09663 l� POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINOPERMITNUMREH
09663
INSPECTION DIVISION
JOB INSP CTION RECORD
• PERMIT EXPIRATION
- _-� JOE.ADDRESS Iax1J} T# L # PERMIT EXPIRES IF WORK
OWNCI CONTRACTOR ( IS NOT STARTED WITHIN
INSPECTI N DATE INSPECTOR INSPE TIO RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER LAST CALLED INSPECTION.
PERMIT VALIDATION
- PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - ISSUANCE DATE
RLL, . ELECT. PLG. MF"CH,
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING r
MECHANICAL
PER o
ELECTRICAL
i 1
FRAMING
STORIES 'TYPE CONSTR.
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$O.FT.FLOOR AREATOTAL ACREAGE
ROOF
DIAPHRAGM
BUILDIN .USE
HES INDEl El El 1:1
C � YB Oln.r
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
AESEbST,BARGEE NO.
ROUGH
PLUMBING
TRACT NO. PARCELNO.
GAS TEST
MECHANICAL
ACC.DATE ACC FILE NO,
ELECTRICAL FINALS DATE INSP.
FRAMING SAN #
' ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY T"2E
MECHANICAL Yo NE] Yo NE]COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLo zo NE 4
v�
LATH-INTERIOR ELECTRICAL ] L.u.c.
N
LATH-EXTERIOR FIRE DEPT. N� vl] ❑ I
SHEETROCK GRADE FEE SUMMARY I
SHEAR INTERIOR BUILDING BUILDING 1
SHEAR EXTERIOR TEMPORARY APPROVALS 11.
FIREWALLS ELECTRIC PLAN CHECK I
F
GAS EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING 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
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- 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
SOL APPLICATION & PERMIT 09663
A C
h Q BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
O rvER'S AN CHECK VALIDATION
X NPM QTY. ELECTRIC PERMIT FEE
ONE
�•� oNTRAcroRs
AME OUTLETS-SWITCHES-RECEP 10.00/1.00
N 11
�p to-4.No. LIGHTING FIXTURES 10.00/1.00
.� / ADDRESsroRs �f�-QQ�I�Ta APPLIANCES-RESIDENTIAL 4.00
✓X` p PHONE ? it"I PANELS 10.00 DATE OF APPLICATION
ARCH.TETPLAN CHECK FEE P.C.NO.
0rR+GINEER �' • kl�� Rom v e PANELS (OVER 200 AMP) 20.00
LIC,No. SIGNS TRANS. 3.00
ARCH,OR ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
1, r"J'l .✓D -205)U76S z I P TEMP.METER OR POLE INS. 20.00
APPLICANT MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
X o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30,00
rt u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
w 4 ai v (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
w_N z Professions Code,and my license is in full force and effect. E: ❑ El
z o m - License Clam-Lic.Number
-
0 z H w Ua[c Contractor
a y s BUILDING PERMIT
¢ ¢¢ OWNER-BUILDER DECLARATION INFORMATION
oAU - MISC.- REFER TO ORD
3 H 1 hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
¢ o¢ Law for the following reason. 703L5.Business Professions PERMIT ISSUANCE 10.00
� y0-a' Code:Any city or county which requiresapermil loconsirucLalteC
ce a,> Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. DOS,
- CLL requires the applicant for such permit to file a signed statement that TOTAL P TO.
A w m w he is licensed pursuenl to the provisions of the Contractor's License
Fz>
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ f p the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
5-; by by any applicant for a permit subjects the applicant toa Civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(S500)J:
❑ I,as owner of the property,or nay employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the sl.acture is not OCC.GROUP RES.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
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself re of rote his own employees,provided that such improve-
1 ,hmon are through
his or n enipld for sale.provided
thathowevs the building GAS
or
SYSTEM-I INC.4 OUTLETS 6.00
ur improvement is sold within one year of completion,the ownnr- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
/ builder will have the burden of proving that he did not build or m- GAS
INO N PB Omar
prove for purpose of sole.)' INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct the project(See 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSOR RCEL 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 u contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ tum exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby ull'irm that I have a ccrtificme of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.G).
Policy Is Company
O ❑ CCrtille copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z
Z cr"e5 .y is f it the city inspection division. MISC.- REFER TO ORD.
F Applii. Y❑ N❑ Y ❑ N❑
K - _„ A TIFICA'I'HOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
DJ >_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
(This Section need not be completed if the permit is for one TOTAL Y❑ IN E] I Y❑ N❑
D Z hundred dollars($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 mit is issued. I shall not employ any person in any manner so as to
U becmne subject to the Workers'Compensation Laws of California.
0w Date Applicant BUILDING
u ALTER OR ADD TO MECH. 5.00
} W emptioNOTICE TO,Ayou should
become
: If,after making this Certificate sa Ex__
F ? em vision you should become subject to the Workers Compensation APPLIANCE 6.00 PLAN CHECK
provisions io the Labor Code, you mull d forthwith comply with FEE
V such provisions or this permit shall be dremed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PWC.F.M.) 6.00 SEISMIC FEE 'r
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 HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Cie.CJ.
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and slam that the above VENTILATION FAN (SINGLE) 4.00
,info....ation is correct. I agree to Comply with all city and county PLUMBING
..chances and state laws relating to building construction, and BOILER-ODMP(3 H.P.or 100,000 B.T.U.) 6.00
ereby anchorite representatives of this city Io enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection parpows.
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST:TAX
may in any way accrue against said City in consequence of the
plan lingulf tI cSPCO i MECH.CONT. LIC.NO. MECH.
_8 j - TOTAL TOTAL
Si atumApplic.aDContrxclo Date
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OFFICE COPY