C 8482 (2) POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PER",IrQNDh'BER.
INSPECTION DIVISION ' (f x;482
JOB INSPECTION RECORD
Di PERMIT EXPIRATION
.J08 ADDRESS E G (J�C.i UNIT# _L•OT# '
.. / PERMIT EXPIRES IF WORK
OWNER 1V CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER . LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING f
ELECTRICAL '
ISSU CE DATE
MECHANICAL - BLDG.- ELECT, I PLG. MECH.:
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING P RMIT
WOOD FLOOR INFORMATION
PLUMBING - , r VALUATION $IFT,
MECHANICAL'
ELECTRICAL - - PEHMrtT
FRAMING i
INSULATION
STORIES '—TYPE CONS T
O C. ROU RES UNN�LjIS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.. ...�-,
ROOF SD.FT FL• F
DIAPHRAGM
BUILDING USE
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED RES IND CON PB Other
i 0 E ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL r-7-y FINALS DATE INSP. .ACC.DATE ACC.FILE No.
FRAMING SAN #
INSULATION - - PLUMBING
ZONING ENG.SITE NO. '
GAS _
MECHANICAL FIRE SPRINK ENERGY TZE
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ ry❑ y N�
LATH—INTERIORELECTRICAL _ _ FLooD zoNe A.L.u,c.
LATH—EXTERIOR. FIRE DEPT.
SHEETROCK _ GRADE
SHEAR INTERIOR FEE SUMMARY
BUILDING ..� _�
SHEAR EXTERIOR TEMPORARY APPROVALS " BUILDING. ./ e'�.
FIREWALLS ELECTRIC. PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
rH� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
- z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAC
IMPORTANT! -CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL / J -
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION ERMIT NUMBER
BDILDING APPLICATION & PERMIT ^
Put IN
G
O BUILDING
-ELECTRICAL-PLUMBING-MECHANICAL
Ow NE 'a N CHECK VALIDATION
NAME p 25 Z- OTy- ELECTRIC PERMIT FEE
i� 1flit,
�[ CNA.E 3V ONTRACTORSOUTLETS-SWITCHES-RECEP ,�jl6pT{,00
V uc.ND.-'-� 0 LIGHTING FIXTURES 1AM11.00
AOaTRAT
DDRESST % �1r APPLIANCES-RESIDENTIAL 4.00 /
XPHONE�� �C� • PANELS 10.GO DATE OF APPLICATION
ARCRRECT > PLAN CHECK FEE P.C.NO.
on _�✓\rtoJL PANELS (OVER 200 AMP) 20.00
ENGINEER
RLIC,NO. SIGNS TRANS. 3.00
ADDDDRESSSS SPECIAL CIRCUIT 500
A . ENG. . / PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S /J
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
w�
R o O LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
Q U w �I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE
w a'w (commencing with Section 7000)of Division 3 of the Business and D S PLG
R w z Professions Code,' d my license is in full f o
z o m- License C11yy}}s_ Lia Number
8 w t- w Dale ///q� - Contractoru
`DOWNER-BUILDER DECLARATION BU DING PERMI
a, ; D INFORMATION
a-y I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
F .. 0 4 Law for the following reason(Sec.7031.5.Business and Professions VALUATION S/FT.
Code:An cit orcount PERMIT ISSUANCE
� w 4� y y y it my structureg prior permit alter, 7000
W E 4 D requires,demolish,or for such
any permit
tore,pa signed
lO its issuance,talsohat ELEC.CONTR. LIC.NO.
0 LL requires the dp pursuant
for such permit to Ids a signed Statement that TOTAL 5�
o. w m m he is licensed pursuant to the provisions of the Contractor's License .J PER T TO
r z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
1 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
Ic r$ the basis for the alleged exemption.Any violation Of Section 7031.5 STORIES TYPE C NSTR.
by any applicant for ve permit subjects theagplicanuoacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 �UGv
of not more than five hundred Dollars(my em): l �
❑ I,as owner at the property,or my employees with wages as BACK FLOW PROTECT. DEV ICE 4.00
their sole compensation,will(S the work,and the nd Professions
is not DpO,D�p ."C i TS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ��V✓6/L -1V91�1G]"/.
Code:The Contractor's License Law does not apply to an owner of
Property who builds or improves thereon,and who dons such work FIXTURES-PER TRAPhimse5.00
• mentsII're through did own employees.safe.
If,however,that t h improve.
he ilding SQ FT.F OOR AREA TOTAL ACRE'GE
or imprvement hmdnd withinrone yearn l compltion ttheo nen- GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose of sale J' INDUSTRIAL WASTE INTER. 30.00 RE IND CON PS Omef
❑ 1,as owner of the properly,am exclusively contracting with E] C3 El ❑
licensed contractors to construct the project ISec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 600
and Professions Code:The Contractor's License Law does col apply . ASSESSORS PARCEL NO.
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contraalous)licensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO.
❑ [am exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Uum WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORT ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate of consent to self-nsurc,
or a certificate of Workers Compensation Insurance,or a ce ified ZONING
copy Iher�J l$ 33A!�(y]f11��1,36.Y.1. _ 1 ENG.SITE NO.
Policy er �.:aE1U11 U 1'_`s�Z.Tn4T`
O Certified copy is hereby lurnlshed.
Z 2 ❑ Certifi d 'opy is file will the city in,, division. FIRE SPRINK ENERGY T-24
O Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
PERMIT ISSUANCE
CLQLU Cli IICAMPENEAIVDN INS PROM WORKGR$' 1 FLOOD ZONE A.L.UC.
COMPotbe om INSURANCE PLG.LONTR. uC.No. PLG.
::I
/ fThhundred
dolseclies need not he completed if the permit is for one TOTAL Y❑ N❑ Y❑ N
'hundred dollars(5100)or less) ❑
C.7 P
I certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE SUMMARY
LLmil is i Sued, shall not employ any person in ap y manner so as to FEEObeo1 Workcrs'Com et sal ion a ofCal fore'.- �ApPlicam ALTER OR ADD TO MECH. BUILDING
ZNOT , 'f APP (CANT: If,a er m mg thls erhl'inte u ix- 5.00
emption,you should become subject to the Workers'Compensation APPLIANCE
provisions of the Labor Code. You roust forthwith comply with 5.00 PLAN CHECK
U such provisions or,this permit shall be deemed revoked AIR HANDLING UNIT(TO 10,000C.F.M.) 4,00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MCF.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 F
the performance of the work for which this permit is issued(Sec.
3097,Civ C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lenders Address - H EATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that I love read this application and state that the above VENTILATION FAN (SINGLE) 4.00
• information n correct. I agree to comply with all oily and County PLUMBING
herindeby ces
and state 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
above-mentioned property for inspection purposes. BOILER-COMP G,,al 100,000BTU)S E
mE 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
may in any way accrue against said City in consequence of the PERMIT ISSUANCE CONST.TAX
g ting lhis per ` MECH.CONT. LIC.NO. MECH.
+
TOTA
Sgnat al ppluan nlractor TOTAL /y J �
IOFFICE COPY (l