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11666 POST THIS CARD NEAR FRONT OF BUILDING ' PP.RMIT NUMRFR CITY OF CUPERTINO 11666 INSPECTION DIVISION f • JOB INSPECTION RECORD I ^1� �1/(,A //,/// /V�� /w PERMIT EXPIRATION ' JOB ADDRESS �o /•�(��L� '��-uK1l-F#!-� / _LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION 0 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL - ISSUANCE DATE MECHANICAL BLDG_ ELECT. PLc. MECH, DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION ' WOOD FLOOR .. vAL rloN 7$/FT. PLUMBING ] - MECHANICAL - I 1 1 ELECTRICAL - PEHMITTD FRAMING I D-3 STORIES TYPE CONSTR. INSULATION UCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF ' SO.FT.FLOOR AREA TOTACACREAGE DIAPHRAGM - BUILDING USE RESIND CON PB OInX1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSE55ORS PARCEL NO. ROUGH PLUMBING d• 6 TRACT NO. PARCEL NO, GAS TEST: - MECHANICAL p�� -�i ACC.DATE ACC FILE NO. ELECTRICAL p- FINALS DATE INSP. FRAMING SAN # - INSULATION PLUMBING zomwG ENG.SITE NU / S GAS MECHANICAL n FIRE SPRINK ..ENERGY T)9 . , 8 . Y ❑ N❑ Y ❑ N❑ COVER'NO WORK UNTIL ABOVE HAS BEEKNIIGNED HE FLOOD ZONE A.LLLC. LATH—INTERIOR E ECT CAL LATH—EXTERIOR Q SFI E DEPT, - Y ❑ N❑ Y I] N❑ SHEETROCK _ G DE - FEE SUMMARY SHEAR INTERIOR BUI I 7 SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING r FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE O OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGN EDBY BUILDING INSPECTOR, MICROFILM 1 ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC _wLN ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. -Jz SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY - LLAPPUCANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL, POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT aODRE55., 116 66 9 DIV I BUILDING - ELECTRICAL-PLUMBING-MECHANICAL RWNERS f� PLAN CHECK VA ATION • AME QTY. ELECTRIC PERMIT FEE 13 vslr� PHONE CONTRACTOR'S OUTLETS-SWITCHES-RECEP 10.00/1.00 f/ NAME rvo. 7S 4�iwl 1APPLIANCES LIGHTING FIXTURES 10.00/1,00 (/1! DDRESCTOR's A -RESIDENTIAL 4.00 CONTRA PHOrvE, PANELS 10.00 DATE OF APPLICATION PrtECTGri I.+�`1�/tr (+ ✓G• PANELS (OVER 200 AMP) 20= PLAN CHECK FEE P.C.NO. no RL.. ENG W EEO uc,rv0. SIGNS L TRAN5,00 PERMIT VALIDATION UIT S. 3,00 ARCD.OR ENG. SPECIACIRC10 ' ADDRESS ZIP TEMP.METER OR POLE INS. 20.00 n P APPLICANTS MOTORS SEE FEE SCH. ADDPE55 E SERVICE CHANGE r 20: 0 U/fd` w '02 LICENSED CONTRACTORS DECLARATION <u v I hereby affirm that 1 am licensed under provisions of Chapter 9 V l.1 �. ISStlr{NE AME. z w (commencing with Section 7000)of Division 3 of the Business and D i Professions CoderV my license is in full fore BLOC. ELECT. PLG:' '�ME H. z i y W License ss_ Number�.j�2`'Y_!�- VI Y 0 (,51(`1(1 30 �- O H Date - CDnhac[ar_ a EX u E� BUILDING PERMIT w OWNf:R-BUILUIER DIECLARATION w u _ I hereby affirm that I am exempt from the Contractor's s Liconse MISC.- REFER TO ORD INFORMATION as a_ Law for the following reason.(See,7031.5,Businessand Professions PERMIT ISSUANCE 10.00 Q ', ,VALUATION S/FT. to Code:Any city or county which requires a permit to construct,alter, �'�/^\O� Se Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. ��- f(/L f or D requires the applicant for such Permit to file a signed statement that TOTAL PERMIT TO u w 8 he is licensed pursuant to the provisions of the Contractor's License ar Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe i a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE F=. the basis for the alleged exemption.Any violation of5eclion 7031.5 1 STORIES TYPE CONSTR, by any applicant for a permit subjects the applicant to a civil penalty - ALTER-DRAIN&VENT-WATER IEA.) 5,00 of not more than five hundred dollars(55000.): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:Tine Contractor's License Law does not apply to an owner of . properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 /✓ a0.FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 8.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE Prove for purpose ofsale.)' INDUSTRIAL WASTE INTER. 30.00 - RES IND CON PB Omer ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ Iicenud contractors to construct the project(Sec.7044,Business 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 LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY- Tb A.200 the TRACT No, PARCEL NO. reason l am exempt under Sec..,BAKC.for this WATER HEATER�WV NT 6.00 Owner Date WATER SYSTEM - 1; '" ' 5.00 ACC.DATE ACC,FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATI G EQUIP. 5.00 I hereby affirm that I have a certificate ofconsent to self-insure, "7 n, If10 ZONING or eof( o6 Workers'Compensation Insurance, or a certified ENG.SITE N0. copyy thereof(Sec. ). - Policy No.-Company Q ❑ R�Mfied Copy is hereby furnished. FIRE SPRINK ENERGY TIa Z Z IpiCertifie coy filed with 't inspection division. P MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ Q Applicant V N V N y PERMIT ISSUANCE 10.00 /(J �"' � ' CERTIFICATE OF EXEMPTION ROM WORKERS' FLOOD ZONE a.L.U.C. LU _ COMPENSATION INSURANCE. PLG. N R L . O PLG. ,.try Q. O (This section need not be completed if the permit is far one TOTAL ��/ v❑ N❑ V❑ N❑ 0 Z hundred dollars IS 100)or less'.) U O I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT" FEE FEE SUMMARY LL f- mit is issued.I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. C. to Dmc Applicant ALTER OR ADD TO MECH. 5.00 •� BUILDING C r >_ to NOTICE TO APPLICANT: If,after making this Certificate of Ex- F Z emplion,you should become subject to the Workers'Compensation APPLIANCEP7,a eF 5.00 PLAN CHECK his provisions of the Labor Code, you must forthwith comply with FEE 7T U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER1g000C.EM.) 6.00 SEISMIC FEE .fz 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. I MICROFILM 3097,Civ C.). HEATING UNITITO!90,090,B-'TP-) 8.00 �i Lender's Name Lender's Address ELECTRIC HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 7d", I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 •) U information is correct. 1 agree to comply with all city and county PLUMBING J ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.1 6.00 ��yy � hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL 014 CA�_ above mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and -Pen"..which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 O granting of,this MECH.CONT. LIC.NO. MECH. -a7 =,K'�. 39a�1�3 TOTAL 9 TOTAL �(a� v"✓ ignatureaf Applican/ onlractor Date OFFICE COPY