11407 (2) POST THIS CARD NEAR FRONT OF BUILDING
I'FRMIT NUMBER
CIT"F CUPERTINO 11407
INSPECTION DIVISION
• JOB INSPECTION RECORD
�,n/• A PERMIT EXPIRATION
JOB ADDRESS _ dN'8'(�D I e- y AC-C UNIT# LOT#
L PERMIT EXPIRES IF WORK
OWNER T COATRACTOfl vb4mh IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD -180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
UFER 'LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE ISSUANCE DATE
.MECHANICAL BLDG. ELECT. PLG. MECH.
QFy ❑ 1 ❑. ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR
PLUMBING VALUATION $/FT.
� '
MECHANICAL `
ELECTRICAL - �� PERMIT To
FRAMING ' 0440, nem
INSULATION STORIES TYPE CONSTR.
OCC.-GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOFso.FT FLOOR AREA TOTAL ACREACE
DIAPHRAGM
BUILDING USE
RES INO CON P9 Other
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 1:1 ❑ •Q ❑
ASSESSORS PARCEL NO,
ROUGH
PLUMBING
TRACT NO, PARCEL N0,
I GAS TEST - - -
MECHANICAL -
.
ELECTRICAL FINALS DATE INSP. ACC.OATE ACCFILE NO,
FRAMING SAN 0 '
INSULATION PLUMBING
ZONING ENG.SITE NO.
.• � -
GAS
MECHAN L
FIRE SPRINK ENERGY T�24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATIN YO NC Y [:] NO
LATH-INTERIOR ELECT ICAL -FLOOD ZONE A.L.U.C.
LATH-EXTERIOR FIRED PT. Y[:] NO Y❑ N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING$o GHJL ' -1
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING Ice. 1 '
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu ARRANGE
WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX,
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
-APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE B L POINT PEN ONLY
BUILDING PROJECT I DENTI FICA - PERMIT NUMBER
BUILDING APPLICATION & PE T
AG SeloO Teftrlrce P211407
BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S
NAME PLAN CHECK VALIDATION
n�.y 5-I QTY. ELECTRIC PERMIT FEE
eA,
CT PHONE C.7 1
NAMRAcroRs
EEUTLETS-SWITCHES-RECEP 10.00/1.00 O�
APPOLIC.NO. 2 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR
/S� 1 Epp APPLIANCES-RESIDENTIAL 4.00
5 PHONE ✓�'�[ �JL PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER 1 �.
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ADDRESS ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 AAA
APPLICANTS
AD
ADORESREss MOTORS SEE FEE SCH. ✓/(\/
SERVICE CHANGE 2110D
w O o LICENSED CONTRACTORS DECLARATION f dSIL_ J1L�/��j
U,u 1 hereby affirm that I am licensed under provisions of Chapter 9 )ISSUANCE DATE
I" (commencing with Section 7000)of Division 3 of the Business and
4 y `In , BLD LEST. .qtp MECH.
Hoz Professions Code,a my license is in full for d ❑ 1 j j ❑
For- Liceny�Cl,y�l Cor Number u •u
F N w Dale fI 11 Contractor �SI ty Of C
M z W a 1 ,OWNER-BUILDER DECLARATION Pe(%ino �ggpppp1I11IT
D INFORNfXYffSN
xxl; LL N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u o 4 Law for lire following reason.(Sec.7031.5,Business and Professions VALUATION
❑ 7 PERMIT ISSUANCE 10.00
iw> f Code:
e,demysh countywhich requiresa permit tDconstruct,
uance,also
¢ ¢ 4 O improve,demolish,or repair any structure,prior r its issuance,also ELEC.CONTR. LIC.N0. ELEC. OZP)
wu requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
$ he is licensed pursuant to the provisions of the Contractor's License
HiQ Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe SO G.9-/L U ST
Fie Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ H
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES PE CONSTR.
a ; by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
afoul more than five hundred dollars(S500L)
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole coin Pensmion,will do the work,and lite structure 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
. properly who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve
ments arc not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I1NC.40UTLETS 6.00
of improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ 1,as owner of the property,an exclusively contracting with El ❑ i] 1:1 ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Comructor'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 contmctons)licensed pursuant to SEWER-SANITARYV-ST OOfI/10.00
the CUmUattoi S License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec..,B&P.C.for this
reason WATER HEATER W/VENT ,6.00
Owner Duty _ WATER SYSTEM J U L 10 1 M 5.00 ACC.DATE ACC.FILE NO.
WORKFRS'COMPENSA'rION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure, Of u0pultillu
or a certificate of Workers'Compensation Insurance,or a certified 1 ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
Q rlified copy is hereby furnished. FIRE SPRINK ENERGYT-24
Z 2 Ce 'f d appy y„[yyy_with the city inspersion division. MISC.- REFER TO ORD.
f APPicont Ys�-CZJ L-`CC y � N[ y � N�
CC RTII'ICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 U -� FLOOD ZONE 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 S- y E] N❑ Y❑ N
hundred dollars(S 100)or less.)
U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
I-
'LL mit is issued.I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California. BUILDING 57)
y Date Applicant ALTER OR ADD TO MECH. 5.00
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F 2 Sorption,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 10=C.F.M) 6.00 SEISMIC FEE
1 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
Leader's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify(hal 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 BOILER-COMP(3 H.P.OF 100,000 B.T.U.) 6.00 PLUMBING -
Ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the
above-merioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(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 any way accrue.against said City in consequence of the
of oripermit MECH.CONT. LIC.NO. MECH OJ'/TOTAL ole
Apo
e of Appli t/ o tractor Dat
OFFICE COPY -