12861 POST THIS CARD NEAR FRONT OF BUILDING
PFRNPT NUMBER
CITY OF CUPERTINO Q
INSPECTION DIVISION 12,861
- 140B INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS _ NIT# LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR I PEC I N RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
UFER • 1 - LAST CALLED INSPECTION.
PREGUNITE PERMIT VAUDATION�.
r I
POUR NO CONCRETE UNTIL.ABOVE HAS BEEN SIGNED !L r"
UNDERGROUND /SLAB e 7 1 "
PLUMBING -
ELECTRICAL ISSUANCE DATE
MECHANICAL B Dr, ELECT. PLc. mECR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING -
MECHANICAL -
ELECTRICAL
FRAMING
INSULATION STORI TYPE CONSTR.
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR•UNTIL ABOVE HAS BEEN SIGNED
E'/• - 5[),Fi,Fl00(1 AilEA TOTfiL FCFEF4L
ROOF
DIAPHRAGM
t / I LORING USE
RES INU CON PB Otnel
l El El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El ❑
;)-
ASSESSORS PARCEL NO.
F ROUGH Y-f6-4s7 �� -F{t'aV�.
PLUMBING
GAS TEST r r TRACT NO, PARCEL NO.
MECHANICAL _7,2
ACC.DATE ACC-FILE NO.
ELECTRICAL FINALS -, DATE INSP.
FRAMING VS eV„ ?
SAN zorvlNc ENG.SITE No.
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY T2E
MECHANICAL r N� v N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L,U c.
LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Y,o N
SHEETROCK GRADE FEE SUMMARYI
SHEAR INTERIOR BUILDING j,2,97
SHEAR EXTERIOR - TEMPORARY APPROVALS BUILDING .�
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
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 IDENTI KATION PERMIT NUMBER
aNILNING _ APPLICATION & PERMIT
A 505
V BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 12861
NER'S PLAN CHECK VALIDATION
k2TY. ELECTRIC PERMIT FEE
6 PHONE �,/ J
CONTRACTORS
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
N
LIC.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
AONTR , APPLIANCES-RESIDENTIAL 4.00
C
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO,
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT S.QQ PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00 9
APPLICANT'S MOTORS SEE FEE SCH. /Q'dzV
ADDRESS
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION lip f
¢ u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUAN E
(commrncing with Section 7000)of Division 3 of the Business and SLOG. E MECH.
FN i Professions Code,and my license is in full farce and effect E � ❑
z o - License Class _ Lie.Number u
q m w Dale Contractor
CU
¢ S, rc ¢ OWNER-BUILDER DECLARATION 1 ERMIT
iL 06LI MISC.- REFER TO ORD FORMATION
wI- 1 hereby affirm that I am exempt from the Contractor's License
eL 0 m VALUATION , $/FT.
r ,. o¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
ve Code'.Any city or county which requiresit permit to construCL aheq
¢ an Q improve,demolish,or repair any structure,prior t0 its Issuance,also ELEC.CONTR. LIC.NO. ELEC.
- u requires the applicant for such permit to file a signed statement that TOTAL 7-�RMIT TO
ais he is licensed pursuant to the provisions of the Contractor's License R001-
Low(Chapter 9(commencing with Section 7000)of Division 3 of the
i ¢o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE SA-t,
¢r o the basis for the alleged exemption.Any violation of Section 7031.5 STORI TYPE CONSTR.
by any applicant for.permit subjecathe applicant toacivilpenalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 '
of not mom than five hundred dollars(8500).1'.
❑ 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 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 or
r, M1 property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE
` himself or through his own employees,provided that such improve-
��, ;y" 'mems are not intended or offered for sale.if,however,the building GAS-EA.SYSTEM-I INC.40UTLETS 6.00
„! or improvement 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 he did not build or int- BUILDING USE
pr for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 REs IND CON Pe ornar
IAx I,as owner of the properly,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,unit who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsuch projects with a contractors)licensed pursuant to
SEWER-SANITARY-STORM EA.200ft/10.00
the Co hador s License Luw TRACT NO. PARCEL NO.
❑ e xe l unite S c B.&BC for' S WATER HEATER W/VENT 6.00
naso _
Owne DmL WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSAT'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm Our I have a certificate of consent to self-insure,
or a certificate of Workers'Compmuul ion laeaoarCe.or a certified i ZONING ENG.SITE NO.
copy themot'(Sec.3800,Lab.C.), r
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. MISC.- REFER TO ORD.
O Applicant Y❑ N❑ Y ❑ N❑
~ w+ PERMIT ISSUANCE 10.00
LU - CIiRTI1e1CCOMPE EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O This Rection need not be completed if the permit Is for one TOTAL Y❑ N❑ Y ❑ N❑
7) Zhundred dollarsO 100)or less.)
U O I certify that in the performance of the work for which tsohis per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- nett is issued.I shall not unploy any person in any manner as to
Ow become subject it)[lie Workers Compensation Laws of California.
y Dam ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after making Ibis Certificate of Ex-
Z coalition,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 ITO 101000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0AOOGEM.) 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.CJ. - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nome
Lender's AddreHEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
ss
a I certify that l have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or 100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 1D0,000BTU)SEE FEE SCH. MECHANICAL
bove-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Misc.- REFER TO ORD.
C( ertino against fillialitics.judt gmend Cts, costs and expenses which' PERMIT ISSUANCE - 10.001CONST.TAX'
Ga in any way a cr againssaiity in con equen a of the
an i of this per 'L MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
PP an/Cool r - ate 1, 1 . I - I I
OFFICE COPY