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13188POST THIS CARD NEAR FRONT OF BUILDING - CITY OF CUPERTINO PFNMI F NUMBER g� 6$ INSPECTION DIVISION ¢ JOB INSPECTION RECORD ' r_ 1�E PERMIT^EXPI RATION �'•' JOB ADDRESS_ 140 ROSEGARDEN LANE UNIT# LOT# - .PERMIT EXPIRES IF WORK OWNER B. KLEIN CONTRACTOR B KLEIN, IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAS INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION. _ LIFER PREGUNITE - PERMIT VALIDATION JUL 1 6,1987 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB Cit 4 Cupertino ISSUANCE DATE PLUMBING'.' ELECTRICAL MECHANICAL' - BLDG_ ELECT. PLG. MECH. ❑ ❑n ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR .. VALUATION $/FT. PLUMBING — MECHANICAL _ 7 ELECTRICAL - PERMIT ro FRAMING INSULATION _1 STORIES TYPE CONSTR. OCC. GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - SO. FT. FLOOR AREA TOTAL ACREAGE ROOF DIAPHRAGM �• - - BUILDING USE _ RES IND CON PB timer E' ❑ ❑ ❑ ❑ ' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ' ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL- FINALS DATE INSP. ACC.DATE ACC. FILE NO. FRAMING .-7 SAN INSULATION �(✓_ j('7 PLUMBING zoNlNc ENG. SITE No. GAS ' MECHANICAL FIRE SPR INK ENERGY T-24 Y NE]N[] HEATING COVER NO WORK UNTICABOVE HAS BEEN4SIGNED LATH—INTERIOR I . ELECTRICAL_ FLOOD zoNE, Y I] NQ A, L. U.C. Y I] N LATH—EXTERIOR FIRE DEPT. SHEETROCK - _ Y 9 GRADE' _ FEESUMMARY SHEAR INTERIOR BUILDING BUILDINGS '— SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY • OCCUPANCY OF BUILDING IS NOTPERMIT•TED UNTIL BUILDING FINAL ISSIGNE D 13Y BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ; LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z —SEE PERMIT FOR EXPIRATION DATE — MECHANICAL coNST.7Ax IMPORTANT! TOTAL PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. ' .. OFFICE COPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT IDENTIFICATION PPLICATION & PERMIT A BUIL NG -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 13188 BUILDING ADDRESS F (if, OWNER'S p Q.4 Z}`- 'NAME ! �� PHONE La QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION A, NAMpRAcrOR's 1a y,f,0� L OUTLETS-SWITCHES-RECEP 10.00/1.00 Q LIGHTING FIXTURES 10.00/1.00 uc. ND. yv \ ✓ CONTRACTORS ADDRESS PPLIANCES- RESIDENTIAL 4.00 PANELS 10,00 PHONE DATE OF APPLICATION ARCHITECTPLAN OR O ENGINEER uc. Na. PANELS (OVER 200 AMP) 20,00 CHECK FEE SIGNS TRANS. 3.00 ARCH. OR ADDRESS TNG. SPECIAL CIRCUIT 5.00 -PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 ZIP p �D J `7 G/Z7 APPLICANTS ADDREss b ,I / Q/� 'y MOTORS SEE FEE SCH. SERVICE CHANGE 20,00 LICENSED CON 'TRACTO SDECLARATIO7 I hereby affirm that I am licensed under provisions of ha r 9 )` Ci ' A (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License ClassudLic. Number D, Contractor .- BLDG. EL C L MECH. - -�• ❑ _ City of Cupertino BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION affirm that I so exempt from the Contractors lessens, 1 hereby the Law for the following reason. (Sec. 703 L5, permithocnd Professions county whiny structurep oconstr¢Laaeq Code:,, MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 (f VALUATION , $/FT. ELEC. CONTR. LIC. NO. TAL (N TEOLEC. QTY. PLUMBING PERMIT FEE improve, demolish, or repair any structure, prior m its issuance, also demolish, riort requires tire la permit aIIC :signedthat iliaPERMTOhe is licensed pursuant to Iliprovisions o Contractor's Llunsc Law (Chaptor9(commencing with Section 7000)ofDivision3ofthe Business and Professions Code) or that he is exempt therefrom and the basis for the allege) exemption. Any violation of Session 703 L5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): STORIES TYPE CONSTR. ALTER -DRAIN -WATER IEA.) 5.00 ❑ 1, as owner of ilia property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK F LOW PROTECT. DEV ICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF,AREA,COND. 5.00 intended or offered for sale (Sea 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE 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 GAS - EA. SYSTEM - I INC.4 OUTLETS 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 im- prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with - . -.. GAS EASYSTEM OVER 4 IEA) 200 BUILDING USE RES IND CON PB Omer ❑ ❑ ❑ ❑ 0 INDUSTRIAL WASTE INTER.' 30.00 licensed contractors to construct the project (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 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. for or such projects with a contractors) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10,00 TRACT NO. PARCEL NO. ❑ lam ,mptonder Sec. ,B.&P.C.I'nrthn' reason WATER HEATER W/VENT 6.00 _ Owner �bt,/•1/ WATER SYSTEM - 5.00 ACC.DATE ACC. FILE NO, WATER TREATING EQUIP. 5.00 WORKERS'COMPENSAHON DECLARATION 1 hereby affirm that I have a cenificate ofeansent to self -insure, or a certificate of Workers Compensation Insurance, or a certified ZONING ENG. SITE NO. , copy thereof(See. 3800, Lab,C.). Policy No. Company ❑ Ce,ilied copy is hereby furnished. Cl Certified copy is filed with the city' inspection division. Applicant FIRE SPRINK Y ❑ N[] ENERGY T-24 Y [] NE] MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A. L.U.C. COMPENSATION INSURANCE h (This section need not , completed it the permit is for one Y N Y N❑ PLG. CONTR. LIC. NO. PLG. TOTAL hundred delta" (5100) or less.) 1 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 ID QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING 9 ..i� become subject to the Workers' Compensation Laws of California. Data Applicant NOTICE 10 APPLICANT: If, after making this Certificate of I?x- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE emption, you should become subject to the Workers' Compensation provisions at the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10MC.F.M.) 4,00 AIR HANDLING UNIT (OVER 10MOC.F.M.) 6.00 SEISMIC FEE 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. 3097, Civ.C.). ' MICROFILM HEATING UNIT (TO 100,000 B.T.U.). 8.00 Lender's NamAddy Lenders Address - HEATI NG UN IT ER 100,000 B.T.U.) 9.50 ELECTRIC 0 dl) VENTILATION FAN (SINGLE) 4.00 I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and BOILER- OOMP(3 H.P. or 100,000 B.T.U.) 6.00 PLUMBING BOILER -COMP (Over 100,000 BTU) SEE FEE gCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) ee It save, indemnify an keep harmless the City of Cup,rf o gains[ liabilities, judg en costs and expenses whirl may ' y way accrue agmns City in consequ c oft gran ago is permit t MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. 7 'TOTAL TOTAL 3� -� Signalurc of Applicant/Contractor Da Vri-i" 6yrY