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12589 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY -OF CUPERTINO , 12589 INSPECTION DIVISION JOB INSPECTION RECORD C q PERMIT_EXPIRATION J'. �C / V E 0� UNIT# LOT# JOB ADDRESS �� M PERMIT EXPIRES IF WORK OWNER /� � E. S �"J Sol- CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM, UFER LAST CALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT. PLG, MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOG INFORMATION VALUATION $/FT. ' PLUMBING . MECHANICAL ELECTRICAL a PERMIT TO ftWFRAMING 'j I 1 1 IJ v INSULATION 7 \-) ST DRIES TYPE CONSTR. OCG GROUP REB.UNITS PLACE NO SUBFLOOR UNTIL ABOVE-HAS SIG-NEI) ' ROOF , 50.FT,FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES INDCON PB plrvx APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ROUGH - ASSESSORS PARCEL NO. PLUMBING GAS TESTTRACI NO. PARCEL NO. ShUv�ar Ate-^ MECHANICAL ELECTRICAL -/ FINALS DATE ACC.DATE ACC.FILE NO. FRAMING 7-('1 SAN tf INSP, INSULATION PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL ,s e FIRE SPRINK ENERGY L}4 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING A Y ❑ N❑ Y ❑ N❑ LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C., LATH-EXTERIOR 2.55'4-7 FIRE DEPT. Y❑ N❑ Y ❑ N SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING �g SHEAR EXTERIOR' TEMPORARY APPROVALS BUILDING Pil FIREWALLS ELECTRIC PLAN CHECK GASFEE 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 ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 0�ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL 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 I'.UI LDING PROJECT IDENTIFICATION PERMIT NUMBER RUILDING APPLICATION & PERMIT ADDRESS - 12589 Q- �Be• �� BUILDING -ELECTRICAL-PLUMBING-MECHANICAL ,s OMR-1 - PLAN CHECK VALIDATION / Tif NA QTY. ELECTRIC PERMIT FEE -7 C [ `'� PHONE NAME /l corvrRAcroRs 4j,/ UTLETS-SWITCHES-RECEP 10.00/1.00 J3 Cl ��(1 , Gbo<,T- CL. uc.Ho. 144-'ia LIGHTING FIXTURES 10.00/1.00 o� / nooassCTORs CA"n° CC1f'Z4 9SgaqV�/ l PPLIANCES-RESIDENTIAL 4.00 PHONE -(p/x /07 / PANELS 10.00 DATE OF APPLICATION OARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER c LIC.No. SIGNS TRANS. 3.00 AOORESS ENa SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 A"P" EAS EE SCH. _ MOTORS SEE F .�J ADDRESS SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION a u ri I ereby affirm that I am licensed under provisions of Chapter 9 Z w a e (Commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE H m 2 Professions Code, d Ty license is in full force' ie�S`7f BLDG. ELECT. PLG. MECH. zo 0 m W License la Lia Numb e YY Incl -® CO r US - Contractor R 16J r < , -' BUILDING PERMIT ¢ ¢ w a OWNER-BUILDER DECLARATION 0' O MISC.- REFER TO ORD INFORMATION w g u N I hereby affirm that I am exempt from the Contractor's License F.L 0 4 Law for the following reason.(See.7031.5,Businessand Professions PERMIT ISSUANCE 10.001VALUATION $/FT. w Code:Any City or county which requiresa permit to construct,alter, ¢ K QO D improve,demolish,or repair any structure,prior m its issuance,also ELEC.CONTR. LIC.NO. ELEC. ¢ requires the applicant for such permit to file a signed statement that TOTAL p A w es w he is licensed pursuant to the provisions of the Contractor's License Cv 1 J PERMIT TO H z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe /l Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE �l v ¢ F$ the basis for the alleged exemption.Any violation of Section 7031.$re STORIES TYPE CONSTR. d3 by any applicant fora permit subjects $500).the licam toALTER-DRAIN 5.00 of not mothan five hundred dollars(5500)J: ❑ I,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 docs not apply to an owner of property who buildsimproves thereon,and who does suh work FIXTURES-PER TRAP 5.00 - so.FT FLOOR AREA TOTAL ACREAGE himself or through hisis Own employees,provided that such such improve- ments are not intended or offered for sale.IL however,the budding GAS-EA.SYSTEM-1 INC.4 OUTLETS 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 im- BUILDING USE Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CDN PB Omer ❑ I,as owner of One property,am exclusively contracting with licensed contractors to construct file project(Sec. 7044,BusinessLAWN SPRINKLERS- 1 INC 5 V.B. 6.00 AS and Professions Code:The Contractor's License Law does not apply SESSORS PARCEL NO. 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. ❑ lam exempt under Sec ,B.&P.C.for Ods reason WATER HEATER W/VENT 6.00 .Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent m self-]marc, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.0 / Polic NoCompany Jd 0 .iBcd copy is hereby furnished. FIRE SPR(NK ENERGY T 24 0 Cer fi ply is with the city inspection division. F- p nPphcan MISC.- REFER TO ORD, YO NO v 0 NO ix: w CERTIFICATE OF BXEMP(ION FROM WORKERS' PERMIT ISSUANCE 10.00/6- FLOOD ZONE A.L.U.C. - W � COhIPENSATION INSURANCE P .coryrR. LIC.rvoCL . PLG. /�l! ❑ (This Section need not be completed if the permit is for One *1L L"M1{ T `11 TOTAL v Y N� Y N[_ U O hundred dollars(S 100)or less.l I certify that in the performance of the work for which this per- OTV MECHANICAL PERMIT FEE SUMMARY IL I- mit is issued,I shall not employ any person in any manner so as m FEE U become subject to the Workers'Compensalion laws of California. /`` 0 C. Date Applicant ALTER OR ADD TO MECH. 500 BUILDING ` ( V'`0 } 2 NOTICE TO APPLICANT': If,after making this Certificate of Ex- k k: 1- - emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK Provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE `f7 1 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.). M3 a� HEATING UNIT(TO 100,000 B.T.U.) 6.00 Lender's Namc Lender's Address HEATINGUNIT(OVER100,000B.T.U.)9.50 ELECTRIC 3� Q9 I certify that I have read this application and state 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(3 H.P.or 100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE BCH. above-mentioned property for inspection purposes. MECHANICAL 45 0q) (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 may in any way accrue against said City in Consequence of the PERMIT ISSUANCE 10.00 Q granting of this pern4l.�, MECH.CONT LIG NO. MECH. a S' TOTAL TOTAL Z3 97 Signature of Applicant/Confracmr ate OFFICE COPY O