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12654oPOSTTHISCARD NEAR, FRONT OFBUILOING Vn '. CITY OF CUPERTINO PFRMIT NUMBER 12654 INSPECTION DIVISION JOB. I.INSPECT,I/ON,R��E�CORD •:" 1o3'FSO LFI Dce I)'a PERMIT EXPIRATION' JOB ADDR ESS - 71Vf� UN LOT# I _PERMIT EXPIRES IF WORK OWNER CONTRACTOR, IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION,• INSIfECTION DATE INSPECTOR INSPECTION R CORD FOUNDATION p -J&- UFER PREGUNITE. - I. I PERMITVAUDATION " n " KITUR NOICONCRETE UNTIL ABOVE HAS BEEN SIGNED ,. -t r1n. UNDERGROUNID_/SLAB PLUMBING' 9 r jut: ELECTRICAL f - ^'— L•IS$UANCE DATE' ' ' - I �( �,C CT. PLG. MECH.'� MECHANICAL - „ n '4 �BUaoINU ID 0 "C]. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED PERMIT -INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL PERMIT TO ELECTRICAL _ - I •" Y , J (� FRAMING - - IN CATION7 STORIES TVPE comsTR, .441 OCC. GROUP .RES. UNITS IP.LTACE NO SUBFL OR UNTIL ABOVE HAS BEEN SIGNED ROOF" $O. FT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUIL UING USE. - 3 RES 'IND CON PB DO.., 29 ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PAHCEL NO. 71"m ,. _ _ N' w,, •' ROUGH PLUMBING "pc 007'0 q 9 -i % GAS TEST' 16 '-30-F7 TRACT N0. PARCEL N0. ' MECHANICAL ELECTRICAL ., FINALS INSP.FRAMING ACC'DATE -ACC. FILE NO. �•JD"ATE SAN # IA153 8r•, ' INSULATION -• PLUMBING .• ZONING ENG. SITE NO. ,GAS.'MECHANICAL FIRE SPRINK ENERGYT24 i ❑�'❑N❑ V ❑ N=Al COVER NO WOR NTIL ABOV HAS BEEN SIGNED HEATING FL000 zoLATH-EXTERIOR`' r ❑ LATH -INTERIOR _ ELECTRICAL' FIRE DEPT- SHEETROCK (;4- rJ. GRADE FEE SUMMARY SHEAR INTERIOR BUILDING -BUILDING SHEAR EXTERIOR ; TEMPORARY APPROVALS. - FIREWALLS r ELECTRIC '%� -_ PLAN CHECK FEE. GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEISMIC FEE j r %Y• OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDINGFINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM T. . ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC ��, T) — 11J ONE WORKING DAY BEFORE REQUIRED INSPECTION. Q PLEASE GIVE JOB ADDRESS.WHEN PHONING; - PLUMBING-, MECHANICAL ' - Z' -r. —SEE PERMIT FOREXPIRATIONDATE— CONST. TAX IMPORTANT! TOTAL 7 C %� 9% PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. _ OFFICECOPY - r " APPLICANT TO FJLL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FICATION APPLICATION &PERMIT ELECTRICAL-PLUMBING-MEMECHANICAL PERMIT NUMBER 12654 EIIILOING ADORESs 0 PLAN CHECK VALIDATION CITY ELECTRIC PERMIT FEE I v/+DNE 446-1913 T TRAc7oRsNAME qq UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10,00/1.00 DebCOr Corooratill LIC.No. 365712 CONTRACTOR'a ADDRESS21625 Stevens Creek Blvd PPLIANCES-RESIDENTIALp.00 IPANELS 10.0016 Cupertino, 95014 PRONE 446-1913 DATE OF APPLICATION cRlTlicT on, Seals & Assoc .c-15162 ENGINEER • Ste hen' Clark uc. NO C-6362 2000 PANELS (OVER 200 AMP) . PLAN CHELK.FEE SIGNS TRANS. 3.00 ARCH. OR ENG. ADDRESS Seals, Oakland, CA SPECIAL CIRCUIT 5,00 PERMIT VALIDATION rrEMP. METER OR POLE INS. 20.00 Clark, r IP 1"] �] APPLICANTS ooiess T9 I MOTORS I fSEE SEE SCH. CHANGE 20.00 21625 StevensSERVICE L v' LICENSED CONTRACTORS DECLARATION 1111 9. '! 1 T, % v y 1 hereby afl'ina that I not licensed underprovisionsof Chapterl) (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Cla§s, Lic. Number_HS]12�� S DANTE Pau Pf Pis f Yf.I ID BSDG : LECT!t I I•PLG. MECH. - -7 Dale • /it]l ti -Contractor-Dencor Corp- BUILDING PERMIT - OWNER -Il UI1.DI!E DECLARATION I hereby affirm that I am exempt from the Contractor's License Code:Law rthe Anycitylorcountywhicng reason. Sec.uires a permBusiness t tocostProfessions Code: Code: Any city or county which structure permit loconsua ce, also IIIIpfOVc, demOI15I1, Or repair any $/NCtllle, prior IO Its ISr11a11Ce, aI50 requires the applicant for such permit to tile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and INFORMATION' MISC.- REFER TO ORD - VALUATION $/FT. -� PERMIT ISSUANCE 10.00 7<0 -- ELEC. CONTR. LIC. N0. ELEC. / TOTAL 166- PERMIT TO OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 703 t.5 byanyapplicant fora permit subjects theapplicanttoacivilpenalty .four more than five hundred dollars ($500) ): �. �y✓ /J'� ALTER-DRAIN&VENT-WATER(EA.) 5.00 ❑ I, a5 owner of the property, or my employees with wages as Iheir 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 does not apply to an owner of property who builds or improves thereon, and who docs such'work himself or through his own employees, provided that such improve- mends are not intended oroffered for Sale. If, however, the building SO. FT. FLOOR AREA �' �S 9,�D TOTAL ACREAGE - . _ 13 FIXTURES - PER TRAP 5.00 S I GAS - EA. SYSTEM -1 INC.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 ProveforPurposeofsele.). ❑ I as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE R�5 I❑ ON ❑ Other °�C INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a contractors) licensed pursuant to the Contractors License Law.. ❑ I am exempt under Sec. ,B.&I'.C. for this reason SEWER-SANITARY+STORM EA. 200ft/10.00 I /(0) TRACT NO, eO PARCEL NO, I WATER HEATER W/VENT 6.00 --• Owner . Date WATER SVSTEMI +-''r 5.00 ACC. DATE' ACC. FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof(SEe 3g00, Lab.C.). Policy No. Cnlnp.Ry USF & G - - �;i .1 n env}j- D ZONING ENG. SITE NO. " - AW Certified copy is hereby furnished. Cenifiebe�+Y OS _EIWOwIm the city inspection division. A PP Went CC:: LL'' ll:: ��--kk'' FIRE SPRINK y N � � ENERGY T-24 Y N � []- MISC.- REFER TO ORD. PERMIT ISSUANCE 10.00 Q CERTIFICATEOFEXEMPTIONFROMWORKERS• FLOoo ZONE A.L.U.C. PLG, CONTR. LIC. NO. PLG. /A TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y N y N 1-1 QTY. MECHANICAL PERMIT FEE FEE SUMMARY humdroG dollars ($100) or loss.) 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 10 become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex- BUILDING ALTER OR ADD TO MECH. 5.00 APPLIANCE-„ 5.00 AIR HANDLING UNIT (TO 10000C.F.M.) 4.00 PLAN CHECK FEE - emption, you should become subject to the Worker' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. UNIT,IOVER 10 DC.F.M.) 6.00 -SEISMIC FEE- /,2' CONSTRUCTION LENDING AGENCYAIRHANDLING Thereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). I I 1' EXHAUST FOOD"(WITH DUCT) 5.00 s� MICROFILM I HEATING UN IT ITQ 100,000 B.T.U.) 8.00 HEATING UNIT'(OVER 100,000 B.T.U:)9:50 - ELECTRIC /�a .- Lender's Name - Plaza -Rai A]C Leader'sAddre« ma n lvd._SJ-9.`311 I certify that I have read this application and state that the above information is correct. I agree t0 c mply with all city and county ordinances and state laws relatingtobuilding construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING $' BOILER- COMM H.P. Or 100,000 B.T.U.) 6.00 BOILER -COMP lover 100,000 BTU) SEE FEESCH, MECHANICAL 34 -- hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - '" REFER TO ORD. - CONST. TAX py a y (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 in consequencerof the PERMIT ISSUANCE 10.00 0 mnti of this III t 7 CONT. LIG. NO. MECH. TOTAL 3 TOTAL � aK� Signature o licant ConactorDate OFFICE COPY