10003 -77
POST THIS CARD NEAR. FRONT OF BUILDING
PERMIT N'MIR
CITY OF CUPERTINO
INSPECTION DIVISION 1 •
JOB INSPECTION RECORD
•'• {: ,
PERMIT EXPIRATION
JOB ADDRESS UNIT
LOT# -
' PERMIT EXPIRES IF WORK
OWNER Ci- CONTRACTOR IS NOT STARTED WITHIN
INsPtdTtON DATE INSPECTOR INSPECTIO RECORD 180•DAYS OF PERMIT ISSU.
FOUNDATION - - ANCE OR 180-DAYS FROM
UPER ' LAST CALLED INSPECTION.. '
PREGUNITE p- - PERMITVALID ATION,
-POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - QQ, �{� •�
UNDERGROUND /SLAB
/-O
" PLUMBING -
ELECTRICAL - e Is NCE DATE'
MECHANICAL BLDG, ECT. Pcc. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - , BUILDING PERMIT_
WOOD,FLOORINFORMATION
PLUMBING - : VALUATION iS/FT:
MECHANICAL -
ELECTRICAL .P RMIT TO
FRAMING - 'i / �• /�J. { '.
INSULATION' - STORIES TYPECONSTR.
OCC. ROUP' qES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • `` '
./ ROOF' ' - SO.FT.FLOOR AREA TOTAL ACREAGEI
DIAPHRAGM
BUILDING USE'
- .RES INU ICON ,PB . ow,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED „. Ele
• -
ASSESSORS PARCEL NO,
ROUGH
PLUMBING
GAS TEST � -;/_
TRACT NO. PARCEL NO.
'
. MECHANICAL �3-�(� - I
ACC.DATE ACC.FILE NO.
.. ELECTRICAL - "" FINALS DATE INSP. '
FRAMING SAN # -
ZONING ENG.SITE NO.'
INSULATION � PLUMBING � � ,
GAS
MECHANICAL FIRE SPRINK ENERGY T.}4
' . COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� "E:]
LATH—INTERIOR - '- ELECTRICAL - _ � FLOOD ZO NE A.L.U.C.
_
LATH—EXTERIOR FIRE DEPT. G Y Q ' NC) Yo .NC:] '
SHEETROCK GRADEFEESUMMARY
SHEAR INTERIOR - BUILDING G .
SHEAR EXTERIOR - - TEMPORARY APPROVALS BUIcoIrvG'
FIREWALLS- ELECTRIC PLAN CHECK
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv' ` - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY.BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505; EEECTRIC
a�' ONE WORKING DAY•BEFORE REQUIRED,INSPECTION. I
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
- SEE PERMIT FOR EXPIRATION DATE- MECHANICAL
` IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
. OFFICE COPY - -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
9U LOI NG PROJECT I DENTI FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 000
A E56
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OwNE 'B PLAN CHECK VALIDATION
Cot'ItFIr R_ANE CITY. ELECTRIC PERMIT FEE
' ONE
cAAMERACTORs UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.N LIGHTING FIXTURES 10.0011.00
nooRESS R� S PPLIANCES-RESIDENTIAL 4.00
PH PANELS 10.00 DATE OF APPLICATION
OR IT CT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE
ENGINEER
UC.No. SIGNS TRANS. 3.00
ARCH.ss ENG, PERMIT 5.00 PERMIT VALIDATION
zlv EMP.METER OR POLE INS. 20.00 1
APPLICANTS MOTORS SEE FEE SCH. n /til -_s',v'•-I"^J
ADDRESS
SERVICE CHANGE 20.00
omz
FOO LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 AID
c u I hereby affrpt that 1 and licensed under provisions of Chapter 9 I6 NCE DATE
< (commencing with Section 7000)of Division 3 of the Businessanti BLDG Plgl�. MECH.
F m z Profession and my.liccnse is in full T� Lf J-j
o i w o License Cla - Lic.Num T .
Uate Contrucl
4 y
X a wOWNER-BUILDER DECLARATION INFORMATION
wR.LL H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LL o J Law for the following reusnn.ISec.703 L5,Buviness end Professions VALUATION 5/FT.
- PERMIT ISSUANCE 10.00
Code:Any city or county which«quios a pemut to construct,aIle" n/1/J
2 Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 0gQ/�.�/.
O¢ requires the applicant for such pemlil to file a signed statement that TOTAL PER T TO
w$ he is licensed pursuant to Ilse provisions of the Contmet.',License
I z i Law(Chapter9(commencing with Section 7000)of Division 3 of the -
i o Blssiness and Professions Code)or that he is eeempt therefrom and CITY. PLUMBING PERMIT FEE
M r the basis for the alleged exemption.Any violation of Section 7031.5 STORIES IrYPE CONS-TR,
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(5500)):
❑ I,as owner of the property,or my employees with wages m BACK FLOW PROTECT. DEVICE .4.00
their sole compensation,will do the work,and the sl ruclure is not DCC.GROUP RES.UNITS
intended or offered for sale(Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractus 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 FT.FLOOR AREA TiALACREAGE
• himself or through his own employees.provided that such improve-
ments are not intended or offered for sale.If.however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, - . - .
the owner- GAS EASYSTEM OVER 4 IEA) 2.00
builder will have the burden of proving that he did not the
or inu BUILDING USE
RES IND CON B Orher
prove for purpose of the.p INDUSTRIAL WASTE INTER. 30.00
❑licensed es owner of the property,he outert(See,pntnct ing with ❑ ❑ ❑ ❑
adPro inions ors to construct the project(Sec. does Business LAWN SPRINKLERS-1 INC 6 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Codcproperty Contractor'sbildLicense Law does not apply
to tar owner of property who builds tr improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
conthe Cels for
or'sLprojects Lwith amntractolls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's LitfpY Law. TRACT NO. PARCEL NO.
❑ tum exempt under Sea ,B.&P.C.fur Ibis
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC,FILE NO.
WORK ERS'COMPENSA'f10N DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate ofeunsent to sel Ginsum, -or a certificate of Workers'Compensation Insurance,or a certificJ ZONING ENG.SITE NO.
Copy thereof(See.3800,LabI ��, '
Policy No. Compan
O ❑ Certified copy is hereby rnlshed.
z Z ❑ Cer if•d b city inspection division. FIRE SPRINK ENERGY T-Z4
I-- O ApphcantMaso- MISC.- REFER TO ORD.I it y❑ N❑ r ❑ N[3
w CERTIFICATE OI'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
O (This sect,6. need bol he completed if the permit is for one TOTAL Y El Y E] N❑
Z hundred dollar,(5100)or It..) -
U O I certify that in the performance of the work for which this per. CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL I- 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.
Date - Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING
>_ w NOTICE. TO APPLICANT: If,after making this Certiliculc of Iix-
F- Z emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code,you must forthwith Comply with FEE.
such provisions or this permit Shall he deemed revoked. - AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE ,
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work forwhichthis permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC P
I certify that l have read this.,plication and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct I agree to comply with all city and county PLUMBING
ordi ccs and it laws relating to building construction, and BOILER-CONP(3 H.P.or 100,000 B.T.U.) 6.00
a. ,
representatives of this city toenter upon the BOILER-COMP (Owe tIX),ODO BTU(SEE FEE SCH. MECHANICAL
property for rasped ion purpoxs.•
save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
liabilities,judgments, costs and expenses which CONST.TAX
ace ainst said City in consequence of the PERMIT ISSUANCE 10.00
m . - MECH.CONT. LIC.NO. MECH.
TOTALTOTAL
lica Contractor Dale
OFFICE COPY