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11005 r, POSTTHISCARD NEAR'FRONTOFBUILDING PFRMIT'NUMBER 'CITY OF CUPERTINO INSPECTION DIVISION '. 1.1005 JOB INSPECTION RECORD PI PERM'�IITI •EXPI RATION' JOB ADDRESS L L �� !/��, UNIT# k' _LOT# ' PERMIT EXPIRES IF WORK w i . OWNER CONTRACTOR IS�'NO�1 NRgRT-E`D WITHIN • INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAY. ..OF PERMIT ISSU- FOUNDATION - - - ANCE OR 180 DAYS FROM ` - UFER LAST CALLED INSPECTION. . ' ' � - � - •� � PR EGUNITE PERMIT.VALIDATION ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED6 .J>l✓c`(�, UNDERGROUND /SLAB' F/1f /) / ��f1 / PLUMBING / ©..a'+" {U . ELECTRICAL J • ISSUANCE DATE MECHANICAL / BL ELECT. P MECH, ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN,SIGNED " BUILDING PERMIT '- .WOOD FLOOR INFORMATION .. .;..PLUMBING _ - LUAT ON SIFT. MECHANICAL •„ . - .. - - '� �V. ELECTRICAL y PER Ir TO ' FRAMING - - Qv J - - INSULATION - STORIES TYPE CONSTR. - - � • - OCGGROUP RES.UNITS IREACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED . 1 POOP • , SD,FT.FLOOR AREA -'TOTALACREAGE DIAPHRAGM ., ' . - BUILDING USE RES IND ' CON PB O,her APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 0 ❑ Ej ❑ - -ROUGH ASSESSORS PARCEL NO. PLUMBING ' GAS TEST - - - TRACT NO. PARCEL NO. MECHANICAL ACG DATE ACC.FILE NO: ^ ELECTRICAL > FINALS' " DATE �INSP, . FRAMING' - SAN ZONING - ENG.SITE NO. INSULATION � PLUMBING -/J - . GAS' „ t - . . ., .. HRESPRINK MECHANICAL '" "ENERGY T4G COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ' HEATING :"PI NE) . - LATH=INTERIOR U,C. ELECTRICAL FLOOD ZONE A,L LATH—EXTERIOR " ,,�i FIREDEPI.' ❑" NO ' Y ❑ NO SHEETROCK GRADE 71E M AJLY SHEAR INTERIOR - BUILDING ' SHEAR EXTERIOR' ;, TEMPORARYAPPROVALS FIREWALLS - - - P ELECTRIC GAS ,NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR.ARRANGE FOR INSPECTION BYPHONING 252-4505, o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING,' Z PLEASE GIVE JOB ADDRESS WHEN-PHONING. SEE PERMIT. FOR EXPIRATION DATE MECHANICAL. ' IMPORTANT! ,CONST.TAX - ,,,•-�----- PLEASE,READAEVERSE SIDE BEFORE CAWING FOR FINAL INSPECTIONS ' TOTAL', OFFICE COPY ' 14PPLICANT TO'FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY V pill LD1 NG PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT ADDRESS ^ O O I� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I Vh OWNER'S - PLAN CHECK VALIDATION ® NAME QTY. ELECTRIC PERMIT FEE PHONE CONTRACTORS �Iu mb.r�.x OUTLETS 10.00/1.00 NAME 4:T y PD Llc:No. Q LIGHTING FIXTURES 10.00/1.00 ADDRESS rolls PPLIANCES-RESIDENTIAL 4.00 p PHONE �o.T7 PANELS 10.00 (.r89 DATE OF APPLICATION ORcerrscr PANELS (OVER 200 AMP) 20.00 PLAN CHEC,K1yFEE P,0.NO. ENGINEER • ,r)'161i1n@ ' uc.No SIGNS TRANS. 3.00 ARCH.OR ENO. PERMIT VALIDATION ADDRESS - SPECIAL CIRCUIT 5.00 n / ZIP EMP.METER OR POLE INS. 20.00 ADDRESS N/�FrrGl,r AMOTORS SEE FEE SCH. ' IYYY��'fff NNN ,I oREss SERVICE CHANGE 20.00 '02 LICENSED CONTRACTORS DECLARATION a v v I hereby affirm that I am licensed under provisions of Chapter 9 2 w (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE HZ Professions Co u d y license is in full to pµ @@ c. BL G. ELECT. LG. MECH. Z. H y G Licen� lass _ Lic.Numbe ❑ ❑ a se E J L' Con[mdor idl U ¢ ¢ Wb IC a OWNER-BUILDER DECLARATION BUILDING PERMIT F o a INFORMATION X ; y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD F LL m j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 wATION $/FT. Code:Any city or county which requiresa permit toconstruct,alter, q� re ¢ ¢Q improve,demolish,or repair any structure,prior to its issuatIC0.also ELEC.CONTR. LIC.NO. ELEC. E D M requires the applicant for such permit to file a signed statement that TOTAL a w oat he is licensed pursuant to the provisions of the Contractor's License PERMIT T rZi Law(Chapter 9mommencingwith Section 7000)OfDivision 3ofthe 5 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE UVMV I I"'� al I-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a3 � by nny opplicmlt fora Permit subjects the applicant ton civil penalty ALTER-DRAIN&VENT-WATER (EA.)of not more than live lmndred dollars($500).). _ O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 occ.GROUP RES,UNITS their sole compensation,will do the work,and the structure is not 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 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments arc not intended or offered for sale.If,however.the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or an- GAS-EA.SYSTEM-OVER 4 IEA•) 2.00 BUILDING USE prove for purpose ofsaleJ' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ I•as owner of the property,am exclusively contracting with - ❑ 0 ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL.NO. and Professions Code:'fhe Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 l�.f contracts for such Projects with a contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Seca ,B.&P.C.for this WATER HEATER W/VENT 6.00 Owner 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 conscnl DI Welt-in Mlre, or a certificate of Workers'Compensation Insurance,or u certified ZONING ENG.SITE NO. copy the .f�j'�i7f,(,+nq fort'Lab.C.).r• l' I'nlicy Nl lSlnpany x--CT-�•� l_ws+.n_yq.Ly� O ❑ Cerr I y is bereby furnished V 'Z Z Certified fop .s filed wi lh lh city i sgdc,ion division. FIRESPRINK ENERGY T 24 O Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N[3 CC w CERTIFICATE OF EXEM ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTR. LIC.No. PLG. CL O (This section need no[ be completed if the permit is for one TOTAL Y E] N� Y❑ N[D � Z hundred dollars(5100)orless.) U O 1 certify that in the performance of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SU A LL I-, mit is issued,I shall not employ any person tri any manner so as to U become subject to the Workers'Compensation Laws of California. U i. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING >- W NOTICI: TO APPLICANT: If,after making this Certificate of Ex- F ? eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, FEE you must forthwith comply with U Such Provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 - SEISMIC FEE 1 hereby affirm that there is a construction lending agency for . EXHAUST HOOD(WITH DUCT) 5.00 the VerPonnnnce of the work for which this permit is is,,d(Se<. MICROFILM •�^ 3097,filer's .am 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 s I certify that l have read this application andslate tile,oat above VENTILATION PAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorise representatives of this city to enter upon the BOILER-COMP (Over 108000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONSTTAX may in any way accrue against said City in consequence Of tile .e PERMIT ISSUANCE 10.00 ^^r grantingo is permit, MECH.CONT. LIC.NO. MECH. TOTAL TOTAL L> -- Stgnamrcol rpant/Contractor Date OFFICE COPY