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13628 POST THIS RD NEAR FRONT OF BUILDING Cl OF CUPERTINO PEHMITNUM9ER `r 13628 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOBADDRESS 940 S. STELLING ROAD UNIT# LOT# - PERMIT EXPIRES IF WORK OWNER REDEEMER LUTHERAN CHURQUICTOR COGUN INDUSTRIES ISNOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD - 180 DAYS OF PERMIT ISSJ- FNCE OR 180 DAYS FROM FOUNDATION - LASTCALLED INSPECTION. UFER PREGUNITE' PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING - �-./ , ELECTRICAL :�SS_JANO AT MECHANICAL - . - BLDG. E Een. 1 F MECH. El ❑. ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION' WOOD FLOOR VALUATION s/FT. PLUMBING - MECHANICAL - - HMIT TO ELECTRICAL FRAMING STORIE TYPE CONSTR. INSULATION OCC.GHOUI' RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF SO,FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES INU. CON PB Ogmr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ . ❑ ❑ ❑ _ ASSLSSOHSFAHCFLNo. ROUGH PLUMBING TRACT NO. PARCEL NO. GAS TEST MECHANICAL .• ELECTRICAL , ACC.DATE ACC.FILE NO.�yF„INALS DATE INSP. FRAMING SAN # ' ZONING ENG,SITE NO, INSULATION PLUMBING GAS FIRE SPRINK ENE RG MECHANICAL V T29 COVER'NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v ❑ NE:] v N4 LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C. � LATH—EXTERIOR FIRE DEPT. ' v0 NYo No SHEETROCK GRADE - FEE SUMMARY. SHEAR INTERIOR - BUILDING - - SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC I PLAN CHECK GAS FEE NO'TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC • o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. 11- SEE PERMIT FOR EXPIRATION DATE = MECHANwAL IMPORTANT! covsT:rax PLEASE READ REVERSE SIDE BEFORE. CALLING FOR FINAL INSPECTION. TOTAL • OFFICE COPY - ��_ tAM T TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY G PROJECT I DENTIFIC N PERMIT NUMBER APPLICATION & P IT J�y 13628 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL PLAN CHECK VALIDATION 0 OTY. ELECTRIC PERMIT FEE CONTRACTOR'S NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 f( 'LIC.NO. LIGHTING FIXTURES 10.00/1.00 ro RacroR's PPLIANCE$-RESIDENTIAL 4.00 AD RESS / PROx g PANELS 10,00 DATE OF APPLICATION AR HITEcr OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.rvo. SIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT n 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE IN8.4 t 20.00 0. APPLICANTS MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE ',U 20.00 0 D o o LICENSED CONTRACTORS DECLARATION �J �� • 8 a v I hereby affirm that I am licensed under provisions of Chapter 9 C j, �-^'ISSUANCE DATE y w (commencing with Section 7000)of Division 3 of the Business and ¢ y BLDG. ELECT. PLG. MECH. H N z Professions Code,and my license is in full force and effect L ❑ ❑ p z m W License Class - Lic.Number y � Date Contractor P wmt a B {a ING PERMIT IS ¢o a u OWNER-BUILDER DECLARATION IXORMATION E g I- 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD H u ow - VALUATION $/FT. J Law for the following reason.(See.703 1.5,Businessand Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, r 00 ¢ or ¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. D , requires the applicant for such permit to file a signed statement that TOTAL P MIT TO X $•,a he is licensed pursuant to the provisions of the Contractor's License F z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe f 2 D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE a H $ the basis for the alleged exemption.Any violation ofSection 7031.$ STORIES TYPE CONSTR. u. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($500).): ❑ 1,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,AR EA,COND. 5.00 Code:The Contractor'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 so.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 meats are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 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. 30.00 RES IND CON PB Other ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:'I'be Contractor's License Law does not apply to an owner of property who builds or improves thereon,unit will) LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ l am 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. 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 ZONING ENG.SITE NO. copy thereof(Sce.3800,Lab.C.). Policy No. Company '0 ❑ Certified copy is hereby furnished FIRE sPRINK ENERGY T24 Z Z ❑ Certified copy is fled with the cityinspectiondivision. MISC. REFER TO ORD. p Applicant Y [] N[3 Y ED NE] p: va PERMIT ISSUANCE 10.00 � - CERTIFICATE OF EXEMPTION FROMWORKERS' FLOOD ZONE A.L.U.C. W > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. CL O ('Phis section need not be completed if the permit is for one TOTAL v N Y N� Z) 2 hundred dollars IS 100)or less.) U 0 1 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 ' O Whecome subject to the Workers'Compensation Laws of California. y Dam Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE TO APPLICANT: II',after making this Certificate of Ex- F 2 emption,YOU Should become subject to the Workers'Compensation APPLIANCE 5.0.0 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such-provisions or this permit shut[be deemed revoked. AIR HANDLING UNIT(TO 10PMC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10MIC.RM.) 6.00 SEISMIC FEE 1 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 UNIT ITO 100,000 B.T.U.I 8.00 MICROFILM 3097,Civ.CJ. Lender's Name H EATING UN IT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC 1 certify that 1 have read Ilds 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 BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize-representatives of this city to enter upon the BOILER-COMP Over 100,000 BTUI SEE FEE SCH. MECHANICAL ubovcanentioned properly futinspection purposes. (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 CONST.TAX may in any way acetic against said City in consequence of the gr is permi IF MECH.CONT. LIC.NO. MECH. / TOTAL TOTAL �/� ''��//ss Si a of Applicant/Contr Dat AP OFFICE COPY -