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12789 POST THIS QARD NEAR FRONT OF BUILDING ' COO OF .CUPERTINO 0 PfR 11TN MRER INSPECTION DIVISION 1.2799 JOB INSPECTION RECORD _ r PERMIT EXPIRATION JOB ADDRESS T - LOT# /1 PERMIT EXPIRES IF WORK OWNER CONTRACTO { IS NOT STARTED WITHIN INSPECTI DATE INSPECTOR fNSPEcTiON RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION _i ANCE OR 180 DAYS FROM LAST CAJD LIFER MPECTI ON. PREGUNITE PERMIT VALIDATION MAR 2 0 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ; ./CO.Of CUp8rI1R0 PLUMBING - - - - ELECTRICAL . ISSUANCE DATE - MECHANICAL -BL c .ELECT. I PLG. I MECH. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING P aM WOOD FLOOR T INFORMATI VALUATION SIFT, PLUMBING MECHANICAL ELECTRICAL - , PERMIT To FRAMING h - INSULATION _L r4,Jf'� c SGa STORIES TYPE CONSTR. r , OCC.GROUP 'r RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF '. $O,FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM - BUILDING USE RES IND CON PB OIM1rI APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑/ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT NO PARCEL No GAS TEST . MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING �, L 'tC.J.- -�� SAN INSULATION PLUMBING zoNlNc ENG.SITE No. GAS - . MECHANICAL' _ FIRE SPRINK' ENERGY T94 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Yo. N� ` 11 NEI . ILATH-INTERIOR - _ ELECTRICAL FLOODZONE AL.U,C. ' LATH-EXTERIOR y" .FIRE.DEPT. - v0 N❑ vC] NE, SHEETROCK - p.. GRADE . FEE SUMMARY SHEAR INTERIOR BUILDING _ SHEAR EXTERIOR -.( TEMPORARY APPROVALV Ir BUILDING FI REWALLS ELECTRIC - PLAN CHECK ' GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC �► Fw ONE WORKING DAY BEFORE REQUIRED, INSPECTION. PLUMBING >� z PLEASE GIVE JOB ADDRESS WHEN.PHONING. -,SEE PERMIT FOR EXPIRATION DATE MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL PCiNT-PEN ONLY BU LDI NG PROJECT I DENTIFICr PERMIT NUMBER BUILDING APPLICATION & PAT ` '2 BUILDING -ELECTRICAL-PLUMBING -MECHANICAL12789 bNNER'SJ - I/ PLAN CHECK VALIDATION NAME TY. ELECTRIC PERMIT FEE PHONES, conTRA T R 23�.<�O B�• UTLETS-SWITCHES-RECEP 10.00/1.00 N ME IN .4433 ILIGHTING FIXTURES 10.00/1.00 S ✓ "CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 J A Oness /J s �/ PHONE,( PANELS 10.00 DATE OF APPLICATION AR mTECT - - PANELS (OVER 200 AMIN 20.00 PLANCHECK FEE .C.NO. OR ENGINEER . sec.No. SIGNS TRANS. 3.00 17RCHSENO .SPEOIALCiIRC.UIT 5,00 PERMIT VALIDATION ADDRES zip TEMP.METER OR POLE INS. 20.00 PAID APvucANTS MOTORS SEE FEE SCH. AOOR �� p / SERVICE CHANGE 20.00 w o o LICENSED CONTKA RS DECLARATION rt is. I hereby affirm that I am licensed under provisions of Chapter 9 Q CE DATE N< w (commencing with Section 7000)of Division 3 of the Business and DG. ELECT. PLO: MECH. H O i Prufnsions Codc, I my hcenm is in full for, cad of e / ❑ El ❑ o a 2 - Licen ass_ Lic.Number , H u, Dote. Contractor BUILDING PERMIT ¢ ¢ BE sE OWNER-BUILDER DECLARATION INFORMATION W I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD P VALUATION $/FT. HLLo ¢ Law for the following reason.(Sue.7031.5,Ihuilassand Professions PERMIT ISSUANCE 10.00 Cod,Any city or county which requires a permit to consuRmt,alter, re Q ¢Q Improve,demolish,Or repair any stonture,prior to its Issuance,also ELEC.CONTR. LIC.NO. ELEC. - O u requires the applicant for such permit to file a signed statement that TOTAL �O PERMIT t o w$m he is licensed pursuant to the provisions of the Contractor's License \ - / H x r Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe �d/ /C 0'x/ ZZ ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT - FEE ¢ F $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. w. by Buy applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(S500).): ❑ 1,as owner of the property,or my employees with wage;as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the stmmeture is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractors License Lsw does not apply to an owner of properly who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 S¢FTpLOOggREA TOTAL ACREAGE himself or through his own employee,provided that such improve-dens are not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM-11N C.4 OUTLETS 6.00 orimprovement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- proveforpurposeofsole.). INDUSTRIAL WASTE INTER. 30.00 RE INO coN PB Omar ❑ I,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec 7044,Rosiness LAWN SPRINKLERS-1 INC 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 ILAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractods)licensed pursuant to the Contractor's License Law, SEWER-SANITARY-STORM EA.200f1/10.00 - TRACT NO. PARCEL NO. ❑ lamexemplunder See. ,B.&P.C.fer this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK IiRS'COMPI:NSATION DECLARATION WATER TREATING EQUIP. 5.00 I lmreby affirm that 1 have a cefific,le of consent Inseif-insum' ZONING ENG.SITE NO. or a chore cam of Workers'Cnmpen. tion Ip.ym9Le,gt..n cerljt iuA copy thareoC(Scc.7ROQ Lab.C.l. Polity No. Company Hoed y� hereby fu FIRE SPRINK ENERGY T-24 Z � ❑ Ce i aop is Bled ilh a city ins ti I division. MISC.- REFER TO ORD. /' ppll Y❑ N❑ Y ❑ N❑ Fy - Cr CERTIFICATE PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. e COMPENSATION INSURANCE W _ COMPENSAURANCE PROM WORKERS' PLG.CONTR. LIC.NO. PLG. Y❑ N❑ v ❑ IN F] CL ❑ I'I'his section Deed not be completed if the permit is for one TOTAL Z hundred dollars($100)or less.) U O 1 certify that in the perfommnce of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY L U mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. Ed Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- I- ? emptier,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.EM.) 6.00 SEISMIC FEE - U I hereby affirm that there is a construction lending agency forD (W ITH DUCT) 5.00 Elie Performance of the work.for which this permit is issued(Sec. HEATING UNITIVO 100,000 B.T.U.) 8.00 MICROFILM 3097,CD.CJ. - Lender's Name Address Lender's Address HEA IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC e/O •� I certify that I have read this application and stare that the above VENTILATION FAN (SINGLE) 4.00 information is come[.I agree to comply with all city and county PLUMBING �'a• ordinances and Stam laws relining to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above�menllured property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against .21, Nea,jud cols, costs and expenses which CONST.TAX any'Way act,/ ag t said City in consequence of the PERMIT ISSUANCE 10.00 a ns 0f this ! MECH.CONT. LIC.NO. MECH. TOTAL TOTAL 'Sigruttye c pplicant/Contractor Date OFFICE COPY