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11833f JOB ADORE S OWNER INSPi FOUNDATION LIFER PREGUNITE MBING MECHANICAL ELECTRICAL FRAMING INSULATION FIMIIIIIJ, DIAPHRAGM APPLY NO R PLUMBING GAS TEST . MECHANICAL ELECTRICAL i . ,FRAMING I NSU LATI ON POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO . INSPECTION DIVISION JOB INSPECTION RECORD l`✓�'Vl� �Vi �NI/L (/S_UNIT# MACONTRACTOR :CTION JDATE INSPECTOR INSPECTIO I Y UNDERGROUND./SLAB ROOF UNTIL SAN * PLUME GAS PFRNIIT NUMBER 11833 PERMIT EXPIRATION LOTS#,r PERMIT EXPIRES IF WORK I.4A lhA IS NOT STARTED WITHIN IECORD180 DAYS OF PERMIT ISSU- atnLw� ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. rCT R7 1.186) City of Cupertino ISSUANCE DATE . ELECT. PLC MECI l o. BUILDING PERMIT INFORMATION J IPERMIT RES IND ENG SITE NO. MECHANICAL FIRE SPRINK v�N� [NtRGV I"I4 "y� NQ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE `'❑ No A,LLLC. Y❑ N❑ LATH -INTERIOR ELECTRICAL LATH -EXTERIOR- FIRE DEPT. SHEETROCK 2, 18 GRADE FEE SUMMARY SHEAR INTERIOR BUILDING - BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS - ELECTRIC PLAN CHECK FEE GAS SEISMIC FEE _ NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEO BY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252-4505, F ONE WORKING DAY BEFORE REQUIRED INSPECTION. D� .• PLEASE GIVE JOB ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - MICROFILM' ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE_ CALLING FOR FINAL INSPECTION. TOTAL ' OFFICE COPY. . O Z_ Z y D= - LU CL Z) Z UO LL U Ow I"' Z Z E APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ti a::1jBU I LDING PROJECT IDENTIFICATION APPLICATION &PERMIT BUILDING -ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 11833 °"'LGI"° AaoRE�D � OWNER OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHONE - DATE OF APPLICATION CONTRACT ORS NA E OUTLETS -SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.0011.00 CONTRADDREACTOR's - ACTO )) lea / 'f) JVPT /L V Ld,NJ?HON E.9,) �VOV PPLIANCES- RESIDENTIAL 4.00lqq PANELS 10.00 ARCHITECT - OR V' ENGINEER L .No. � PANELS (OVER 200 AMP) 20,00 PLAN CHE�FEE P.C. NO. SIGNS TRANS. 3.00 ARCH.OR ENG zIP SPECIALCIRCUIT 5,00 C%MITVALIDATION City�" of �S UQ�rfl?o EMP. METER OR POLE INS. 20.00 ASC ADDRESSCJ 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 Professionsco aP y license is in full far cy Licensq ass v Lic. Number -� BLD ELECT. El PLG. MECH. ❑ 11Dalel-'6L=Qt �+slJ. Contractor. BUILDING PERMIT OWNER -BUILDER DECLARATION I hereby affirm ing I am exempt from the Contractor's License Law for the followingreason, ywhi Sec.uiresa permittocnstrofessions coq Code: Anymolish countywh icy structureP prior to improve, demolish, or repair any structure, prior tO ifs issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License INFORMATION MISC. - REFER TO ORD VALUATION A �}Q S/FT.. PERMIT ISSUANCE 10.00 ELEC. CONTE. 4C. NO. ELEC. TOTAL PERMIT T OTY. PLUMBING PERMIT FEE 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 Sect ion 7031.5 STORIES TYPE C STP. ALTER -DRAIN & VENT -WATER (EA.) 5.00 by any applicant for a permit subjects the applicant toacivilpenally of not more than five hundred dollars (S500L): ❑ 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 (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 Code: The Contractor's License Law docs not apply to an owner Of whdoes o work who builds or improves thereon and h property p FIXTURES - PER TRA P 5.00 sG. PT.PLooR ARE A T TALA REAGE o c such improve- counts are not intended or offered for sale. If, however, the building mental re through his own employees, provided that such int ilding ments GAS - EA.SVSTEM - i INC. 4OUTLETS 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 licensed contractors to construct the Project (Sec. 7044, Business GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING USE RES IND PB Omer ❑ ❑ ❑ El INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSO13SPARCEL NO. and Professions Code: The Contractor's License Law dues not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS - OV ER 5 (EA.) 1.00 contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA, 200ft/10.00 TRACT NO. PARCEL N0. ❑ lam exempt under Sec. ,B.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Data WATER SYSTEM 5.00 - ACC. DATE ACC. FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workeri Compensation Insurance, Or a certified ZONING ENG. SITE NO. copy thereof (Sec. 3800, L.ab.C.). - Jkleky NO. Company 0rlifia1 copy is her by furnijbcd. ❑ Cc tiffl jIj, o y Is I d wI t My insp oI division. pplicanlOta-7 FIRE SPRINK Y ❑ N❑ ENERGY T-24 Y [:]N ❑ MISC. - REFER TO ORD. PERMIT ISSUANCE 10,00 FLOOD ZONE A.L. U.C. RTIFICATE 017 EXEMPTION FROM WORKERS' PILO. CONTE. LIC. NO, PLG. TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y❑ N❑ Y❑ N❑ MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars 0100) or less.) I certify that in the performance Of the work for which this per-OTV mit is issued, I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California. Data Applicant NOTICE 'TO APPLICANT: 11, after making this Certificate of Ex- emption, you should become subject to the Workers' C°nspensation BUILDING p J' ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 31a I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Cre.CJ. - EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.0.50 ELECTRIC Leader's Name Lender's Address VENTILATION FAN (SINGLE) 4.00 PLUMBING I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property 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 i consequence of the MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 . MECH. CONT. Mg TOTA ECH TOTAL p {i ' Stgna[ure Of pplicanl/ ontractor Date OFFICE COPY