C8237 POST THIS CARD NEAR FRONT OF BUILDING, PER ,IT`DAIBER
CITY OF CUPERTINO I
INSPECTION DIVISION
JOB INSPECTION RECORD ,
PERMIT EXPIRATION
JOBADDRESS ( T'# LOT#
'---! - PERMIT EXPIRES IF WORK
OWNER - CONTRACTOR �. IS NOT-STARTED WITHIN,
INSPECTION DATE INSPECTOR INSPECTION REMR15 180 DAYS OF PERMIT ISSU=
FOUNDATION - - ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
LIFER - ,PERMIT VALIDATION
PREGUNITE "
POUR NO CONCRETEUNTILABOVE HAS BEEN SIGNED /
� 9F� •�.,
UNDERGROUND /SLAB �(JjI, /j/).t f\
PLUMBING
ELECTRICAL, - - ISSUANCE DATE.
MECHANICAL BLDG. ELECT. PLG. MECH.
V. ❑
El IT
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED • J' BUILDING PERMIT
WOOD FLOOR ; ° INFORMATION
VALUATION $/FT.•
PLUMBING
MECHANICAL
ELECTRICAL, 'U,vERMn�Ta
' n
FRAMING '
•,/STORIES T ECONSTR.
.' INSULATION � f"
• • _ UCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROOF
50.FT.FLOOR AREA TOTAL ACREAGE -
I s'
DIAPHRAGM +
BUILDING USE
! REST IND CON PB Olde+
""- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ` •f- W
_
"•ASSESSORS PARCEL NO.
ROUGH :
PLUMBING < �J
GAS TEST
TRACT NO, PARCEL NO.
' .. '
MECHANICAL
_ - ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS' DATE INSP.
FRAMING SAN #
ZONING ENG.SITE NO. +
INSULATION PLUMBING - r'
GAS
FIRE SPRINK ENERGY T]0
MECHANICAL
COVER NOWORKUNTIL ABOVE HA� BEEN SIGNED HEATING '" Y ❑ N❑_ [:] ;NAT.
Q -
LATH—INTERIOR
- ELECTRICAL u000 zorve A.L.0 c.
LATH—EXTERIOR FIRE DEPT. - Y N� w ❑' N❑
SHEETROCK GRADE FEESUMMARY
SHEAR INTERIOR BUILDING: '
BUILDING
SHEAR EXTERIOR - TEMPORARY APPROVALS
FIREWALLS ELECTRIC 7 PLAN CHECK
GAS FEE. . _ ..
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY, ', SEISMIC FEE
UCCUPANCYOFBUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM'
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC"
F, ONE WORKING DAY BEFORE REQUIRED INSPECTION.' PLUMBING
o�f ' PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - SEE PERMIT FOR EXPIRATION DATE — MECHANICAL'.
CONST.TAX' '
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL 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
BUILDINGaOORE55 -ELECTRICAL-PLUMBING-MECHANICA 8237
AN, e6
O.NE.'S PLAN CHECK VALIDATION
NAME 17 OTY. ELECTRIC PERMIT FEE
PHON152
COulbeeft, R
NA UTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
O ° PPLIANCES-RESIDENTIAL 4.00
ADDRESS /
°IJE PANELS 10.00 DATE OF APPLICATION
" " C PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.c.No.
Y
ENGINEER
LIC.NO, SIGNSTRANS. .3.00
ARCW OR ENG, SPECIAL CIRCUIT 5.00ADDRPERMIT VALIDATION
SS
ZIP TEMP. METER OR POLE INS. 20.00
APPLICANTS F
MOTORS SEE EE SCH.
ADDRESS
SERVICE CHANGE 20.00
Se i LICENSED CONTRACTORS UECLARATION TEMP.POLE 30.00
¢ U U I hereby affirm thin I ant licensed tinder provisions of Chapter 9 ISSUANCE GATE
w (commencing with Section 7000)of Division 3 of lite Business and BLDG. ELECT. PLG. MECH.
ri Professions Code anti any license hint full force and effect.
z D vi - License Class_ Lic.Numher
9 r o Ua to Commctor
¢ x cer55� - BUILDING PERMIT
¢ ¢ w a OWN[R-BUILDF.R DECLARATION
U INFORMATION
odMISC.- REFER TO ORD
w 3 LL m I hereby affirm that I am exempt from the Contract,,,',es,andPro License
ns VALUATION $/FT.
F u o j Law for the following reuun..(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code.Any city or county which requires a permit Fo construct•alter,
aa a 0 improve,demolish,or repair any structure,prior to its issuance.also ELEC.CONTR. LIC.NO. ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w m m he is licensed pursuant to the provisions of the Contractors License
re z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
i D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r e the basis for the alleged exemption.Any violation of Section 7031.5 6 0 IES Y BTR,
i3E' by'any applicant(or a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5,00
of not more than five hundred dollars(S500).):
❑ 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,AR EA,COND. 5.00
Code The Contractor's License Law does not apply to!if,owner of
property who builds or improves Fiction,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTALACREAGE
• mentslare of ugh intended
ow..emred for Sale.if.ed however,tire
improve- GAS-EA.SYSTEM-1 6.00
mints are not intended or offered for sale.If.however the building
or improvement is sold within one year of completion,Ri owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
proveof will have the burden of proving that he did mol build or im- R IND CON PB Other
prove for purpose of sale.I. INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑
❑ L as owner of thu property,ant exclusively. 7044, ing with
licensed contractors Cod to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to t owner of property who builds toimproves Thereon and who LAWN SPRINKLERS-OV OVER 5(EA.) 1.00
co tracts fur such projects with a contralor(s)licensed pursuant to
th Co rector's License Law. SEWER-SANITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
am exempt under.I ,B.&P.C.for this WATER HEATER W/VENT 6.00
r, m
Owner D.Ic WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'CONIPF.NSA ON DECLARATR WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure. ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lub.CJ.
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is Filed with the city inspection division.
0 Applicant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
�J
CC to CER"IT FICA FE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LLI > COPFNSATION INSURANCE PLG.CONTH. LIC.NO. PLG.
a O 1"(bis section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
Z:) Z hundred dollars(SI00)or IcssJ
U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is issued.I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
0 y Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING S�
} W NO'T'ICE '1'O APPLICANT: If,after....king this Certificate of Ex-
t ? emption,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 1g000OF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 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 for which this permit is issued(Sec. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UNIT(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
in I'onamion is correct. I agree no conoply with all city and county PLUMBING
-COMP(3 H.P.or 100000 B.T.U) 6.
ordinances and slate laws relating to building construction, and BOILER , 00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL
- above-mentioned property for inspection purposes.
(We) agree to save• indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue age' st said City in consequence of the PERMIT ISSUANCE 10.00
gran' mfttls per it. MECH.CONT. LIC.NO. MECH.
/ TOTAL TOTAL
S u A n me U
INSPECTOR COPY