8837 (2) POST THIS CARD NEAR FRONT OF BUILDING
PFRMIM NUMBER
CITY OF CUPERTINO5�7
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
• JOB ADDRESS v✓ �`^� U # LOT#
PERMIT EXPIRES IF WORK
OWNER - CONTRACTOR F IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPItCTION RECORD 180 DAYS OF PERMIT ISSU-
'FOUNDATION - ANCE OR 180 DAYS FROM
LIFER
•I - LASTCALLED INSPECTION.
PREGUNITE
PERMIT VALIDATION
� ,
i
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND SLAB
/ /
- PLUMBING
ELECTRICAL . r IssunNCE Dnre
MECHANICAL - 80G. ELECT. PLG. MECH:
. . r D El.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR I INFORMATION
. PLUMBING - VALUATION $/FT.
MECHANICAL
ELECTRICAL - we rtro
FRAMING f I
INSULATION �-
ST RI S - TYPE C S R.
d
OCC.(ROUP 1 RES.D RS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF . �E r SO.FT.FLOOR AREA TOTAL ACREAGE `
DIAPHRAGM BUILDING'USE
RES IND CON PB • 0"I,'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED VI ❑ ❑ ❑ ❑
ROUGH - - 7,11 A SSESSORS P ARCEL NO.
PLUMBING �«
GAS TEST • TRACT NO. PARCEL NO.
MECHANICAL
"ACC.DATE ACC�FILE'NO.
ELECTRICAL � � FINALS � DATE INSP. _
FRAMING SAN # '
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY T 24
" - MEC ICAL, Q N ❑ v ❑ NEI .
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED H ATI
LATH—INTERIOR
LECTRIC - FLOOD ZONE A.L.u.C.
LATH—EXTERIOR FIRE EPT. Y❑ N❑ •v ❑ N❑
SHEETROCK - - GRADE - FEE SUMMARY
SHEAR INTERIOR - BUILDINGS-( 3V I '
SHEAR ExTERIORTEMPORARY APPROVALS
NJ
BUILDING' .•-� ���
FIREWALLS - ELECTRIC PLAN CHECK !
GAS. - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS.BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING,252-4505; ELECTRIC '
16- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
-,SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
` IMPORTANT! CONST.TAX M1
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY ' `
APPLICANT TO FILL IN INFORMATION WITHIN RED LIES - USE BALL POINT PEN ONLY
PERMIT NUMBER
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT
°°"°�° 8837
DDRESS
F BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OINNER'5 PLAN CHECK VALIDATION
NAME DTV. ELECTRIC PERMIT a •' FEE
• .�.1 DNE D4G 3533
CONTRACTOR'S
NAME OUTLETS-SWITCHES-RECEP 10.00/7.00
LIC.NO, LIGHTING FIXTURES 10.00/1.00
ADDRESS
TORS APPLIANCES-RESIDENTIAL 4.00 -
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.L.NO.
ENGINEER
LIC.NO, SIGNS TRANS. 3.00
ARCH OR A DORESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT'$ V��ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
a u w I hereby affirm that I am licensed under provisions of Chapter 9
a (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
wi Professions Code,and my license is in full force and effect. BLD . ELECT. PL❑G. MECH.
Z2
o m - License Class Lic.Number
9 r Date CRntractor
Y E J
iL R w a
OWNER-BUILUCR DECLARATION BUILDING PERMIT ?,
iL °' " MISC.- REFER TO ORD INFORMATION
X ; w I hereby affirm that I am exempt from the Contractor's License
u o a Law for the followingreason.(Sec,7031.5,Business and Professions VAL AT ON - $/FT.
H - PERMIT ISSUANCE 70.00 /
Code:Any city or county which Structure permit construct,alter.
issuance.also
ir¢FO improve,demolish,or repair any shuctur<,prior l0 its issuance.also ELEC.CONTR. LIC.NO. ELEC.
K
en requires the applicant for such permit to file a signed statement that TOTAL
a. w m u he is licensed pursuant to the provisions of the Contractors License PERMITTO
Hit
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
4 o Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT -FE
H $ the basis for the alleged axanption.Any violation of Section 7031.5 STOPIES E CONS
d ; by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.BACK FLOW PROTECT. DEVICE 00 I 1,L
OCC.GROUP AES.uNS
of not more than five hundred dollars(55000.):
❑' 1,as owner of the property,or my employees with wages as 4.00
- their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sul:. 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 SO.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided that such improve-
mmselfonot hroughintended oroffered oyee sale.lf,ed that such
building GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
hail he burden Of proving that he did not build or int BUILDING USE
pr efor purpose sale.). INDUSTRIAL WASTE INTER. 30.00 E IND CON PB, stout
❑ I,as owner of c property,um exclusively contracting with
*Pcvn.cd.coRtraq.=.ntrac'Or' t const lvcl the project(Sec. ones,I{us RussLAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSOR$PARCEL NO.
OnI or'sLicense Law docsnot applyo aper In Riles or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
s ch cis it a ' nuactots)licensed pursuant to
ois w. SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO.
so Se . 11.&PforthisWATER HEATER W/VENT 6.00
Ik deWATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
RK: 'C 1 PENSAT10N DECLARATION WATER TREATING EQUIP. 5.00 ,
I hereby affirm that I have a certificate of consent to sell'-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec,3800.Lab.C.).
Policy No. Company
Q O Certified copy is hereby furnished. FRE$PRINK ENERGY T-24
Z Z CII
Certified copy is filed with the city inspection division. N� v N4
Applicant MISC.- REFER TO ORD.
p: 'A PERMIT ISSUANCE 10.00
LU - CERTIFICATE ENEAEI EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
W �_ COMPENSATION INSURANCE: PLG.CONTR. LIC.N0. PLG.
1 O (This section need not he completed if the permit is for one TOTAL V IN YD NE]
:) Z hundred dollars 1$100)or less,)
U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE • FEE SUMMARY
W F mit is issued,I shall not enhploy any person In any nhanner so as to
O W become subject to the Workeri Compensation Laws of California.
Date Applicant BUILDING
}'tail NOTICE TO APPLICANT: If,after making this Certificate Of Ex- ALTER OR ADD TO MECH. 5.00
F Z emption,you should become subject to the Workers'Comnmiattion 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 10MC.F.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.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
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 state that the above VENTILATION FAN (SINGLE) 4.00
' info is correct. I agree to comply with all city and county - PLUMBING
mantes a state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
Shoveaulhori representatives of this city es enter upon the BOILER-COMP(Over 100,000RTU1 SEE FEE SCH. MECHANICAL
above m t forinsp ocRonfth purposes.
e) ag e t sa indeu nify and keep harmless the City of MISC.- REFER TO ORD.
Cu ertino a i t Iia lilies, d cots, costs and expenses which PERMIT ISSUANCE 10.001CONST.TAX
mer any. true u it said City in consequence of the
matings MECH.CONT. LIC.NO. MECH.
4 TOTAL TOTAL
Signature ofA 'cant/ ntructor
Dar e
OFFICE COPY