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11081 POST THIS CARD NEAR FRONT OF BUILDING PfiNMIT NUMBER CITY OF CUPERTINO �$� INSPECTION DIVISION . JOB INSPECTION RECORD ry �/'// d- yp��• ,PERMIT ~EXP'IFRAT�ION UNTSLOTdJOB ADDRESS 10SOO N- be hZA RWd - Ik ' _ PERMIT EXPIRES IF WORK OWNER \� . r CONTRACTOR q, &S'I IS 'NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION LIFER LASTCALLED INSPECTION. - �� "0 .J'C1-e'1 PREGUNITE O_K..�¢ ..L,u. PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL - BLDG. ELECT. PLG. ECR. o ❑ ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - ' BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION S/RT. .PLUMBING MECHANICAL' ' ELECTRICAL PERMIT TO FRAMING sroRlEs --TYPE corvsTR INSULATION . OCC GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.FT.FLOOR AREA TOTALACREAGE DIAPHRAGM BUILDING USE ' RES IND CON PB Oine, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO, ROUGH PLUMBING TRACT NO. PARCEL NO. GAS TEST' MECHANICAL ' ' ACC DATE ACC.FILE NO, ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO, INSULATION PLUMBING GAS MECHANICAL FIRE SPRINK ENERGY T 74 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N Y ❑ N[:] LATH-INTERIOR ELECTRICAL FLOOD ZONE aL.u.c. LATH-EXTERIOR FIRE DEPT. ❑ No Y N[3 SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR - TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UN TIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN.PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! covsT.rnx 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 ` BU I LDING PROJECT I IDENTIFICATION - PERMIT NUMBER BUILDING yip APPLICATION & PERMIT 0211081 D RES Q 0 � U BUILDING -ELECTRICAL-PLUMBING-MECHANICAL WNER'S PLAN CHECK VALIDATION AME OTV. ELECTRIC PERMIT FEE CONTRACTOR [OUTLETS-SWITCHES-RECEP 10.00/1.00 °pp 3' t -S1�0 AME fi uaN LIGHTING FIXTURES 10.00/1.00 7 a 10 �r NT AO °R' at]/�S 1 (oq(6�1 APPLIANCES-RESIDENTIAL 4.00 ♦K� A ORE S �7'� P PANELS 10.00 DATE OF APPLICATION A CITEPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. O ENGINEER LIC.NO. ISIGNS TRANS. 3.00 ADDDRESS ENO' SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 PUCANTS MOTORS SEE FEE SCH. _ ADDRESS L/IA` / SERVICE CHANGE 20.00 /64 /��/�sst Foo LICENSED CONTRACTORS DECLARATION v1�1v Y�! -� a u I hereby affirm that I am licensed under provisions of Chapter 9 155 N a a (commencing with Section 7000)of Div Sion 3 of the Business and BLDfrx; C MECH. R D i Professions and my license is in ful me of t Y i O'�, License Cl IS Lic.Num ❑ ❑ ❑ O m H w Date Contracto 2u QVr m¢ a OWNER-BUILDER R-BUILDER DIiCLAR ICA ONS_ BUILDING PERMIT E o d U MISC.- REFER TO ORD INFORMATION E 3 u s- 1 hereby affirm that I am exempt from the Contractor's License y VALUATION S/FT. F u 04 Law far the following reason.(Sec.703 L5,Business and Professions PERMIT ISSUANCE 10.00 m� Code:Any city or cou my which requiresu permit oconslruct,eltet ��O OOO BE> improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. aI D LL requires the applicant for such permit to file J signed SL'JLemCBI that TOTAL PERMIT TO n w$ he is licensed pursuant to the provisions of the Contractor's License e Fz>w La..(Chapter 9(commencing with Section 7000)of Division 3 of the a tluisiRest and Professions Code)Or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE a r the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any upplicmtt for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(8500).): ❑ 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 Jo 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.FLOOR AREA TOTAL ACREAGE himself or through his own employees',provided that such improve- meets are nut intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE FIT will have the burden of proving that he did not build or im RES IND CON PB Omar prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively conlraCting with ❑ ❑ ❑ ❑ ❑ 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 commoners)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO. WORKERS'COMPFNSATION DECLARATION WATER TREATING EQUIP, 5.00 1 hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,ora certified copy thereof(See.3800,Lab.0 Policy No. Company ! O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z ❑ Cernr, y s�,fjlc_ it t �aW��.'nspcvtum division. MISC.- REFER TO ORD. ❑ ❑ O Applicant L� "r \ Y ❑ N❑ Y N y PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0 c. CC T CERTIFICATE:OF EXEMPTION FROM WORKERS' _ LI _ COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. Y❑ N❑ Y❑ N❑ 1 O (This section need not be completed if the permit is for one TOTAL D Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued.I shall not employ any persop in any...a nner so as to U become subject to the Workers'Compensation Laws of California. BUILDING Z/-J3 UJ Dale Applicant ALTER OR ADD TO MECH. 5.00 >. m NOTICE TO APPLICANT: If,after making this CertiNcate of Ex- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the "hot Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE .� 1 hereby affirm (hal the ie is a construction lending agency 1'or EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM the Civ aHEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50 - ELECTRIC Lender's Address /��/ I certify tha I have read this application.,,it state that the above VENTILATION FAN (SINGLE) 4.00 information is rrecL I agree to comply with BII city unit county PLUMBING ordinances an ate laws relating to building construction, and ! LER-COf(3 H.P.Dr 100,000 B.T.U.) 6.00 hereby author .e representatives of this city toenterupon the BOILER-C OMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mention¢ roperty for inspection purposes. - (We) agree t ave, indemnify and keep harmless the City of MISC.- REFER TO ORD. ino agains iabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX m yin an way ecru¢ said City in consequence of the gr tip Is MECH.CONT. LIC.NO. MECH. _ TOTAL TOTAL \' SWIdurc ofA 'cent tractor Dale OFFICE COPY