8890 (2) POST THIS CARD NEAR FRONT OF BUILDING
:PFRMIT NUMBER ' et I
CITY. OF; CUPERTINO, 8390
INSPECTION.DIVISION
JOB INSPECTION ECORD
r PERMIT EXPIRATION ?.
JOB ADDRESSI' -4 41N T LOT#
PERMIT EXPIRESIF.WORK..
OWNER cONTR ACTOR IS NOT STARTED WITHIN
INSPECTION DATE ' INSPECTOR. y IN CT NR CORD, �i80'oAYS.OFPERMITISSU ,
ANCE OR 180 DAYS FROM
FOUNDATION ' �' •LAST CALLED INSPECTION': •
UFER
' PREGUNITE - _ -,PERMIT VALIDATION
S
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
' UNDERGROUND /SLAB'
PLUMBING' - C%�✓ ^
i
ELECTRICAL, - - . $SsU41NCE DATE
MECHANICAL, - - 'BLPkG. ELECT' PLG. .MECH.' ,
El
.DO NOT POUR,FLOOR UNTIL ABOVE HAS BEEN SIGNED :.,' >s, '/`, : Bu DING PERMIT,
I' NFORMATION
d ' WOOD FLOOR.
VALUATION $IFT..
- PLUMBING' .� - - - - - ,i / r,
• MECHANICAL .° .. � `•.�'la I -
PERMIT O�
ELECTRICAL � ' - .i ° 'q; - •'"(
FRAMING
INSULATION - ,3 I 'r, STORIES -"y CONSTR.'
t •
` OCC,GROUP 'RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROOF - ` • + SOFT4LOORAFEA TOTAL ACREAGE
DIAPHRAGM.
- - BUILDING USE
IF IND' CON PB DII
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑` " ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST •• IPACT NO,:J PARCELNO.
MECHANICAL -
�ACC.'DATE ACC.FILE NO,
ELECTRICAL FINALS DATE INSP.
FRAMINGa SAN
NSULATION # ' s ` •I.
Sk L;
ZONING •ENG SITE N0.
I � PLUMBING. �'
• GAS
' - - MECHANICAL " - -FIRESPRINK ENERGY T�24
' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` ❑.r,Y"❑ sv ❑ -"❑ '
FLOOD ZONE A.L.U.C.
LATH-INTERIOR �� _� ELECTRICAL
LATH-EXTERIOR -' FIRE DEPT. v❑ N❑ .Y�, ry❑
SHEETROCK - • GRADE 'FEE SUMMARY
i SHEAR INTERIOR BUILDING" - ,
BUILDING a
SHEAR.EXTERIOR TEMPORARY APPROVAL'S. P'�' r ••
FIREWALLS ELECTRIC •PL'AN CHECK , - f'
- . GAS.
' NO-TAPE OR PLASTER UNTIL ABOVE HAS.BEEN SIGNED- OCCUPANCY. , :,, .SEISMIC FEE,, `
UCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY 6UILOING INSPECTOR.
4MICR.0FILM
uJ ` ARRANGE FOR' B
.INSPECTION _ Y PHONING-,252-4505,.` ELECTRIC
o�+ ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING A- t
GSWHEN PHONING
Z PLEASE. IVE JOB ADDRESS .
- SEE PERMIT FOR EXPIRATION DATE -, , MECHANICAL
IMPORTANT! CONST ,TAX }
'`PLEASE.,READ REVERSE SIDE BEFORE - TOTAL
' CALLING FOR FINAL IN
.
' i • :'OFFICE COPY! -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.BUILDING PROJECT. IDENTIFICATION I - PERMIT NUMBER
BUILDING APPLICATION & PERMIT
'POOR S O O(V'J 11 O
/�33 BUILDING -ELECTRICAL-PLUMBING-'MECHANICAL fVl
y OwNER'S • - PLAN CHECK VALIDATION
NAIVE - - OTY.
PHONE ELECTRIC PERMIT • FEE
36~71
OOONTERACTOR5 - UTLETS-SWITCHES-RECEP 10.00/1.00 '
^�ke LIGHTING FIXTURES - 10.00/1.00
-r-oU N RA T48;,5, ,C PPLIANCES-RESIDENTIAL 4.00
Pb Q:�B/�?O/VT /1 vL.
S /C TO PHONE PANELS , 10.00 DATE OF APPLICATION
ORcmTEcr PANELSIOVER200AMP) 20.00 PLAN CHECKFEE- P.C.NO.
ENGINEER - ,uC.NO. S(GNSTRANS. 3.00
ARC" OR ENG. - PERMIT VALIDATION
ADDRESS ' SPECIAL CIRCUIT 5.00
' +
Zn, TEMP.METER OR POLE INS. 20.00
ADDRESS - MOTORS SEE FEE SCH. �n
> SERVICE CHANGE 20.00
wo o' LICENSED CONTRACTORS DECLARA'T'ION TEMP.POLE - 30.00
u u I hereby affirm that I am licensed ander provisionsof Chapter f) - ISSUANCE DATE
vHi a m (commencing with Sect 7000)of Division 3 of the Business and 'BL G. ELECT. PLG. MECH. -
H N z Professions Code,an, license is in full for�L�1�f
pi,n License Class _ Lie.Numher_i7_T.QS,.a�� ❑
Date ContractorL� -�/�
a L f 0 � E/r�"- BUILDING PERMIT
a O NI' BUILDER DECI HA'TI )N
Eoa" MISC.- REFER TO ORD N O TION -
w ; LL w I hereby affirm that 1 am exempt from the Contractor's License L O
FLLNj Law for the following reason.(Sac.7031.5,Businessund Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requiresa permit toconstruct,alter,
rtae c 20 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO.. ELEC. I
i w m u requires the applicant for such permit to file a signed statement that - TOTAL PE MIT TO
he is licensed pursuant to the provisions of the Contractor's License 1 -
HiQ Law(Chapter 9(commencing with Section 7000)of Division 30fthe
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
w. by any applicant for u permit Subjects aim pplitmrt too civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars($5001.):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the It
is not
OCC:GROUP RES.UNITS
intended or offered for sale(See. 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 builds or improves thereon,and who docs such work FIXTURES-PER TRAP :5.00 SO.FT.FLOOR AREA, TOTAL ACREAGE
himself or through his own employees,provided that such improve-
I
memsare not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-1 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 Moving that he did not build of int-
' prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 IND - CON PB Omer
O I,as owner of the property,am exclusively contracting with RE ❑ ❑ ❑ ❑
licensed contractors to construct the project(See 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 -
contractsforsuchprojecis with a contractod0liceawd pufacaut to SEWER-SANITARY-STORM EA.2001t/10.00
Om Contractor's License Law. TRACT NO. PARCEL NO.
❑ 1 am excnnpt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 -
masoT
.Owner , Date WATER SYSTEM 5,00 ACC.DATE ACG FILE NO,
WORK ERS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00 -
I hereby affirmthatI have a certificate of Consent to self-Ilbare, - ZONING ENG.SITE NO.
_ or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3900,Lith.C.).
Company
�KAo
-
O O. Cil liOed copy is her by furnished FIRE SPRINK ENERGY T-24
Z ZO p Ce tified co 's tiled will he inspection division. MISC.- REFER TO ORD. yN ,v
14, ❑ ❑ ❑ N❑
~ rn f PERMIT ISSUANCE - 10.00
2 > .IiRTIFICATI>OP P11 I )NRO 7 VOI $' FLOOD ZONE, A.L.U.C.•
W _ COMPF. ATION INSURANCE PLG.CONTR. LIC.NO. - PLG. v❑ N❑ v ❑ N❑
- d
This section need t be completed if the mit is in), one TOTAL -
Z hundred dollars($100) rlessA
U O • l certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
IL I- mit is issued,I shall,not employ any person in any...Ther so as to
Q Wbecome subject to the Workers'Compensation Laws of California.
y Dute Applicant _ ALTER OR ADD TO MECH. 5,00 BUILDING
- } Do NOTICE TO APPLICANT: If,after making this Certificate of Ex-
♦- Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK -�s
provisions of the Labor Code, you must forthwith comply with - FEE
(� such provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0OOOCEM.) 6.00 SEISMIC FEE' '
1 hereby affirm that there is a cca strurim 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.). H EATING UN IT(TO 100,000 B.T.U.) 8.00
Lender's r H EATING UN IT(OVER 100,000 B.T.U.)9.50 .
Lender's AddAddress ELECTRIC
'I certify that I have read this application and state that the shove 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 o1' this city to enter upon the BOILER-COMP (Ove,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.- '
(Wu) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
r' Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any accrue against Sas sty in consequence of the PERMIT ISSUANCE 10.00
granting of tl s' a it
H.CONT."' LIC.NO. MECH.'
TOTAL TOTAL
Signa cof Applicant/ it - Date
.. - OFFICE COPY