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13575 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO RMITNDM1iBER 'INSPECTION DIVISION 13575 JOB INSPECTION RECORD 11082 BEL AIRE COURT PERMIT EXPIRATION JOB ADDRESS UNIT LOT# ' PERMIT EXPIRES IF WORK OWNER MARTIN HOLLMANN CONTRACTOR RODGER WOOLEY ISNOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTIONRECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM U F E R LAST CAL CED I NSSP,ECTION. PREGUNITE PERMIT VALIDATION , ��® POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB �o-e. In _ PLUMBING �... ELECTRICAL MECHANICAL BLDG. ELECT. PLG. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN,SIGNED BUILDING PERMIT ❑ WOOD FLOOR INFORMATION ' PLUMBING VALUATION S/FT. MECHANICAL ` ELECTRICAL PERMIT TO FRAMING INSULATION - STORIES TYPE CONSTR,' OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.FT.FLOORAREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES, IND CON PB Omr, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ROUGH - ASSESSUHS PARCEL NO. PLUMBING.t CTAS TEST TRACT NO. PARCEL NO. MECHANICAL - ELECTRICAL �L•$1-S s— FINALS -;;:DATE INSP. ACC.DATE Acc.FILE No, FRAMING J.7• SAN # INSULATION alli. PLUMBING _;�y � zoNiNc ENG,SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING �8 Y❑ N❑ Y ❑ N❑ LATH—INTERIOR ELECTRICAL. FLOOD ZONE A.L.U.C. LATH—EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING _ SHEAR EXTERIORTEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE w OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ~O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMeINc Z PLEASE GIVE JOB ADDRESS WHEN PHONING,. t — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. i . - OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER GLI ING APPLICATION & PERMIT AooR ss _ e � s BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 135 OWNER's PLAN CHECK VALIDATION 75 NAE QTY. ELECTRIC PERMIT FEE o NONE S� CONTRACTOR UTLETS-SWITCHES-RECEP 10.0011.00 ,O e. sec.NO. LIGHTING FIXTURES 10.00/1.00 ADDRREESSSS Ds PPLIANCES-RESIDENTIAL 4.00 AD PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECff FEE P.C.NO. oR PANELS (OVER 200 AMP) 20.00 ENGINEER (G _ uc.No. SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION ADDRESS SPECIALCIRCUIT 5.00 ZIP EMP.METER OR POLE INS. 20.00 ,q neo ESSTs MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION <u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSITI� TE, vH, ¢y (commencing with Section 7000)of Division 3 of the Business anJ BLDG. ELECT. MECH. H y z Professions Code,and my license is in full force and effect. o i w W License Class Lie.Number Date Contractor BUILDING PERMIT ¢ ¢w¢ OWNER-BUILDER DECLARATION INFORMATION wO au u MISC.- REFER TO ORD 3 N 1 hereby affirm that I am exempt from lire Contractor's License VALUATION SIFT. H LL o J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 t7 Code:Any City or county which requires a permit to construct,alter, ce a ¢ NO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. K O u requires the applicant for such Permit to file a signed statement that TOTAL PERMIT TO n ro he is licensed pursuant to the provisions of the Contractor's Licensez i Law(Chapter 9(commencing with Section 7000)of Division 3 of the //V f 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE the basis for the alleged exemption,Any violation of8eclion 7031.5 STORIES TYPE CONSTR. ii - 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).): ❑ L as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 Oce.GROUP RES.UNITS sole compensation,will do Ilse work,and the structure is not intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such'in prove- mentsarenot intended oroffered for sate.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA ) 200 BUILDING USE builder will have the burden of proving that h . . . e did not build or im-No RES IND CON PB Omer Ne for purpose ofsaleJ. INDUSTRIAL WASTE INTER. 30.00 I,as owner of the property,am exclusively contracting with 1:1 ❑ ❑ 1:1 El licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 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 contractoos)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,BAP.C.f ,this WATER HEATER W/VENT 6.00 reason Owner WATER SYSTEM 5.00 ACC.DATE PCC.FILE NO, WORK ERS'COMPENSAT'ION DECLARATION WATER TREATING EQUIP, 5.00 1 hereby affirm that I have a certificate of consent to self-insure. ZONING or a certificate of Workers'Compensation Insurance,or a Certified ENG.SITE NO. copy thereof(Sec.3800,Lab.C.L Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z ❑ Certified copy is filed with the city inspection division. O Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑ T PERMIT ISSUANCE 1000 ~ , LU - CERTIFICATE EXEMPTION IO TION PROM WORKERS' FLOOD ZONE A.L.U.C. W �_ COMPEE NSATION INSURANCE: PLG.CONTE. LIC.NO. PLG. 1 O (This Section need not be completed if the permit is for one TOTAL t-2,o) Y❑ N❑ Y ❑ IN 7Z hundred dolls,,($100)or less.) UO I Certify that in the p,b.UduHcC of the work for which thio Pe,- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- ' mit is issued,I shall not employ any person in any manner so as 10 OW becomesubject to the Workers'Compensation Laws of California. y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 5Z; CS >. m NOTICE:TO APPLICANT: If,alter making this Certificate of Ex- ♦- ? cnsption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith conmly with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(EVER 10P00C.F.M.) 6.00 SEISMIC FEE 1 hereby affirm But 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 HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC Q �- 'sY Lender's Address ( certify But lhave read this application and state that the above VENTILATION FAN (SINGLE) 4.00 . �J information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-CON>P(3 H.P.or t00,0008.T.U.) 6.00 Q hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL 411 IV 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 PERMIT ISSUANCE10.00 CONST.TAX may in any way accrue against said City in consequence of the gmIvroftus PC an MECH.CONT. LIC.NO. ME HL n . - TOTAL TOTAL �' Signature,of lApplieanl/Contractor Date `- O FICECOPY f-