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12182POST THIS CARD NEAR FRONT OF BUILDING ' CITY OF CUPERTINO . INSPECTION DIVISION JOB INSPECTION RECORD /- 1/ JOB ADDR SS O �lD `mel h n V��f UNIT# LOT 4t OWNER CONTRACTOR - - PFRMIT NUMBER 12182 •PERMIT EXPIRATION PERMIT EXPIRES IF WORK. IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR. 180 DAYS FROM LASTCALLED INSPECTION- INSPECTION I DATE I INSPECTOR INSPECTION RECORD FOUNDATION I/� UFER - PREGUNITE PERMIT VALIDATION 'PI - ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' UNDERGROUND/SLAB PLUMBING - ELECTRICAL - - .MECHANICAL -- - L ELECT. I ❑ PLCA MECH, ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $SFT. PLUMBING MECHANICAL ELECTRICAL • - PEHMITT l FRAMING - - INSULATION - DRIES TYPBCONSTR:!- - OCC. GROUP RES.UNITS- PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF SO, FT. FLOOR AR EA TOTAL ACREAGE DIAPHRAGM BUILDING USE i[$ IND CON PB Omer ❑ • ]�1C/ Iw u7'�/� APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED✓ ASSESSORS PARC EL NO. , ROUGH PLUMBING - GAS TEST - - TRACT NO. - PARCEL NO. MECHANICAL 3-2.+S ACC DATE ACC: FILE NO. - ELECTRICAL _•1 . -I FINALS DATE INSP. FRAMING ( SAN k ZONING ENG, SITE NO. - IN ULATION 7 PLUMBING GAS FIRE SPRINK Y ❑ N❑ ENERGY T 24 Y ❑ N❑ • MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING -1 FL000 zorvE ' v NE] n.Lu.c. v C] NE] LATH -INTERIOR • - ELECTRICAL .. .. LATH -EXTERIOR FIRE DEPT. FEE SUMMARY SHEETROCK - -, GRADE is"' SHEAR INTERIOR♦ - BUILDING N BUILDING SHEAR EXTERIOR TEMPORARY APPROVAL FIREWALLS ELECTRIC - - PLAN CHECK FEE I , .. GAS SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LOING INSPECTOR. ICROFILM- MICROFILM- - LUARRANGE FOR INSPECTION BY PHONING 252-4505, F ONE WORKING DAY BEFORE REQUIRED INSPECTION. 00 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z -' —SEE PERMIT FOR EXPIRATION DATE —' ELECTRIC PLUMBING .MECHANICAL coNsr. TAX IMPORTANT!' PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION.' TOTAL OFFICE COPY A 2 "7�. O Z Z I"' 0 X W_ 0-0 0 0 U_U Ow }' h F 2 A *I APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY . BUIILDI NG PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER -, 121.8 Z (WILDING ADDRESS /O ! ! O D C OWNER'S NAME T` 6ry =HONE zss-3o6 QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION Ste' CONTRACTOR'SUTLETS NAME - SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 LID. NO. CONTRACTOR'S ADDRESS ' APPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 PHONE DATE OF APPLICATION ARCHITECT OR ENGINEER uc. NO. PANELS (OVER ZOO AMP) •20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARC" .OR ENG. ADDREss 500 SPECIAL CIRCUIT . PERMIT VALI DATION TEMP. METER OR POLE INS. 20.00 ZIP t APPLICANT �OF ANTS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am Ilcensed•under provisions of Chapter 9 '-ISSUANCE DAT A (commencing with. Section 7000) of Division 3 Of the Business and ELECT, MECH. Professions Code, and my license is in full force and effect. License Class - Lic. Number ❑ ❑ Dale - Contruclor - BUILDING ERMIT . OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (See. 7031.5, Business and Professions Code: Any city or county which requires a permit 10 Construct, alter, improve, demolish, or repair any Structom, prior to Its Issuance, also INFOR ATION MISC. - REFER TO ORD VALUATION $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License , TOTAL PERMIT TO Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is'exempt therefrom and the basis for the alleged exemption, Any violation of -Section 703 L5 QTY. PLUMBING PERMIT FEE Moo RIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.) 5.00 by any applicant for a permit subjects the applicant to a civil penalty of not more than five Imntlmd dollars (5500).). BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sce. 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- mentsamnolintendedoroffered 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 im- prove for purpose of sale.). ❑ L as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 SPRINKLERSC 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 , ER 5 (EA.) 1.00 contracts for such projects with a contraclons) licensed pursuant to the Contractor's License Law. M EA. 200ft/10.00 TRACT NO. PARCEL NO. NN5 6.00 " ❑ tum exempt under Sec: .B.&P.C. for this reason Owner ate 5.00ACC.DATE ACC. FILE No. WORKERS'COMPIENSA'IION DECLARATION P. 5.00 1 hereby affirm that I have a certificate of Consentto self -insure, or a certificate of Workers Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lub.C.). Policy No. Company ❑ Certified copy is hereby furnished. ❑ Certified copy is fled with the city inspection division. Applicant11 -FIRE SPRINK Y [:]N ❑ ENERGY T-24 y El N❑ MISC.- REFER TO ORD. CERTIFICATE 01: EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0 C. PLG. CONTR. LIC. NO.PLG. TOTAL Gv COMPENSATION INSURANCE (This section need not be completed if the permit is f.,r one Y ❑ N ❑ Y ❑ N ❑ QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or loss.) I certify that in the DmInnnunae of the work Ibr Which this per- mit is issued, I shall not employ any person in any manner so as to become subject to theworkeri Compensation laws of California. Date Applicant - BUILDING ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT': If, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with' Such provisions or this permit sha11 be dcancd revoked. CONSTRUCT ION LENDING AGENCY APPLIANCE' 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10MC.F.M.) 6.00 SEISMIC FEE V EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM 1 hereby affirm that Them is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.), HEATING UNIT (TO 100,000 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Nan10 Lender's Address I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING . BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100.000 BTU) SEE FEE SCH, MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned Properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against Said City in consequence of the - MISC. -- REFER TO ORD.. CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT: LIC.ND. MECH. TOTAL TOTAL granlin ofthis per 1� . -, Signature ofA mans/Contractor Due ;/✓ OFFICE DOPY