11919 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 11919
INSPECTION DIVISION
JOB INSPECTION RECORD
^^ /J� � PERMIT EXPIRATION
JOB ADDRESS— /s_=v/ ,/(A �( UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OFPERMITISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
LAST CALLED INSPECTION.
PREGUNITE - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB ,
PLUMBING
ELECTRICAL ISSUANCE DATE V.
MECHANICAL BLDG. ELECT: PLG MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR INFORMATION
VAWATION
PLUMBING $/FT.
MECHANICAL '
ELECTRICAL PERMIT TO
FRAMING
INSULATION STORIES `TYPE CONSTR,
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF 50.FT.FLOOR AREA TOTAL ACREAGE
kGAS
HRAGM -
BUILDING USE
RES IND CON PB OFnr,
PLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ❑ ❑ ❑ ❑ ❑
ROUGH ASSESSORS PAR CEL NO,
MBING
TEST TRACT NO. PARCEL NO.
MECHANICAL -
ELECTRICAL J -?�- ALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING .,,Z. 6 SAN '
INSULATION PLU BIN zONINc ENG.SITE No.
GA
ME HANICA FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HE TIN Y ❑ N❑ Y ❑ NO
LATH-INTERIOR ELECTRICAL 12 .}. FLOOD ZONE A.CU.C.
LATH-EXTERIOR - FIRE DEPT. Y❑ N❑ 1 'N❑
SHEETROCK IGRADE
FEE SUMMARY
SHEAR INTERIOR
BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS FP BUILDING : .;,,,'•„
FIREWALLS ELECTRIC PLAN CHECK
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 BV BUILDING INSPECTOR.
MICROFILM.
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED-INSPECTION.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL is
CALLING FOR FINAL INSPECTION.
OFFICE COPY '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
• ADDRESS rr _/
'.'✓ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 11919
OwNER'S PLAN CHECK VALIDATION
NAME 43DC[sC V 7-4-1\1QTY. ELECTRIC PERMIT FEE
PHONE
CONTRACTOR'S
NA - J UTLEIS-SWITCHES-RECEP 10.00/1.00
UC.ND.3XC®/y3 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR PPLIANCES-RESIDENTIAL 4.00
ADDRESS J
OPHONE✓` -3 -0 PANELS 10.00 DATE OF APPLICATION
RRCHITECi PANELS(OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
IC,NC,. SIGNS TRANS. 3.00
ARCH.OR ENG. n• PERMIT VALIDATION
A& '` SPECIAL CIRCUIT 5.00 -
L "P/q 784- TEMP.METER OR POLE INS. 20.00
ASMOTORS SEE FEE SCH. , -1
ADDREDDRESSS l �
,la 1.
SERVICE \-
CHANGE 20.00 •" L/
X D LICENSED CONTRACTORS DECLARATION r r •/r% T�
a U I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
as Q w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H G 11 fLice.v J= d my license is in full ford and e 'ec ❑ ❑ ❑ ❑
z z I License las Lic.Nwnber
o W IJa[e CIF ontractor
IF a, E J
0 w a OWNER-BUILDER DECLARATION BUILDING PERMIT
MISC.- REFER TO ORD INFORMATION
u, °' H 10.00 I hereby affirm that I am exempt from the Contractor's License VALUATION
F u_0s Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE S/FT.
f Code:Any city or county which requires a permit to construct,alter,
i ��
2 2 O O mprove,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH, - LIC.NO. ELEC.
u requires the applicant for such permit to file a signed statement that TOTAL
A so m he is licensed pursuant to the provisions of the Contractor's License PERMIT T
Hi
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Q �Ni OrQ
i D Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ H0 the basis for the alleged exemption.Any violation ofSection 7031.5 STORIES TYPE CONSTR.
i 5_:F by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars($500).) ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole comtpensation,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
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended oroffered for Sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or hnpolvenrent is sold within one year of completion,the owner- GAS EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that h -e did not build or im- BUILDING USE
Prove for Purpose ofsele.). RES IND CON PB OtM1er
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 El El El ❑ F-1licensed 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 docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts far such projects with a contractods)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL No.
❑ I am exempt under Sec. ,B.&P.C.for his
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure,
\, or a Certificate of Worker.Compensation Insurance,or a certified ZONING ENG.SITE N0,
X Copy thereof(Sec.3800,Lab.CJ.
TA TCS . �J
I'oNo. Company L�� /•r
0
Q Certified p IS hereby furnished.7 FIRE SPRINK ENERGY T24
Z Z ❑ CertiOel y s filed nyp�inspection division.
F O Applicant°TT IC MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
Ir N CERTIIICA OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CIL 0 This section need not be Completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
::) Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F 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.
1 Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING is S�
} m DateNOTICE TO APPLICANT': If,after making this Certificate of Cx-
F Z emplion,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=CF.M.) 4,00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10.00DC.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 thew rk f w ch I permit i issued(Sec. MICROFILM
3097,Civ.C.). . �j��'Q HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name ,V !t:K
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
® I certify that 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 PLUMBING
ordinances and stale laws relating to building construction, and BOILER-COMP(3 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.
above-mentioned property for inspection purposes. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino oludirst liabilities,judgments, costs and expenses whichCONST.TAX
may in way see a,against sal City in consequence of the PERMIT ISSUANCE 10.00
gmnli this permit. - MECH.CONT. LIC.NO. MECH.
//� TOTAL TOTAL 7 �J
Si alum n pelican Contractor Uo4 `-
OFFICE COPY