18509 (2) POST THIS CARD NEAR FRONT OF BUILDING ERM(T NUMeeR.
CITY OF CUPERTINO 18509
INSPECTION DIVISION
JOB INSPE CTIQ_N RECgRD
/ (� �•� .,IVC PERMIT EXPIRATION
'JOB ADDRESS�( � `s (° - ( L 0.1 UNIT# LOT# PERMIT EXPIRES IF, WORK
OWNER CONTRACTOR ( IS NOT STARTED WITHIN
INSPECTION DATEP I INSPECTOR INSP TION RECORD 1B0 LI DF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM .
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLEDINSPECTION.
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF vnl+pm vnLn.n rloN
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED O S V S�
UNDERGROUND /SLABk 1J (�N ��� �`►�l N."{'� �
yvV tet- I
PLUMBING,' F
ELECTRICAL ISSUANCE OATE '
MECHANICAL - BLDG ELECT,I PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - ..-BUILDING PERMIT
INFORMATION
WOOD FLOOR - VALUATION
SIFT.
PLUMBING •.D DvLU
MECHANICAL +
PERMIT TO
ELECTRICAL _ I
FRAMING I ' I 1?V
r SIOHIES IYPE�CONSTR,'
INSULATION V ,
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE NO FINAL'INSP HALL BE MADE BEFORE sD.IT.aoDR ABFA roTAL ACHLAce
DIAPHRAGM . THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND ;CON PS Om.... '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ L `� ❑ 'E]
- .ASSESSOHS PARCEL NO
ROUGH SAN.0
PLUMBING ELECT.ENERGY
iHACI NO PARCEL NO
TUBS 8 SHOWER PAN - -PLUMBING ENERGY ' -
MECHANICAL I MECH.ENERGY ,
ELECTRICAL ACC.DATE ACC,FILE NO.
BUILDING ENERGY
FRAMING ' ELECT.FINAL TEST ZONING ENG,SITE NO.
'INSULATION �'� fj PLUMBING
GAS TEST - GAS
FIRE SPRINK ENERGY i-]4
' MECHANICAL aL NL ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING -
FLODD/ONE A.L 7C
EXTERIOR SHEAR ELECTRICAL RELEASE I
INTERIOR SHEAR' FIRE DEPT. Y L NL r L NL
SHEETROCK ' GRADE - FEE SUMMARY
EXTERIOR LATH „ - BUILDING -
INTERIOR LATH TEMPORARY APPROVALS BUILDING �6 I n
SCRATCH COAT - ELECTRIC PLAN CHECK '
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE do 501
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. NfICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
~ I ONE 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 7
CALLING FOR FINAL INSPECTION. Y /
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDINGPROJECT IDENTIFICATION
rAPPLICATION & PERMIT , PAE-
RM.ITNUMBER
BmILr9-', l l20 A.
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL18
5
On
.
3S 1 71h
Gn f LN AAA(
GAINER PLAN CHECK VALIDATION
NAME (/ NIU QTY. ELECTRIC PERMIT FEE rig
. IQh ICI IA� VHONE vV`�i
CONTRACTOR'S
Nk ME �y UTLETS-SWITCHES-RECEP 10.00/1.00 pA'p
U n 'Gyi�c:No.l l LIG HTI NG FIXTURES 110.00/1.00
CONTRAOao s
aOOREss Fos G'F PPLIANCES-RESIDENTIAL 4.00 C�' • U,
//��'' /4-��
tJ PHON IJ PANELS 10.00 DATE OF APPLICATION T
CHITS PLAN CHECK FEE P C.NO.
ENGINEER ru y
GE2 PANELS (OVER.200 AMP) 20.00
G'!R QQI"r uc.No. SIGNS TRANS. 3.00
ARCH.OR ENG. PERMITVA❑DATION
AODREu SOS q+-T0 S SPECIAL CIRCUIT 5.00 '
I&D EL ZIP 94 0Z1 TEMP. METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH,
ADP u
J 4✓ C; y SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION v•r/-yl-'V"` 11 v `�nJ
a u U I hereby all that I OR licensed under provisions of Chapter ,.r•e s n O 4f1OQ ISSUANCE DATE T
I" (commencing with Section 7000)of Division 3 of the Business and
mi Professions Code,and my license is in full force and effect. 10 V Y w Hz t.zv•. BLDG. ELECT. PLG. MECH.
z o o - License Clan Lic.Number - ❑ El H D Date, Contractor fife of 1•'17C�lOQ
a x 4 I BUILDING PERMIT
¢ ¢w
3 a OWNER-BUILDER DECLARATION INFORMATION
w O a H 1 hereby affirm that I am exempt from the Contractor's Limr,w MISC.- REFER TO ORD
u VALUATION S/FT.'
F ¢ O`� Law for the following reason.(Sec.7031,5,Businessand Professions PERMIT ISSUANCE. 10.00
Code:Any city or cotmty which inquires a permit to constnmL alter,
2 Q 0 improve,demolish,or repair any structure,prior to its i uance.also ELEC.CONTR, LIC.NO. ELEC.
0 , Tectonic the applicant for such permit to flu a signed statement that TOTAL PERMIT TO
a w S w he is licensed Pursuant to the provisions of the COntnlCIOT s License
F z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he u exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r the basis for the alleged exemption.An
gc p he violation of Section malty STORIES TYPE CONSTR.
a ; by any applicant lora hundred dollars
S500).licam wucivil penalty ALTER-DRAIN VENT-WATER (EA.) 5.00
of not more than 11re hundrtJ Jollan(55007.1:
❑ I,as owner of the PmParty.or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the stmctnue u not
intended or offered for sale(Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. '5.00
Calc 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 sa Er.FLOOR AREA TorAL ACREAGE
• menta re not hrough
ownemployees,for It.If,ed that however.
the
improve. GAS-EA.SYSTEM-1 6.00
mems me not intended or nemmd for sola If,however,the building
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 int
prove for par'..ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES .IND PB Orb..
IDI,as owner of the protwny,ant ex ClusivCly C ndmL'oCt'mg with ❑ ❑ ❑ ❑
licensed contractor to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSOM PARCEL NO,
and Professions Code:T'he 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 contructorls)licensed pursuant to SEWER-SAN V-STORM EA.200ft 10.00
the Contractors License Law. ( TRACT NO. PARCEL NO.
❑ I am exempt under Sec .H.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner -,)ate WATER SYSTEM - 5.00
ACC.GATE ACC.FILE N0.
WORKERS'CO.MPENSAFION DBCLARA'I'ION WATER TREATING EQUIP. - -5.00
1 hereby affirm that I have a certilicam of consent m sel Ginsure.
I, cc,til,idc of on m
Workers'Comperi,tiInsunee,or a eeniDeZONING
d ENG.SITE NO.
copy thereof(Sec.3800,La a.C.). '
Policy No. Company
O ❑ Ce Rifedcopy is hereby l inmished. FIRE SPRINK ENERGY T-24
Z Z !flicant ed�yLy isfledewith he city specyon div cion. MISC.- REFER TO ORD. ❑ ❑ ❑- ❑
O Applicant CQ�(..,f i��((� V N V N
~ wPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W - CCRTI PIC ATI'.UP I AXTIO\INS 1'1 FROM WORKERS'
W > COs1PISN5Al0NSURANCE PLG.CONTR. LIC.NO. PLG.
-() (This N:rtioa need not he completed if the Penuit ig for one TOTAL Y❑ N❑ Y [:] NE]N
hundred dollars(5100)Or I..)
U O ,I certlty that in the,performenev of the work for which this per- QTYMECHANICAL PERMIT FEE FEE SUMMARY .
LL I- mit is issued, 1 shall not an PlOy any person in any Inanncr sO as,o
U become subject to the Workers Compensation Laws of Calil'omiu.
v'a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO AI'I'hICANI': 11;after making this Certif ewe of nix- ..
Z emption,you should become subject to the Workers'Conrpensution APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this parrot shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10 17-F.M.) 6.00 SEISMIC FEE
1 hereby afpnn that there is a construction lending agency fur EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which the permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is cored. I agree m ttmtply 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 repmunidism of this city to enter upon the BOILER-COMP IOxer 100,000 BTU)SEE FEE SCH. MECHANICAL
mentioned entioned properly for inspection purpoas. _
(We) atimc to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, coals and expenses which PERMIT ISSUANCE 1000 CONST.TAX
may in any way acame against said City in conwyucncC of lire
granting o hupemn II ` MECH.CONT. LIC.NO. MECH.
!! /�T�V. 2_5`B: ( TOTAL TOTAL
Signature of Applicant/C mctor Datc /
OFFICE COPY