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C 09759 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY' OF CUPERTINO . 079 'INSPECTION DIVISION , ` JOB INSPECTION RECORD /W PERMIT EXPIRATION • JOBADD ES /'l (/f�/ V// ' 'UNIT# 40 - 'PERMITEXPIRES IF.WORK L L. OWNER ' CONTRACTOR IS NOT STARTED-WITHIN INSPECTION DATE INS ECTOR INSVECTION RECORD 180DAYS OFPERMIT ISSU- ANCE OR,180 DAYS FROM 'FOUNDATION V - LAST CALLED INSPECTION. UFER' PREGUNITE - - - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB . PLUMBING '•�•.*,. r. . • ELECTRICAL �� D� �� ISSUANCE DATE . MECHANICAL - - OLD ELECT I PLG. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 7BUILDING PERMIT .'� WOOD FLOOR INFORMATION J V PLUMBING ALUATION - $/FT. � J , ,rF F MECHANICAL - �,� ELECTRICAL I NPER-IT To FRAMING INSULATIONSlwwqrs TyP CONSTR. OCC.GROUP' RES.UNITS - PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF , - - SO.FT,ILOOR ARE. TOTAL ACREAGE . DIAPHRAGM - - BUILDING USE E IND CON ; PB Go— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING - - NO, -PARCEL NO. GAS TEST �� • - .TRACT ' MECHANICAL - - - ACC.GATE ,ACC.FILE NO. ELECTRICAL FINALS - DATE INSP. ' _ FRAMING -- �-�- 7. SAN # - ZONING ENG.SITE NO. INSULATION - PLUMBING - ` - GAS ' MECHANICAL - 'FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y NE Y ❑ N❑ " LATH—INTERIOR ELECTRICAL c FLaoD zorvE ..L.u.c,' LATH—EXTERIOR - - I FIRE DEPT. YE] "❑ ,Y ❑ N❑ SHEETROCK- - - GRADE - FEE SUMMARY SHEAR INTERIOR BUILDING - - SHEAR EXTERIOR' - BUILDINGVALS ' FIREWALLS ELECTRIC, PLAN CHECK ]GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY'OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM. .ARRANGE FOR INSPECTION BY PHONING 2524505, ELECTRIC F- ONE WORKING•DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. . ' - SEE PERMIT FOR EXPIRATION DATE -: '. ' MECHANICAL - „IMPORTANT! .. *CONST:TA. X., ._..`-.... .::-,. PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR.FINAL INSPECTION. ' ' - OFFICE COPY, APPLICANT TO FILL IN INFORMATION WITHIN-RED LINES -USE BALL POINT PENO.NLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER A BUILDING APPLICATION PERMIT 09759 BUILDING - ELECTRICAL-PLUMpBIyKNG-dMECHANICAL NPME9 A' 1 P' r ',Ta „u 6sy ¢ lyyg PLAN CHECK VALIDATION ., QTV': :3Y4y ,lELECTRIC PERMIT•` 4' +gFEE ' ' PHONE .i . arawgx4Tx CONTRACTOR'S - ,-•OUTLETS-SWITCHES-RECEP 10.00/1.00 - Al AVAO LIC.NO.v 4, LIGHTING FIXTURES 10.00_/1.00 CONTRACTOR a AONTRAS PPLIANCES-RESIDENTIAL 4.00 ' C PHONF35Z43) PANELS - 10.00 DATE OF APPLICATION OC TE _ • PANELS (OVER 200 AMP), 20.00 PLAN CHECK FEE P.C.NO. R ENGINEER LIC.NO. SIGNS TRANS. 3.00 AARCH.OR DDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION • za, TEMP.METER OR POLE INS. 20.00 ADDRESS MOTORS' SEE FEE SCH. AS /J �..�.,.�..� ' .SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION TEMP,POLE 30.00 rm . a v 1 hereby affimt that I stn licensed under provisions of Chapter 9 SS PNCE GATE Z, w (commenung with Section 7000)of Division 3 of the Business sad BL MECH. w i Pro fesslons Code and my license hs in full Co ndAf ❑ 2.z,n - License�GGlass ,�p, -Lhc Nr - ' ff o. Date N'�'a�" Y1'1 Conlmct F m w ¢ OWNER-BUILDER DECLARA ION x °A ° - MISC.- REFER TO ORD eN`'aIN FORMATION;,' ' ' ' 3 w H 1 hereby affirm[hof I am exempt from the Contmclor's License io Law for the following reason:(Sec.7031.5,Bo,messaad Professions PERMIT ISSUANCE VA UATION $/FT. Code:Any city or county which requires apermit to construct,alter, 10.00 � rt 4 p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. - , i u requires the applicant for such penult to file a signed statement that TOTAL PERMIT TO w he Is licensed pursuant to the provisions of the Contractor',License H Pe e, Law(Chapter 9(commencing with Section 7000)of Dhnslon 3 offhc as - ' v ° >, Business and Professions Code)or that he Is exempt therefrom and OTV7 :•N x e - P,LUMBINGtPERMIHTk +=Fr x PJFEEt, CE r the basis for the alleged exemption.Any violation of Section 7031 $ n- : ' .x • ' -= s a '4 x x STORIES TYPE CONBTR. i by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).):' 0 1,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 Property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO. ,FT, sFLOOR AREA TOTAL ACREAGE himself re through his own employees.Provided that however,t h improve- (VV`-" ments mself a throughot did orofferedemplo ees,or provided thatsthe building GAS-EA.SVSTEM-11NC.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 am- B ILOING USE prove for purpose of sale.), - INDUSTRIAL WASTE INTER, 30.00 RE IN CON PB Oma, a 1,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:The Contractor's License Law does not apply 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 contractors)licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00 the Contractor's License Low. TRACT NO. PARCEL NO. O Inc exempt under Sec. " ,B.&P.C.for this reason WATER HEATER W/VENT 6.00 Owner Date 'WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATI ON DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate mf consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO, �I copy thereof ISeq'3800,Lab.C.) ,/- Policy No. Company ; 4o�T� ❑ Certifiedcopy is her Fy unished. FIRESPRINK ENERGY T 24 1 {h tm 't Inspection division. Y ry0 Y ❑ NF] Z Z ❑ Ce 'fia y is C ed ' MISC.- - REFER TO ORD. � O 'Applicant - , y - CURTI FICA E OF E MPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. CO SA ION CL > .(Thin section.need nOl4 be completed INSURANCE tlseppenniT is for one PLG.CONTR. LIG NO. TOTAL V N❑� Y N� ao D'Z hundred dollars($100)or less.) n •a y . „ _. . oa 'U O 1 certify that in the performance of tits work for which this per QTYt ',-"MECHANICAE PERMIT tai' t x 'FEE", e. +-'*A#F,EE 8UNIMARY`+%4,AP `� LL!U mit is issued,I shall not employ any person in any manner so as to "` "•Kd O W become subject to the Workers'Com 1 Compensation Laws of California. IS. Date Applicant ALTER OR ADD TO MECH. 5.00 'BUILDING } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- J )..• Z 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 FEE such provisions or this permit shall be deemed revoked AIR HANDLING UNIT ITO i9=C.F.M.) 4.00 CONSTRUCTION LENDING'AOENCIY AIR HANDLING UNIT(OVER 10=C.FM.) 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.L HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG UN IT(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 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 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon She inspection above-mentioned property forBOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL hipurposes. (We) agree to save; indemnify and keep harmless the City of MISC.- REFER TO ORD. - h Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may-in any way accrue against said City it conse Vence of the PERMIT ISSUANCE 10.00 g of this perm' MECH.CONT. - LIC.NO. MECH. TOTAL ignature fAppiican mir•4or ate STOTAL • OFFICE COPY