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13976 POST THIS CARD NEAR FRONT OF BUILDING PER M IT NUMBER CITY OF CUPERTINO3976 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 11091 SANTA. TERESA UNIT# LOT# PERMIT EXPIRES IF WORK OWNER EUGENE COLMAN CONTRACTOR ALL WEATHER HEATING IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT IIt AWE OR 180 DAYS FROM FOUNDATION LASTCALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED J� UNDERGROUND /SLAB ' PLUMBING ELECTRICAL ISSUANCE DATE BUGEO �';IP`LG. yME N MECHANICAL . ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 7 BUILDING PERMIT INFORMATIq WOOD FLOOR —777777 vnwnnoN s/Fr. PLUMBING ' MECHANICAL ELECTRICAL PERMIT TO FRAMING INSULATION STORIESI TYPE CONSTR. OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF. SO FT FLOOR AREA TOTAL ACREAGE �Y DIAPHRAGM BUILD USE HES IND CON ON PB Ober APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING GAS,LEST - TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL FINALS. DATE INSP. ACC.DATE ACG,FILE NO. FRAMING SAN # ZONING ENG,SITE NO. INSULATION PLUMBING GAS - MECHANICAL FIRE$PRINK ENERGY T-24 —/ _ Y ❑ N❑ Y ❑ N❑ .COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LAA ,/Sp_ LATH—INTERIOR ELECTRICAL PioaD ZONE A.L.u.c. LATH—EXTERIOR FIRE DEPT. v❑ N❑ Y ❑ No , SHEETROCK GRADE - FEE SUMMARY I ' SHEAR INTERIOR - BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY- SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BYBUILDING INSPECTOR, MICROFILM I ARRANGE FOR INSPECTION BY P=252-4505 ELECTRIC UJ ONE WORKING DAY BEFORE REQPLUMBING z PLEASE GIVE JOB ADDRESS•WHEMECHANICAL _j :_',— SEE PERMIT FOR EXPIRAIMPORTANT! covsT.TAX PLEASE READ REVERSE SIDE BEFORE' TOTAL CALLING FOR FINAL INSPECTION. i OFFICE COPY ' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT ADOREss 3 7 �.Y•er� BUILDING -ELECTRICAL-PLUMBING-MECHANICAL � NER'B - PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE &La � P .7140 • L PHGNE` CONTE oRs A UTLETS-SWITCHES-RECEP 10.00/1.00 NAME 'CLl4q({� LQ� L5f'No. LIGHTING FIXTURES 10.00/1.00 DONTRACTORS APPLIANCES-RESIDENTIAL 4.00 DRESS U We �E 11 PANELS 10.00 DATE OF APPLICATION ARCHITECTPLAN CHECK FEE P.C.NO. OR PANELS IDV ER 200 AMP) 20.00 OAgll ENGINEER t Llc.NO. SIGNS TRANS. 3.00 ARCH,OR ENG. SPECIAL CIRCUIT $,OO _P ER MIT VALIDATION ADDRESS ZIP EMP.METER OR POLE INS. 20.00 %) N0 9 ANTS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 �"k• w o a LICENSED CONTRACTORS DECLARATION a u P I hereby affum that I am licensed under provisions of Clmpter 9 ISSUANCE DATE y< w (commencing with Section 7800)Of Division 3 Of the Business and BLDG. ELECT. PLG. MECH. r w i Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑ z o w- License ClassLia Number - P Date Conlmetor rt , f BUILDING PERMIT rSa OWNER-BUILDER DECLARATIONa ct W U INFORMATION DA MISC.- REFER TO ORD aa 3 LL H I hereby affirm that I am exempt from the Contractors License VALUATION $/FT. FLLOQ Law for the following reason.(Sec.7031.5,Business Professions PERMIT ISSUANCE 10.00 Cade:Any city orcounty which requires a permit to construct,alter, ES a, Improve,demolish,or repair any structure,prior to lis Issuance,also ELEC.CONTE. LIC.NO. ELEC, u requires the applicant for such Permit to file signed statement that TOTAL PERMIT TO w m m he is licensed pursuant to the provisions of the Contractor's License r- ¢> Law(Chapter 9(commencingwith Section 7000)of Division 3 oflhe a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE r D the basis for the alleged exemption.An g p heapplicnt too cion malty 5 RIE TYPE CONBTR. i ;� by any applicant for ImPlmddollars(SSOO applicant too civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC,GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Conlmclor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES,PER TRAP 5,00 50,FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments arenot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 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 of sale.). INDUSTRIAL WASTE INTER. 3000 RES IND CON PB Omer CI 1,as owner of the property,am exclusively contracting with . ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec, 7044,'BusinessLAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law docs not apply to an owner oIproperty who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA,) 1.00 contracts for such projects with a rnntructorts)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO, PARCEL NO. ❑ lam exempt under Sec.-.BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORK E RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 - I hereby affirm that I have a certificate of Consent to salt-Insure, ZONING ENG.SITE NO. of a certificate of Workers'Compensation Insurance,or u certified Copy Ihereof(Sec.3800,Lab.CJ. Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T44 _Z 2 ❑ Certified copy is filed with the city inspection division. ~ O Applicant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ w PERMIT ISSUANCE 10.00 LU - CCRI'IPICA TEEs P-XEMPTIPROM WORKIiRS' FLOOD ZONE A.L.U.c. W COMPENSATION INSURANCE PLG.CONTE. LIC.No. PLGCL , Y❑ N❑ Y❑ ❑ Z (This dollars need not be completed if the permit is for one TOTAL N hundred dollars(5100)or less.) U O I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of California. y Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING >_ m NOTICE TO APPLICANT: If,after making this Certificate of Ex- L.. Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 r o CONSTRUCTION LI7NDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE re I hereby affon that theis a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). - r HEATING UNIT(TO 100,000 B.T.U.) 8.00 I Q Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and 130ILER-COK(P(3H.P.or100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. BOILER-COMP(Over 100.0008TU1 SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 Ur CONST.TAX accrue may in any way against said City in consequence of the granting of th is perm it. MECH.CONT. LIC.NO. MECH. TOTAL tJ TOTAL Signature of Applicant/Contractor Date d6X OFFICE COPY - -