - . PLUMBING
GAS
FIRE SPRINK ENERGY T 24
1 VGRADE
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ° "�
' FLOOD ZONE A.L.U,C,
LATH—INTERIOR v� N❑ vl] NQ
LATH—EXTERIOR
SHEETROCK FEE SUMMARY
SHEAR INTERIOR _
SHEAR EXTERIOR - TEMPORARY APPROVAL 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 ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC e .
O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB, ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION'DATE - MECHANICAL
IMPORTANTI -CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFIC@COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENT[FICATION PERMIT NUMBER
ADiLDNG� APPLICATION & PERMIT O
ADI L-IBUILDING-ELECTRICAL-PLUMBING-MECHANICAL
L
OWNE 5 PLAN C CK VALIDATION
?� NAME b OTY. ELECTRIC PERMIT FEE
PHONE
ME A ° TyL /�' UTLETS-SWITCHES-RECEP 10.00/1.00 p -
( / LIC.No. 3 , 7 s LIGHTING FIXTURES 10.00/1.00
N.74 TEAC OPs LANCES-RESIDENTIAL 4.00
//r7�0 PHONE /I PANELS 10.60 DATE OF APPLICATION
ARC HIRECT v PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER �-
uc.No. SIGNS TRANS. 3,00
ARCH.OR ENG. SPECIAL CIRCUIT S,QQ PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANrs
ADDRESS MOTORS SEE FEE SCH.
ADDRESS O
SERVICE CHANGE j 20.00 cU4U
Hao LICIiNSED CONT RACI'ORS DECLARATION J
a u w I hereby affirm that I am licensed under provisions of Chapter 9 AA ISSUANC5 DATEAAno
(commencing with Section 7000)of Division 3 of the Business uad
Q y n LOU.BEf��.rggg T. LO:' MECH.
r w i Professions COJ nd I ry license is in full fur 'I r afflYt 4.L�'
¢ i m o- License C Lic.Number .7'C u � Iw7R�` 6 ❑
4 m I-w batt Commctor C;� 0�
a mf BUILDING PERMIT
It ¢ Sc u - OWNER-BUILDER DECLARATION INFORMATION
E:
3 e. I hereby affirm that I am exempt trout the Contractor's License MISC.- REFER TO ORD
a.In VALUATION $/FT.
1- 00 J Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 /0-
5 Code:Any city or county which requires a permit to construct,alter,
QQ2 improve, or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. �i pjP /�eUYD
a lE D¢ requires lite applicant for such permit to file a signed statement that TOTAL 3p � PERMIT TO
w re he is licensed pursuant to the provisions ol'the Contractor's License
F z a Law.(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4 D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ H 0 the basis fur the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).):
0 I,as owner of ilia property,or my employees with wages as BACK F LOW PROTECT. DEV ICE 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,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 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
, meats are not intended or offered for sale.If,however.the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
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-
provefor purpose ofsale.). INDUSTRIAL WASTE INTER. 30,00 RES IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
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 Property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(a)licensed pursuant to SEWER-SANITARY-STORM EA.200ftI10.00
the Contractor',License Law. TRACT NO. PARCEL NO.
0 I un exempt wider SeC. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dam WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby alTirm that I have a certificate of consent to self-insure,
of a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.0 I
Policy No. Company
O ❑ Certified cup hereby fu niched. FIRESPRINK ENERGY T 24
Z Z .[Certified c ¢ Oled t1l'[t_e,.cy[y,�Inspection division.
HApplicant >;0-ln�,Y��/L- z MISC.- REFER TO ORD. y N❑ v ❑ N
to ,B�/")J PERMIT ISSUANCE 10,00
LU CIiR ICCOIPE SATIOTINSURO ORKGRS' FLOODZONE A.L.U.C.
W � COMPENSATION INSURANCE PLG.CONTR. LIC.No, PLG.
CL Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
hundred dollars IS 1 O or less.)
U O 1 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 in as to
O W 'become subject to the Workers'Compensation Laws of California.
C1. Date -ApplicantALTER OR ADD TO MECH. 5.00 BUILDING �.�n ��
>_ W 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
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10ADC.F,M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the perform
ante of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address -
L., I certify that 1 have read this application and stale that the above VENTILATION FAN (SINGLE) 4,00
�I information is correct.I agree to comply with all city and county PLUMBING
onlinan<es 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 g
bove-mentioned property for inspection purposes. 01 LER-COMP(Over 100.000 BTU)SEE FEE$CH. MECHANICAL
a
(We) agree to save, indemnify and keep harmless the City of MISC.- - REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses whichPERMIT ISSUANCE 10.00 -CONST.TAX
may in any way accrue against said City in consequence of the
grantin It pe MECH.CONT. LIC.NO. MECH.
`p TOTAL TOTAL r14!
tore of Applicant/Contractor at -
OFFICE COPY