Loading...
12793POSTTHIS qWD NEAR FRONT OF BUILDING ' CITrOF CUPERTINO / INSPECTION DIVISION �j? JOB INSPECTION RECORD I Ino /1 (C/ JOB AD RESS O � # I�" LOT# OWNER © R PERMIT NUMBER 12793 l PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. 'INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION 3 -lam` ?Ro17'w'a �� - ov SUIT¢ /oo -/Zo UFER PREGUNITE 3`�o�a / $/f�i�G $ri 7AZ /Oo.-17a PERMIT VALIDATION ' /Q' V issu NCE Dare POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL - a G ELEc PL M c 91 . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED eul olNc ERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL ELECTRICAL ERMI n' FRAMING INSULATION � , STORIES TY CONSTR. Occ. GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF :ip. FL FLOOR AREA TOTAL ACREAGE DIAPHRAGM - _ ' BUILD USE H 0 ES IND O PR Owe, ❑ 0 ❑ ' 0 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH PLUMBING ASSE550 5P RCEL NO. GAS TEST e rRAcr No. PARCEL No. MECHANICA0 ELECTRICAL Y 0-•$ FINALS DATE INSP. ACC. GATE ACC. FILE NO FRAMING P �� - % SAN# INSULATION PLUMBING ZONING 'ENG. SITE No. GAS MECHANICAL FIRE SPR INK Y E) Nol EN ERGYT2< A � "� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL FL00020NE A.L.U.C. LATH—EXTERIOR FIRE DEPT.' SHEETROCK- GRADE - FEE SUMMARY SHEAR INTERIOR BUILDING — BUILDING .µ SHEAR EXTERIOR TEMPORARY AP -ROYALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPgNcv SEISMIC FEE ' OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505„ o� 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 7Q' Or rICE COPY APPLICANT TO FILL IN INF0gft-xTION WITHIN RED LINES - USE BjL POINT PEN ONLY PERMIT NUMBER BUI LOI NG PROJECT I DENTI FICA APPLICATION & PE BUILDING -ELECTRICAL -PLUMBING -MECHANICAL 12793 BUILDING _ °DRE66/Oo ss .�/ 7 . f �� t. ANER_ONNQ�eq LT NnME_.--•`�-�'�- C ' PHONE /f, / CITY. ELECTRIC PERMIT FEECxNTn PLANCHECK VAL ON DATE OF APPLICATION NAME AcroRs UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 (�CjOONNTRACTORS r r✓b`_ ,,HWl//N �R-&,� q /r _.j]/PHONE APPLIANCES- RESIDENTIAL 4.00 10.00 ARCHITECT OR ENGINEER LIC. No _PANELS PANELS (OVER 200 AMP) 20.08 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADDRESS ENc' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION TEMP. METER OR POLE INS. .20.00 zm " PAR p 1 B (j T119�� ASxr$ ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00. LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and y license is in full force o effrzC� / License Class Lic. Number ISSUANCE DATE B I PLG. MECH, ❑ ❑ are /Contractor t OWNER -BUILDER DECLA ATION I hereby affirm that I am exempt from the Contractor's License Professions Law ferny city or countng y which requires a permit to p permit to consua c alter, Code: Any city or county it any structure, improve, demolish, or repair any structure, prior t° its 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 Law (Chapter 9(commencingwith Section 7000) of Division 3 ofthe Businessand Professions Code) or that he is exempt therefrom and BUILDING PERMIT INFORMATION MISC. - REFER TO ORD VALUATION S/FT. PERMIT ISSUANCE 10.00 ELEC. CONTE. LIC, N0. ELEC. TOTAL PERMIT TO lA%%prG /H����ssss,���ssss�0(0, CITY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 1 by any applicant for a permit subjects the applicant tea civil penalty of not more than five hundred dollars (S500f): 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 REB. UNITS DRAINS -FLOOR, ROOF, AREA, 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 6Q. FT, FLO0R AREA TOTAL ACREAGE GAS-EA.SYSTEM-11NC.40UTLETS 6.00 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 int- prove for purpose ol,,del'INDUSTRIAL O I, as owner of the property. am exclusively contracting with - . .. GAS EASYSTEM -OVER 4 (EA) 200 BUILDING USE RES IND CON PB Otha, ❑ ❑ ❑ ❑ ❑ . WASTE INTER30.00 licensed contractors to construct the project (See. 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 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00con ASSESSORS PARCEL NO. the Cont forsuch the ctor'shceneclswitha contractors) licensed pursuant to License Law. SEWER -SANITARY -STORM EA. 200ft/10,00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-, B.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. GATE ACC. FILE N0. WATER TREATING EQUIP. 5.00 WORK ERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certifieme of Workers Compensation Insurance. or a certified ZONING ENG. SITE NO. copy thereof(See. 3800, Lab.C.L eeT -s' Policy No. Company U / A' FIRE SPR INK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ `O� Certified copy is hereby furnished. s�Certifie y is filed with t c't 'n pection ision. Applicant ] C6* , ! MISC. - REFER TO ORD. CE EXEM 'ON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG.CONTR. LIC. NO. PLG.' TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ N❑ Y ❑ N❑ hundred dello rs (S 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 BUILDING �7Q 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 MECH500 . . 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 10MC.F.M.) 4.00 AIR HANDLING UNIT (OVER I0,000QF.M.) 6.00 SEISMIC FEE p CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued (Sec.HEATING 3097, Civ.C.). MICROFILM UNIT (TO 100,000 B.T.U.) 8.00 HEATING UN IT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Lender's Address 1 certify that I 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 ordinances and state laws relating to building construction, and PLUMBING BOILER- COW (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which ma in any way accme, against said fly in consequence of the CONST. TAX PERMIT ISSUANCE 10.00 grti of lhi a MECH.CONT. LIC. NO.4,41 TOTAL TOTAL 02 > Signott e o App llcanl/C tractor D e� OFFICE COPY