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13365POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD ' 10161 BUBB STREET - JOB ADDRESS - UNIT# LOT# ' OWNER 'BRAB 1. - CONTRACTOR' BARRON ELEC - PERMIT NUMBER 13365 PERMIT EXPIRATION - PERMIT EXPIRES IF WORK IS NOT STARTED WikTHIN, 180DAYSOFPERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. !{ INSPECTION DATE INSPECTOR INSPECTION RECORD F,OUNDATION - - r LIFER PREGUNITE PERMIT VALIDATION ISSUANCE BATE / RPOUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB - PLUMBING ELECTRICAL -� -MECHANICAL Jul �� BLDG. "El ELEC PLG. tMECH. ❑ ❑ [DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ity UI 'P"ef BUILDING PERMIT INFORMATION - WOOD FLOOR VALUATION $/FT. PLUMBING - - MECHANICAL ELECTRICAL •(i�(./1 PERMIT /.��Tyo , FRAMING INSULATION STORIES. TYPE CONSTR. • IP,LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ., OCC. GROUP. RES. UNITS ROOF SOFT, FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB OMer ❑ __E-1❑ 1-1 1:1ASSESSORS APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH " PARCEL NO. PLUMBING 1 GAS TEST TRACT NO. PARCEL NO. .. MECHANICAL ' ELECTRICAL' FINALS DATE INSP. ACC.UATE- ACC. FILE NO. FRAMIG- SAN # - ,INSULA . TION •• PLUMBING - zoNlNc ENc.slrENo. GAS FIRE SPRINK NE] ENERGY T 24 ❑ "❑ • MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL FLOODZONE Y 0 NE] A.L,U. C. Y ❑ N� LATH—EXTERIOR FIRE DEPT. - SHEETROCK - GRADE FEE SUMMARY SHEAR INTERIORA BUILDING - - , SHEAR EXTERIOR TEMPORARY APPROVALSBUILDING FIREWALLS ELECTRIC�,. PLAN CHECK FEE -I - GASPYA NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED' OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS,NOTPERMITTED UNTIL BUILDING FINAL ISSIGNBD BY BUILDING INSPECTOR. MICROFILM _ U.I. ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION.' Z PLEASE GIVE JOB ADDRESS WHEN.PHONING. . -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY ' •APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDI NG PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER ^ r 133 b `� BUILDING ADGREss OWNER'S NAME - QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PRONE Co Nr oRs - NAM 10 UTLETS-SWITCHES-RECEP 10,00/1.00 ILIGHTING FIXTURES 10.00/1.00 Lie. No ADDRESS s ooREss � �Q{ G APPLIANCES - RESIDENTIAL 4,00 PANELS 10.00 ONE q DATE OF APPLICATION ARCHITECT - ENGINEER / - LIC NO 1 / PANELS (OVER 200 AMP) 20,0 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCWOR ENG. ADDRESS SPECIALCIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 ZIP �f Na - ADDRESr MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 • LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000) of Division'3 of the Business and Professions Code and y license is in full fore a elle License Class Lie. Number 4 Date Contractor ., , BLDG. ELECT. ❑ PLG. MECH. ❑ ❑ qa j `7 �4 BUILDING PERMIT OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor'sMISC. Contractor's License Law for the following reason. (Sec. 703 1.5, Businessand Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also Inquires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencingwith Section 7000)of Division 3 oftle Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 703 L5 INFORMATION RVE O ORD - f t VALUATION S/FT. PERMIT ISSUANC X� 10.0010 i ELEC. CONTR. LIC. NO. ELEC. r3 TOTAL 30 I PERMIT TO /-��� C QTY. PLUMBING PERMIT FEE I STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ALTER -DRAIN & VENT -WATER (EA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve. ments are not intended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.00 S4 FT. FLOOR AREA ' TOTAL ACREAGE GAS - EA. SYSTEM -11 NC.4 OUTLETS 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,). ❑ 1, as owner of the property, am exclusively contracting with GAS- EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Other. ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 IEA.) 1.00 ASSESSORS PARCELNO. licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Centmctolh License Law. Cent, SEWER -SANITARY -STORM EA. 2008/10.00 TRACT NO. PARCEL NO. under Sec. ,B.&P.C. For this reason - WATER HEATER W/VENT 6.00 ' Owner Date SYSTEM 5.00 WATER ACC. DATE ALC. FILE NO. I''�. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified - ZONING ENG. SITE NO. - copy theref . 600, LAC.). Policy No. Company �Sjspea-C oy-,o - - FIRE SPANK ENERGY T.24 ❑ Certified copy is hereby furnished. -M Certifier "Rojs_ Oled with inspection division. Applicant- UJ y N ❑ ❑ y N ❑ ❑ MISC. - REFER TO ORD. CERTIFICATE OE EXEMPTION FROM WORKERS' PERMIT ISSUANCE 70.00 FLOOD ZONE A.L.U.C. PLG.CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE section need not be completed if the permit is for one y❑ N❑ Y❑ NE] OTY MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars (S 100) or less.) I certify that in the performance of the work for which this per- mil is issued, I shall not employ any person in any manner so as to BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK emption, you should become subject to the Workers' Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked FEE AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=QF.M.) 6.00 SEISMIC FEE. CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.CJ. ' HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEAT[ NG U N IT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC 3o Lender's Name Lender's Address I certify that I have read this application and slate 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 IOver 100,000BTUI SEE FEESCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless tile City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue, against said City in consequence of the PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL granting of this permit. tl-Sr/ Silpt of Applicant/Contractor Date OFFICE COPY