12126 POST THIS CARD NEAR,FRONT OF BUILDING
• ' .. PFRMII DUMPER
CITY OF CUPERTINO 121$6
INSPECTION DIVISION
JOB INSPECTION RECORD: 0`
- PERMIT EXPIRATION
/jl
JOBADDR ESS `� O - , , '^— UNIT# -_LOT# PERMIT EXPIRES IF WORK
OWNER. CONTRACTOR IS NOT-STARTED WITHIN
INSPEC ION DATE INSPECTOR INSPECTION RECORD 180 DAVS.OF PERMIT'ISSU-
ANCE OR 180:DAYS FROM
FOUNDATION - LASTCALLEDINSPECTION.
LIFER
PERMIT VALIDATION
PREGUNITE `
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Y
UNDERGROUND /SLAB / fXl
PLUMBING
ELECTRICAL ISSUANCE'OATE
MECHANICAL " e BLDG, ELECT. PEG. MECH.
. ❑ ❑ E- ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
- - INFORMATION
WOOD FLOOR L vn wnnoN s/Fr.
PLUMBING _ - -
MECHANICAL - `
' PERMIT TO-
ELECTRICAL ,
FRAMING
STORIES TYPE CONSTR.
INSULATION .. '
I
OOC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE'HAS BEEN SIGNED
SO.FT.FLOOR AREA TOT AL-ACREAGE
ROOF
DIAPHRAGM
BUILDING USE
HES IND CON ,PB Op—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ El ` El ❑ El
ASSESSORS PARCEL NT
ROUGH
PLUMBING . - P
'TR{.CT,NO.: PARCEL NO. -
' GAS TEST -
• MECHANICAL . - -
ACC.DALE ACC,FILE NO.
ELECTRICAL ., FINALS DATE INSP.
FRAMING SAN # ' ,ZONING ENO.SITE NO,
INSULATION , PLUMBING
GAS
FIRE SPRINK ENERGVT-}0
MECHANICAL.. Y Q ..IvE] v ❑ NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING -
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.uc.
LATH—EXTERIORFIRE DEPT.,', YQ ru� , v❑ N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR - BUILDING I t'6—H7 'BUILDING ! :L
SHEAR EXTERIOR TEMPORARY APPROVALS '
FIREWALLS ELECTRIC - PLAN CHECK
-a GAS'. -
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING_INSPECTOR. MICROFILM -
• �, -
ARRANGE FOR INSPECTION'BY PHONING 252-4505, ELECTRIC':
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0� '- PLEASE GIVE JOB ADDRESS WHEN PHONING
Z MECHANICAL '
- SEE PERMIT FOR EXPIRATION DATE - -
IMPORTANT! CONST.TAX. ;
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL C
OFFICECOPY ,.
APPLICANT TO FILL IN INFORMATION WITHIN.RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMITNUMBRR -
�y/, APPLICATION & PERMIT
BUILDING
/ 'ADD Ess 1212 6
oQ-I BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OW ER'S /�n PLAN CHECK VALIDATION
Nis I1 VALL %5=3 3 DTV. ELECTRIC PERMIT FEE
PHONE
COgN�TRACTORS UTLETS-SWITCHES-REECEP 10.00/1.00
CW111VG- _ .NO. 0'2 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S C s� qsulaff APPLIANCES-RESIDENTIAL 4.00
ADDRESS � � ` c,r�•� '
t3 F•�+1xPD ✓ PHONE �*-5' PANELS � 10.00 'DATEOFAPPLICATION
-
_ ARCHITECT PA NELS (OVER 200AMP1 '20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
uc,No. SIGNS TRANS. 3.00
ARCH.OR ENG. - SPECIAL CIRCUIT S.00 PERMIT VALIDATION
• ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00
ADDRErMOTORS OTORS SEE FEE SCH.
SERVICE CHANGE 20.00
'02 LICENSED CON'PRACTORS DECLARATION
v 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
I- BLDG. ELECT. PLG. MECH.
r y 2 Professions Codego my license is in full forfre_ayd IT ❑
2 O y - License Class Lic.Number - <
q r Date Contractor,f�I -:-�
a m s '.>." • BUILDING PERMIT
wu OWNER-BUILDER DECLARATION INFORMATION
F
g u m 1 hereby affirm that am exempt from the Contractor's License MISC.- REFER TO ORD
H t. oj Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 s��l`'s �' VALUATION 8/FT.
w N Code:Any city or county which requiresu permit to construct,alter,
K R G improve,demolish,or repair any structure,prior to its issuance,also ELEC CONTE. LIC.NO. ELEC. ` �!
DLL requires the applicant for such permit to file a signed statement that TDTAL A•1,•t v .PERMIT`-'
wm he is licensed pursuant to the provisions of the Contractor's License v
H =es Law(Chapter9(commencingwithSection 7000)of Division gA� /
Q Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
re = 0 the basis for the alleged exemption.Any violation Of Section 7031.5 STORIES TYPE CONSTR.
s3 _ 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(55001.1:
❑ I,as owner of the 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,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 F IXTUR ES-PER TRAP 5.00 SQ 4L FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
mentsare not intended oroffered for sale.If,howeveq the building GAS-EA.SYSTEM-I1NC.4OUTLETS 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- RES IND" CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE I LATER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
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 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 eontmaods)licensed pursuant t0
the Contractor's License.Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under See.-,B.&P.C.for this WATER HEATER W/VENT,• 6.00
reason
Owner Date WATER SYSTEM �•" - 5.00 3
ACC.DATE ACG FILE LA0.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP--s,, Cl 5.00
1 hereby affirm.that I have a certificate of consent to self-insure. " ZONING
ora certificate of Workers COmpensatic�I jIInsurance.oy+o,r certified ENG.SITE NO.
copy thereof(Sec,3800,Lab.O.).COS.JC.D�pp47
PoliC No. Company_�T.....d
OCerti6ed yI hereby(urns a ^^ _ FIRE SPRINK ENERGY T.OA
Z Z ❑ Certifie p Is file .with ity inspection divisino"
01 Applicant MISC.- REFER TO ORD. y E] N[_ y [:] NE]
~ w PERMIT ISSUANCE 10.00 O ` FLOOD ZONE A.L.u.C.
CI: -ICATE OF :XEMPTION FROM W KERS'
LU - COMPENSATION INSURANCE x PLG.CONTE. LIC.NO. PLG. -02-
y❑ _ NE] Y ❑ N❑
CL O ('Phis section need not be completed if the permit is for one TOTAL' J
Z) Z hundred dollars IS 100)or Icss.)
U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued.I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California. S�
w Date-Applicant BUILDING' _
ALTER OR ADD TO MECH. 5.00
} w NOTICE Poon,TO APPLICANT: IL after to the
this Certificate sa rix-
(_ Z cr vision you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Cit shall
you must drevoke comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10j100 C.F.M.) 4.00 �I
CONSTRUCTION LEN DING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE O
I 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 ISec. MICROFILM
3097,Civ.C.l. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
0 I certify that 1 have read this application and statethat tove VENTILATION FAN (SINGLE) 4.00
innnation is wply rrec[. I agree to comwith all city and he countyab
loPLUMBING
ordinances and state laws relating m building construction, and . BOILER-COMP I3 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 inspection purposes.
(We) a •e to save, Indenmify and keep harmless the City of MISC.- REFER TO ORD.
Cupe"i gar t liabilities,judgments,costs and expenses which CONST.TAX
may y accrl tier" City in consequence of the PERMIT ISSUANCE 10.00
gra mg f i permit v MECH.CONT. LIC.NO. MECH. ,
i1 TOTAL TOTAL 6 do
ign ore o App a 'untractor Date 194- 1
OFFICE COPY