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10075El PbST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION' JOB INSPECTION RECORD I �J JOB ADDRESS ` E • y1 IIT# LOT# OWNER CONTRACTOR PFRNIITNDMBER PERMIT EXPIRATION pERM1T EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU. ANCE OR 180 DAYS FROM 1 LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPE TION RECORD FOUNDATION LIFER PREGUNITE PEO yAID TION NOV City Of CUDBrtIRO ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING - ELECTRICAL MECHANICAL B a ELECT. ❑ PLG. MECH. ❑ ❑. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL ELECTRICAL FERMI r• I s oRIEs lyf CONST9, FRAMING INSULATION OCC. GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO, FT, FLOOR AREA TOTAL ACREAGE DIAPHRAGM E BUILDINGUSE NO CON P8 ON", ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PARCEL NO, TRACT NO PARCEL NO. , PLUMBING GAS TEST MECHANICAL ELECTRICAL DgTE, INSP. ACC.OATE ACC FILE NO. FRAMING INSULATION ZONING ENG, SITE No. WELECTRICAt� - �IREPRINK "�v❑"❑D ENERGYT.j4 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED LATH—INTERIOR - ZONE v ❑ N❑ A,L,U.C. v ❑ No LATH—EXTERIOR FIRE DEPT. SHEETROCK / > GRADE FEE SUMMARY SHEAR INTERIOR BUILDING— BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occupANcv SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM LU 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 ^J OFFICE COPY oac i Foo QUU yzw ¢ n 0.- 2 m -O ww f 6060 X fav, H LLLLoj or y ¢ or eC a aero IC w EiO or v 3 A APPLIGANT TO FILL* IN tNFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY I PERMITNUMBER BU I LDING PROJECT DENTIFICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL 10075 BUILDING ADi'E55 affiSF (`t OWNER NAME K✓�S CITY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHONE DATE OF APPLICATION CONTRACTORS /rrIUAr7VNf&"C. Nyartc144 O. OUTLETS - SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS 711ADDR ss 7 PHONE APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT / ENGINEER LIc. NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARC HOR ADDRESS ENG. / ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATION PAID NOV 2 01965 EMP. METER OR POLE INS. 20.00 APPLICANT s ADDRESS (1Ay A� JmY1'' MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION TEMP. POLE 30.00 I herchy affirm that I am licensed under provisions of Chapter 9 /� �IbABIOU (Commencing with Section 7000) of Division 3 of the Business mut Professions CoJ d my license is in full forei�ff�B�I e(g/�/ License Cla s Li, Number TUU"/T'r DG. ELECT. PLG. MECH. El E Date- _Contractor O ER -BUILDER DECLARATION I hereby alalllo ing 1 am exempt from the Contractor's License Law fornthe ycitllowingreaeov.(he.uires a permit essand Professions Code: Any city or county which requiresa permit to construct, alter, also improve, demolish, or repair any stmt furl, prior to its issuance, also for such permit dr fit a signed actor's i that requires the dp pursuant he is licensed pursuant to the provisions of the Contractor's License BUILDING PERMIT INFORMATION MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION S/FT. ELEO. CONTR. LIC. NO. LEC. - TOTAL PERMIT Law (Chapter 9 (commencing with Section of Division 3 of the Business and Professions Code) or that his exempt e s exempt therefrom and QTY. PLUMBING PERMIT FEE the basis for the alleged exemption. Any violation of Section 7031.5malty byany applicant lora permit donuts $500h.licanl macivil penalty of not more than five hundred dollars (my HIE TYPE CONSTR. ALTER -DRAIN VENT -WATER (EA.) 5.00 ❑ Las owner at the property, or my employees wi0s wages as employees (heir sole compensation, will the work, and the structure is not BACK F LOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions (S Code: The Contractor's License Law docs not apply to an owner of FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenotintended or offered for sale. If, however, the building SO. FT. FLOOR AREA TOTAL ACREAGE or improvement is sold within one year of completion, the owner- builder will have the burden of proving that h e did not build or im- - . -. GAS EASYSTEM OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.).INDUSTRIAL ❑ 1, as owner of the property, um exclusively eontmcting with RES IND CON Pe other ❑ ❑ ❑ ❑ WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 licensed contractors to construct the project ISec. 7044. Business and Professions Cod, I'he Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec B.&P.C. for this reason l�- SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owoer-T� Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORKERS'COM PENSA'IION DECLARATION WATER TREATING EQUIP. 5.00 1 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 er Copy theo Set 3 Co. I-ub.C.). C N� �V Policy No. ompany FV ❑ Certified copy is hereby furnished IDcopy is fled with the city inspection division. Apphcant_p.,� l MISC. - REFER TO ORD. FIRE SPRINK y ❑ N ❑ ENERGY T-24 v ❑ N❑ PERMIT ISSUANCE 10.00 CERTIFICATE OF EXEMPTION PROM WORKERS' COMPENSATION INSURANCE 1'This section need not be Completed if the permit is for one FLOOD ZONE Y ❑ N ❑ A.L.U.O. Y ❑ N ❑ PLG. CONTR. LIC. NO. PLG. TOTAL hundred dollars ($ 100) or less.) I certify that in the Performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to CITY. MECHANICAL PERMIT FEE FEE SUMMARY become sUbjE a Workers Comiof California. ome Applicant ALTER OR ADD TO MECH. 5.00 BUILDING NOTICE DO AI'1'LICAN'I': If, aper making this Cert it irate of lix- APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=0CF.M.) 4.00 PLAN CHECK FEE empr ou, 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 dcmned revoked. AIR HANDLING UNIT(OVER 10=11FM.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, . Lender's Name / MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 am Lender's Address HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to Comply with all city and county or ordinances ad orate laws relating mO building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMM RP. or 100,000 B.T.U.) 6.00 PLUMBING BOILER -COMP IOwr t00,0008TUl SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 (WC) 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 cons e ounce of the CONST. TAX ' ing of lhi A. 8s- MECH.CONT. LIC. NO. MECH. TOTAL TOTAL Aliplature of Apphcunt/Conte tor OFFICE COPY