11056 (2) POST THIS CP RD NEAR FRONT OF BUILDING
CIT OF CUPERTINO PFRM19ITN MBEq
INSPECTION DIVISION
OB INSPECTION ECORD
- PERMIT EXPIRATION
JOB ADDRESS UNIT# LOT.#- `PERMIT EXPIRES IF WORK
r; . IS NOT STARTED WITHIN
'
OWNEI, CONTRACTORINSPECTION . DATE INSP CTOR INSPECTION RECORD AN
DAYS OF PERMITCE OR '180 DAYS FROM
FOUNDATION . - + -
-
_• LIFER LAS TCALLED INSPECTION.
PREGUNITE - PERMIT VALIDATION a
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -:UELECP
UNDERGROUND /SL B'PLUMBING, /p lvbELECTRICAL - 'MECHANICALR[Dc: ecR.
00 NOT POOR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT
• INFORMATION
WOOD.FLOOR VALUATION S/FT.
PLUMBING
MECHANICAL PERMIT To
ELECTRICAL' ,. - - r - - h
FRAMING- ` V 7021
+ - STORIES w TYPE CONSTR:
INSULATION
- s^
• .. ,, _ , .00C.GROUP RES.UNITS
. s
-`� PLACE NO SUBFLOOR UNTIL ABOVE HAS•BEEN SIGNED
A
. ROOF SO,Fr FL00H AREA IOTALALHfAGE'
1
DIAPHRAGM
BUILDING USE
RES IND CON PB OVre. '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ El 0- 0 ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING I GAS TEST TRACT NO., PARCEL NO.-,
MECHANICAL - p7
WA - -
ELECTRICAL 'FINALS S DATE INSP. ncc oATE Acc.PaE No.
FRAMING / SAN
.
ZEN ING ENG.SITE NO:'
II INSULATION PLUMBING' ( - +-I'T
GAS
MECH NIC L ( FIRESPRINK" ENERGY TY4
Ile-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HE
NG "� NC]
.� LATH=INTERIOR - ELEC RICAL
FLOOD ZONE A.L.u,c.
LATH—EXTERIOR - FIRE EPT. . Y[] NoYo NE)
SHEETROCK: _ GRADE FEE SUMMARY
SHEAR INTERIOR
SHEAR EXTERIOR " TEMPORARY APPROVAL'S eulLDwc.'
FIREWALLS . ELECTRIC - '1' - PLAN CHECK
-..r. - .,,• GAS - FEE' ..
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY 'SEISMIC FEE '
' OCCUPANCY.OF BUILDING IS NOT PERMITTED,UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MROFILM'
I,v IC +
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F. ONE WORKING DAY BEFORE.REQUIRED INSPECTION.. PLUMBING v
7 0� PLEASE GIVE JOB ADDRESS WHEN PHONING.'' "
. Z - - I MECHANICAL
SEE'PERMIT FOR EXPIRATION DATE.-'
IMPORTANT! coNsT:'TAX-
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION'. ! f
OFFICECOPY -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE �.L POINT PEN ONLY
BUILDING'PROJECT IDENTI FIC V - PERMIT NUMBER
' a DILOING APPLICATION & PERMIT.
ADRESSa5 (� 11056
6j0 rj �^s�f/..vvNl1 •A..QJ {.7Y� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S - I PLAN CHECK VALIDATION
NAME nn I,O PNONE 446-1✓ "-Ic Iy5 QTY. ELECTRIC PERMIT FEE
LV
NAME Acr Rs �Q S O`� 2tJ UTLETS--SWITCHES-RECEP 10.00/1.00
6 AA G 9 Q.
Se
' C.NO. '7. LIGHTING FIXTURES 10,00/1.00 p
CONTRACTOR'I SS1
PPLIANCES-RESIDENTIAL 4.00
ADDRESS CR
PHONE L' / PANELS 10.00 16 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) .20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER '
' 'Sec.No. SIGNS TRANS. 3.00
ARCH.OR ENO. PERMIT VALIDATION
ADDRESS ISPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00
Ar'S MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
kF O o LICIiNSEU CONTRACTORS•DECLARA'TION /Y���
u-� I hereby affirm that I am licenud under Provisions of Chapter 9 25511A CE
'DATE
,N Q y (commencing with Section 7000)of'Division�3µopf the Business and' E t• BLDG. ELECT. PLG. MECH.
H m i P,ofeasionr CoftWNrR.
se is In full f AA lNl fyLto MAY
r i m - Licens k s 'a Numbe/'l lwlsJ "I n
H w DcClint, for
I•{jRO BUILDING PERMIT
tc tc w < D. DECLARATION - INFORMATION
wo n. ° REFER TO OR
I hereby affirm thus I am exempt Ro+ifl the Crntrucmr'a license MISC.-
3 u V - VALUATION $/FT.
u
O< Law for lire following reason.(Sec.7031.5,Business and Professions i
_ N PERMIT ISSUANCE 10.00
H a, 2 Code: e,decry or county whiny requires prior
toconstruct,alter, - a
W 4 0 improve,demolish,'rr repair any structure,prior to its issuance,a150 ELEC.GDNTR, LIC.NO. ELEC. �"- (ltl '� -
O u requires the applicant for such permit to file a signed statement that - TOTAL PERMIT TO
a, he is licensed pursuant to the provisions of the Contractor's License. A A ,
rza
Law(Chapter 9(commencing with Section 7000)of Division 3 of the - ad)/T/J^,
I i c Business and Professions Code)or that he is excerpt therefrom and OTY. PLUMBING PERMIT FEE
IS $ the basis for the alleged exemption.Any violation of Section 7031.5 1 1 STORIES TYPE CONSTR. .
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATERIEA.) 5.00
of not more than five hundred,dollars($500).):.
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4400 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the shucwre 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
property who builds or improves thereon,and who does such work 3 FIXTURES-PER TRAP 5:00 / "SO.FT.FLOOR TOTAL ACREAGE
himself Or through his own employees,provided that Such improve-
mentsarenotintendedurofferedforsale.IL however,the buildingGAS-EA.SYSTEM-l1NC.40UTLETS (T00
or improvement is Sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA ) 200 BUILDING USE
builder will have the burden of proving that Ito . . .
did not build or im- REB IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. ' ,30.00
❑ I,as owner of the property,um exclusively contracting with -❑ ❑ ❑ ❑ ❑ -
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL No.
`o nroweneroor Codegrope ty whobuilds improves icense aw does thereon.lat and who LAWN SPRINKLERS-OVER 5lEA.) 1.00
property Y
contracts for such projects with it nmtraclorls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 Q �'
tire Contractor's License Law. TRACT N0. PARCEL N0.
❑ lam exempt under Sec.-,IL&P.C.for this WATER HEATER 6.00
reason
Owner .Dale WATER SYSTEM 5.00
,ACC.GATE ACC.FILE NO.
WORKERS'COMPENSA'I'IONDI?CI.ARA'fION WATER TREM�vp uIP{'J lC 't 5.00
I hereby allirm that I have a certificate at consent to self-insure, ZONING ENG.SITE NO.
or a ce liifi�ct.tte.o Worr�ke Comp e sation Insurance,or a certified
Poll y FnaV`��Ct+mp '' �Zu^'• a//rtlno
Q ❑ Certified copy' hereby' mishcd. S, - �j. ' FIRE SPRINK - ENERGY T-Z4
FZ ❑ Certif i Re iib the c' sPecti Aivi n. MISC.- REFER TOO D.
'f'ssC Applicant µ 'Y❑ N❑ Y ❑ N
jr T \ CERTIFICATE P EXEM PION FROM WORKERS', PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u,c.
W COM IiNSAT'ION INSURANCE - PLG.CONTE, LIC.NO.
PLG.•
n- O ('chis Section need not be completed if the permit is Rr one TOTAL W"PlY❑ N Y ❑ N❑
D Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
U_ I- Hit is issued,I shall not employ nny person in nny murmur sI as to
O
U becoma subject to the Workers' pe Conr nsation laws of California.
S�
Date APPlicani CH. 5.00
} w N 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
provisions of the Labor Code, YOU most forthwith comply with f FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10.00011F.M.) 4.00
CONSTRUCTION LIiNDINC AGENCY '
AIR HANDLING UNIT(OVER 10p00C.FM.) 6.00 SEISMIC FEE a o7
I hereby affirm that there is a construction lending agency for EXHAUST HO DUCT) 5.00
• the performance of Ile work for which this pernot-Is issued(Sec. MICROFILM
3097,Civ`.C.L ' HEATING UNIT(TO 100,000 B.T.U.) 8.00 '
Lender's Name HEATING NN•1 ER1Q0,0008.T.U.)9.50 ELECTRIC `s•��-/
Lender's Address
I certify that I have read this application and stale that the above VENTILA N FAN (SINGLE) 4.00 '
Information is correct. I agree to comply with all city and county PLUMBING ���
S mdinances and state laws relating to building construction, and BOILER- O OD B.T.U.1 '6.00
hereby aulhnrite representatives of this city to enter upon the BOILER-CO (Over 100,000 BTU1 SEE FEE SCH. MECHANICAL /r0T7
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino a"- nago,ae,
' nts;costs and expenses which , CONST.TAX ,
r may'In anyd City in ronsequence of the PERMIT ISSUANCE 10.00 6
grand g MECH.CONT. - LIC.NO. ME 1" /,
TOTAL . �5�+ TOTAL 31,9
ls Si Store of ...
• OFFICE COPY