11952 POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO RM1IITNDN,BER
� • A 11952
r. INSPECTION DIVISION
^�F JOB INSPECTION RECORD
PERMIT EXPIRATION
2 i
JOB ADDRESS� a � a NIT# LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPEC ION DATE INSPECTOR NSPE TION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER - LAST CALLED INSPECTION.
PREGUNITE PERMIT vnuonnoN
I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING r
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLG- MECH.
.❑ 01 ❑ ❑I
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOO RVALUATION S/FT.
PLUMBING
MECHANICAL
PERMIT TO
" ELECTRICAL .� l C_•,. �
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
T PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
. - ROOF SQ FL FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
HUIL USE
CON
' RES IND CON PB Olner
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
TRACT NO. PARCEL NO,
GAS TEST
MECHANICAL '
ACC.DATE ACG FILE NO.
.. ELECTRICAL - 'o FINALS DATE INSP.
FRAMING _ SAN * - ZONING - -ENG.SITE-N o.
INSULATION PLUMBING
GAS
FIRE SPRINK
MECHANICAL ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑. N❑ ❑ N❑
LATH—INTERIOR ELECTRICAL FL000 zorvE A.L.0 c.
LATH—EXTERIOR FIRE DEPT. Y❑ No Y ❑ N❑
SHEETROCK GRADE ' FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING.
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE ,
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
1
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
• F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE'
CONST,TAX
IMPORTANT! /
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY ,
APPfICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
UI LDING PROJECT IDENTIFICATION PERMIT NUMBER
avuAnnc APPLICATION & PERMIT 11952
) ,� ADORES. as Co2rE MAD A BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
• ANER'S - PLAN CHECK VALIDATION
NAME
E QTY. ELECTRIC PERMIT FEE
u z�} �F U'Er��►�E 6-93'4
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00NAME
d
LIC.No, LIGHTING FIXTURES 10.00/1.00
ADORESS DDP's APPLIANCES-RESIDENTIAL 4,00
Ess
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
uc,no. SIGNS TRANS. 3.00
ARCH.
.OR RS ENc' SPECIALCIRCUIT S.QQ FERMI ION
AR
ZIP EMP.METER OR POL _ 20.00 18C�
ADDRESS MOTORS SE F �SCH. ` �Ju �)
ADDRESS 7�.
SERVICE CHANG 20.00 Tt*
no
�
'09 LICENSED CONTRACTORS DECLARATION
a u w I hereby affirm that 1 am licensed under provisions of Chapter 9 ow ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. I MECH.
iProfessions Code,and my license is in full force and effect. El 10
2 = License Class Lic.Number
Q 0 z L w Date Contractor
P y f BUILDING PERMIT
¢ ¢ OWNER-BUILDER DECLARATION INFORMATION
¢ o it D MISC.- REFER TO ORD
X ;LL I- I hereby affirm That 1 am exempt from the Contractor's License
wO¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 (� VALUATION S/FT.
Code:Any city or county which requires permit to construct,alter, �- 941&0,on]
rt ¢¢ Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
ww 9 he is licensed pursuant to the provisions of the Contractor's License ^sr�
Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe /NT rA� /l +ivoiY .
Y o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE"
¢ I- the basis for the alleged exemption.Any violation of5eclion 7031.5 STORIES TYPE CONSTR.
u ; by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars(5500.): - ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP PES.UNITS
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
• property 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-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING TSE
builder will have the burden of proving that he did not build or im- RES IND CON PB Olney
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed 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 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 contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA,200ft/10.00 TRACT NO. PARCEL NO.
the Cont
slam exempt under Sec. B.&P.C.for this WATER HEATER W/VENT 6.00
nesoun-
Owner GG NNt' 1 [}1(p,gate WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hercby,affnm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z'2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. y C] N❑ v C] No
Fw O Applicant PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
LLICC - CERTIFICATEOF EXEMPTION FROM WORKERS'
>_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
Z) Z hundred dollars 1$100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued,I shall not employ any person in any manner so as to
U subject to the Workeri Com enation Laws of California.
Obecome sub1
w Date Applicant p BUILDING �SG�
n ALTER OR ADD TO MECH. 5.00 �.
NOTICE TO APPLICANT: If,after making this Certificate of Ex-
H ? 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
(J such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE t S�
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.CJHEATING UNIT(TO 100,000 B.T.U.) 8.00.
Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
. 1 certify 11,811 have read this application and slate that the above VENTILATION FAN (SINGLE) 4,00
information is correct.I agree to comply with all city and coonly PLUMBING
Ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorite representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. 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.TA
may ny way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
gr g ft ' omit. MECH.CONT. LIC.NO. MECH.
- ^-I - TOTAL TOTAL
Signature of PP i nt/Conlr czar Dale
OFFICE COPY