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12510 POST THIS CARD NEAR FRONT,OF BUILDING ,: PFRMIT NU011O CITY OF CUPERTINO 12510 • INSPECTION DIVISION JOB INSPECTION RECORD PEREXPIRATION JOBADDRESS 106552 N. BLANEY UNIT# 1 LOT#• PERMIT EXPIRES IF WORK OwNEFi GIN-LU SHU CONTRACTOR DAR-EN-SHU (CREATI E IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. LIFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ~ k ELECTRICAL ISSUANCE DATE MECHANICAL BLOC. ELECT. PLG. MECH. ❑ ❑ ❑ ij 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION $/FT. PLUMBING MECHANICAL .f PERMIT ELECTRICAL P✓GF, ro FRAMING INSULATION - STORIES TYPE CONSTR. 5-r'3& cL OCC.GROUP RES.UNITS PLACE NO•SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF So.FT FLOOR AREA TOTAL ACREAGE /,) • / DIAPHRAGM � F BUILDING USE RES IND CON - PB Othei APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ -El 0 ❑ El ROUGH tv4_ nye ASSESSORS PARCEL NO, PLUMBING G'i'�"�'J GAS TEST TRACT Na. PARCEL No. MECHANICAL ACC.DATE ACG FILE NO. ELECTRICAL _j FINALS DATE INSP. FRAMING SAN * / ZONING ENG.SITE NO, INSULATION PLUMBING .3—� �- GAs _3_ MECHANICAL -3- FIRE SPRINK ENERGY T-24 N COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y OO NO [:] ❑ FLOOD ZONE A.L.U.C. LATH-INTERIOR 6W ELECTRICAL LATH-EXTERIOR - FIRE DEPT. YC NEJ vl] N❑ SHEETROCK GRADE FEE SUMMARY SHEARINTERIOR BUILDING 74 SHEAR EXTERIOR •. TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SI Gii-EO-1 OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICULI 4 ONE WORKING DAY BEFORE REQUIRED INSPECTION. x,_; PLUMBING G .< 46 o� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT FOR EXPIRATION DATE - K, .• MECHANICAL �- IMPORTANT! ¥ k CONST.TAX PLEASE READ REVERSE SIDE BEFORE ' CALLING FOR FINAL INSPECTION. TOTAL • OFFICE COPV APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY •A PERMIT NUMBER ' BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BGILDING 1 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 2 510 /V wNFos � r. PLAN CHECK VALIDATION NAME pTV. _-TRICPERMITFEE PNONk NMM acrORs A- I� - �j TLETS-SWITCHES-RECEP 10.00/1.003 _� NAME euu uc.No. HTING FIXTURES 10.00(1.00 r, NTRAcrOR's PP=TRANS. ENTIAL 4.00 �'- ADOREss /, ' Q ajyyl.ifv{4.{� PHONE ^r37�� PANIO.00 D " DATE OF APPLICATION ARCHITIT VG PANELS AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER .I.00 Llc.rvo. SIGARCH,OR ENG. 5.00 PERMIT VALIDATION ADDRESSSPE ZIP EOLE INS. 20.00 APPLICANT'S MOTORS SEE FEE SCH. ADDRESS J SERVICE CHANGE 20.00 Foo LICENSED CONTRACTORS DECLARATION t[w F a u I hereby u(firn that I um licensed under provisions of Chapter 9 ISSUANCE DATE vHi a i (Commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H D i Professions Code,Fhy license is in full for99yy�99�� S, o 13 - License Lic.Numher_.1 b 1'�I Is r � Ua[e_ _Contractor BUILDING PERMIT E Ic w OWNG -BUILDER DELL RATION INFORMATION w 3 LL N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD Law for the following reason. 7031.5,Business and Professions VALUATION S/FT. r w U. a g PERMIT ISSUANCE 10.00 /O! Code:Any city or county which requires a permit to construct,alter, Q w ¢0 Improve,demolish.or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC.N0. ELEC. G 0, requires the applicant for such permit to file a signed statement that TOTAL o PERMIT TO 6: TL w8 m Law he is licensed pursuant to the provisions of the Contractor's License y �/ �T ) H ¢> (Chapter 9(commencingwith Section 7000)ofDivision 3oflhe /""// /- a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE H D the basis for the alleged exemption.Any violation of Section 7031.5 STORIES - TYPE CONSTR. n3§ by any applicant for a permit subjects the applicant to a civil Penalty gLTER-DRAIN&VENT-WATER (EA.) 5.00 of not mom than five hundred dollars($500).): ❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and [he structure¢rml intended or offered for sale (Sec. 7044, Business ad 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 IC) FIXTURES-PER TRAP 5.00 so.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. GAS-EA.SYSTEM-I INC.40UTLETS 6.00 / mants are not intended or offered for sale.If,however,the building ? , or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILUMG uSE builder will have the burden of proving that he did not build or im. RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting 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 Crnlructor'S License Law does not apply to as owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contructons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. G TRACT NO. PARCEL NO. ❑ I am exempt under Sec. BAP.C.for this WATER HEATER W/VENT 6.00 G - reason r Owner Date WATER SYSTEM 5.00 V ACC.DATE ACG FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy Ihereof(Sec.3800,Lab.C.). �.',t y Q- S'8� r-� Z Policy No. Company-{fi/YLF_[{&.-� Q [] ,Cern lie do py ishereby formshe FIRESPRINK ENERGYTl4 _Z 2 Cerlilied rs filed the city ins e<lion division. MISC.- REFER TO ORD. Y ❑ N❑ V ❑ N❑ A Phcunt_ h PERMIT ISSUANCE 10.00 Q FLOOOZONE A.L.U.C. - CERI FI'A PY.7tI: 10 WORKERS' 11.1 7 MPIiNSA1'10 INSURANCE PLG.CONTR. LIC.NO. TOTAL a " ❑ ❑ 1 0 V N V ❑ N❑ (This section need not be completed if the permit is 1'or one 0 Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,1 shall not employ any person in any manner so as to �^ Q to become subject to the Workers Compensation Laws of California. BUILDING rl PO Date Applicant ALTER OR ADD TO MECH. 5.00 >_ US NOTICE TO APPLICANT': If,after making this Certificate of I'x' ♦- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comPly wily FEE U such provisions or this Permit shall be deemed revoked. AIR HANDLING UNIT(TO 10j000C.F.M.) 4.00 4 ,93 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQMC.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 S the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 R.T.U.) 8.00 MICROFILM 3097,Civ C.). p Lender's Name HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC a Lender's Address 10 I certify that I have read this application and stale that lim above VENTILATION FAN (SINGLE) 4.00 Q information is correct.I agree to comply with all city and county BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING O ordinances and state laws relating (o building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH, MECHANICAL / above-mentioned properly 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 ISSUANCE 10.00 Q -� CONST.TAX q may in any way accrue against sail City in corse uence of the gra al is perrti MECH.CONT. LIC.NO. MECH. / TOTAL Signa are p icant on[rac'or Date OFFICE COPY