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10010 �STCITTOFECUPERTXAR FRONT ING PERMIT NUNIOER INSPECTION DIVISION JOB INSPECTION RECORD �h�� Hyl PERMIT EXPIRATION JOB ADDRESS (/ u` UNITLOT# r PERMIT EXPIRES IF WORK OWNERcoNiRACTDR - IS NOT STARTED WITHIN IN ECTION I DATE INSPECTOR NSPECTION IRECORD 180 DAYS OF PERMIT ISSU- " FOUNDATION _ b - ANCE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PREGUNITE - PERMIT VALIDATION a. S T POUR NO CONCRETE UNTIL ABOVE HAS BE SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL - ISSUANC ATE MECHANICAL - BLDa ELECT PLG. MECH.. EV DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERM! WOOD FLOOR INFORMATION VALUATION S/F ' .. PLUMBING �� 9 MECHANICAL , 6 �• - ELECTRICAL - PERMIT TO ' FRAMING' _ 2 •,:5 V/ IN ULATION STORIES -TYPE CONSTR. tiy • OCC.GROUP 3 RES.UNITS , ; � . . PLACE NO SUBFLOOR UNTIL ABOVE•HAS BEEN SIGNED ' ROOF - - SO.FT,FLOOR AREA TOTAL ACREAGE DIAPHRAGM ILUING USEF ' RES D CON PB Olncr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCLL NO. PLUMBING GAS TEST iRgCT NO. P-REELNG, �.T— .4 Q .- MECHANICAL ,J/'_• 1 ELECTRICAL - _ FINALS DATE INSP. nccoATEACc.FILE No, FRAMING SAN # ZONING ENG.SITE NO. INSULATION' _ PLUMBING �?Ji GAS f -� FIRE SPRINK ENERGY T7A MECHANICAL - Y El N❑ ❑ NEl COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH-INTERIOR ELECT CALFLOOD ZONE A,L.U.C. , LATH—EXTERIOR T Y❑ N Y ❑' No SHEETROCK GRAD o- FEE SUMMARY SHEAR INTERIOR =tTlNG i SHEAR EXTERIOR .TEMPORARY PP, OVALS - BUILDING FIREWALLS - - - ELECTRIC PLAN CHECK . GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL 13UILDING FINAL ISSIGNED By BUILDING INSPECTOR. MICROFILM. ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE MECHANICAL IMPORTANT! coNST.TAz PLEASE READ REVERSE SIDE BEFORE- TOTAL CALLING FOR FINAL INSPECTION. ? OFFICE COPY. APPLICANT TO FILL IN INFORMATION WITHIN RED LIN LS - USE BALL POINT PEN ONLY BUILDING PROJE N eENT(FIC B PERMIT NUMBER mLOwrAPPLIC ON & PE K A )4e 1001 1A BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 0 OWNER I �� PLAN CHECK VALIDATION .N{{JAfME ae C QTY. ELECTRIC PERMIT FEE S IW'-ll""'IM W PHONE NgMERA//CTOR tp s// OUTLETS-SWITCHES-RECEP 10.00/1.00 7(t+(L(J�(M No. LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ADDRESS 'JAPPLIANCES-RESIDENTIAL 4.00 yzcA( PHONE 17(o 1g,4 PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 OR PM B1 ¢.No. SIGNS TRANS. 3.00 ADDRESS 1ELNO (p+ SPECIAL CIRCUIT '5.00 PERMIT VALIDATION Z2k dRlu HN Iv FEMP.METER OR POLE INS. 20.00 APPLICANT // MOTORS SEE FEE SCH. 1110- ��' 25 �� QCl2 R SERVICE CHANGE 20.00 ❑ o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 av I hereby affirm that I am hec"A'd under provisions of Chapter 9 PATE N <N (Commencing with Section 7000)of Division 3 of the Business and BLOC. ELECT. PLG. MECH. H m z Professions Code,an y license is in full Lure e xylyl gf(gL,-> ❑ Z i m o License CIa 2I Lie.. Contractor -9-S['J55� 0 „('1- In� n H a, Uate Contractor /'Z$'[_, lay�}� (c y `C J a rt w a OWNER-BUILDER DECLARATION BUILDING PERMIT o W. o MISC.- REFER TO ORD INFORMATION K ; LL H I heathy affirm that 1 am exempt from the Contractor's Licrnsc u_ o J Law fill the following reason.(Sem 7031.5,Businussand Profcssions VALUATION SIFT. L - PERMIT ISSUANCE 10.00 yf Cprove,Any mtyor county which structurepermit loconsuance,after, / is 0 improve,demolish,or repair any structure,prior its issuance,also ELEC.CONTR. LIC.NO. ELEC. su O u reunites the applicant for such percent to file a signed statement that TOTAL v w m m he is licensed pursuant to the provisions of the Contractor's Llcensa PERMIT TO F z a Law(Chapter 9(commencingwith Section 7000)of Division 3 oflhe B�mwL E i O Business and Professions Code)or that he is uxcmpt therefrom andOTV. PLUMBING PERMIT FEE sc I- o the basis for the alleged exemption.Any violation of Section 703 LS I STORIES TYPE CONSTR. n by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($5000.): ❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECTDEVICE 4.00 their sole Compensation,will do the work,and the structure is not . OC G RES.UNITS Intended cur offered for sale(See. 7044. Business and Profcssions DRAINS-FLOOR,ROOF,AREA.COND. 5.00 Code:The Contractor's License Law docs(tot apply to an owner of property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such intpruve- mtntsarenot intended or offered for sale.lt;however.the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 3/ 2� or improvement Is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 O builder will have the burden of proving that Im did not build or int- BUILDING USE prove 1,aso neeose of the.l. INDUSTRIAL WASTE INTER. 30.00 y-y ❑ ❑RES IND N IRS❑ o❑ ❑ L as owner of the Property,struct he reject vee contracting with Z licensed contractors to construct the project(Sea. 7044,of apply LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. to Professions Code: ty Conbuildi s License Law Joos not apply to tr owner of property who builds or improvcx(herrn u and who LAWN SPR IN KLERS-OVER 5(EA.) 1.00 R66^146 / _,q O S� contracts for such projects with n contruelor(e)licensed pennant to �7!/J(O L 46 the Commcmri License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO.NO. PARCELNo ❑ lam exempt under Sc, ,B.&P.C.for this WATER HEATER W/VENT 6.00 70UZ \ rLw,2O Owner Dote WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'(7OAIPENSA'TION DECLARATION WATER TREATING EQUIP, 5.00 1 hereby affirm that 1 have a certificate of consent to self-insure. ora certificate of Workers'Compensation insurance or a cer ified ZONING ENG.SITE NO. copy theme f(Sec.3800, parry ).j ,e x�_ / / Policy No. Company ��Certificd Is her lurnjyltetic FIRESPRINK ENERGY T-24 Z = ❑ Certified i. I •A t { city spectiml Division. y N� V N� Applicant _ MISC.- REFER TO ORD. ~ ON PERMIT ISSUANCE 10.00 � - CI;RTIFI ' TIi GI FLOOD ZONE A.L.u.C. W > C0,4F:NSA'110N INSURANCE PLG.CONTR. LIG NO. PLG. CL ❑ (This section need not be completed if the permit is for one TOTAL V N Y 0 N[:JIJ Z hundred or less.) U O hd c (S 100 I certify that in the performance of the work for which this per- QTYFEE SUMMARY . MECHANICAL PERMIT FEE LL i- mit is issued, I shall not employ any person in any manner so as Ip U W become subject to the Workeri Compensation Laws of California. •� a Date Applicant ALTER OR ADD TO MECH.- 5.00 BUILDING 6 �/ >_ Z NOTICI'-'TO APPLICANT: If,after making this Certificate of fix _ emptier,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall be dcmned revoked. AIR HANDLING UNIT(TO 10AOOC.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 3 S� - I hereby affirm that there is a corstnmtima 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',Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read this application anl,ta,,that be above VENTILATION FAN (SINGLE) 4.00 Rumination is correct. I agree to comply with all city and county PLUMBING / ordinances and state laws relating no building construction. and BOILER-COMP(3 H.P.or100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. above-mentioned property for inspection purposes. MECHANICAL (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 �LL Lgraot,Ingfi�ipg'.i2l in any way acrue agar t said City in consequence of the PERMIT ISSUANCE 10.00 l„ s ' MECH.CONT. LIC.N0. MECH. I I/ !� TDTAL TOTAL 930`fY ontractor Date OFFICE COPY