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09555 POST THISD NEAR FRONT OF BUILDING CIT�OF CUPERTINO � � ` PFRMITNUM1,BER` _j INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS D DD '� # LOT# � , - PERMIT EXPIRES IF'WORK' OWNER cONTRAcroR ?/ .' IS" NOT•STARTED WITHIN INSPECTION DAT INSPECTOR 1 ECTION RECORD 180 DAYS'OFPERMIT ISSU- FOUNDATION G - ANCE OR 180 DAYS FROM. LIFER /V D-'D'8S z ' LASTCA'LLED INSPECTION. PREGUNITE - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ; PLUMBING ELECTRICAL UANCE D TE MECHANICAL - - PBLuc. ELECT. PLG. M cR ` DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDeu DING BaM WOOD FLOOR I FORMATIO PLUMBING VALUATION - $/FT. .. MECHANICAL - ' ELECTRICAL � _ PERM,ILT ro A o FRAMING INSULATION - STORIES TYPE.c TR, - OCC.GROUP •RES.UNITS ` PLACE NO SUBFLOOR• UNTILABOVEHAS BEEN SIGNED 'ROOF .. SO 'T,FlO01i wREA TOTAL ACREAGE .DIAPHRAGM i nu U.DING USE RE IND CON PB O,h,, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ '❑ ❑ ROUGH - : ASSESSORS PARCEL NO, PLUMBING GAS TEST TRACT NO. PARCEL NO, MECHANICAL ELECTRICAL Acc,DATE ACC FILE NO. f FINALS DATE INSP. FRAMING - -A SAN # ZONING ENG.SITE NO. INSULATION. � PLUMBING - GAS MECHANICAL • FIRESPRINK 'ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ✓ r` Y ❑ N❑ ° ❑ N❑ LATH—INTERIOR �- ELECTRICAL LOOD ZONE ' LATH—EXTERIOR FIRE DEPT. Y❑. N❑ ' Y ❑ No SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING _ Y -� SHEAR EXTERIOR ARY APPROVALS BUILDINGS .._ FIREWALLS ' - ELECTRIC PLAN CHECK GAS - FEE , NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCYI SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM • ARRANGE FOR INSPECTION,BY PHONING 252-4505, ^ELECTRIC u , ` . ONE-WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING G PLEASE GIVE JOB•-� ADDRESS WHEN PHONING.Z • { : — SEE PERMIT FOR EXPIRATION DATE — -M ECHANICAL , 'CONST.TAX IMPORTANTI " PLEASE READ REVERSE SIDE BEFORE TOTAL . CALLING,FOR'FINAL INSPECTION. • ' ' OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Bt ILDI NG PROJECT IDENTI FICA PERMITNUMBER DAPPLICATION & PE _ 09555 IAoDRESDREss BUILDING — ELECTRICAL—PLUMBING —MECHANICAL OWNER'S PLAN CHECK VALIDATION au�,�� NAME iT •///U� OTY. ELECTRIC PERMIT FEE ONE orvTRAcraRs UTLETS-SWITCHES-RECEP 10.00/1.00 C Qvh ' OC No —DI LIGHTING FIXTURES 10.00/1.00 orvrRAcrons PPLIANCES-RESIDENTIAL 4.00 ' DDRE55 ,..'J L, O �x�y �,�}NIONE p DIS PANELS 10.00 DATE OF APPLICATION ARRCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. O ENGINEER LLIC.NO. ZCJSIGNS TRANS. 3.00 ADDRESS ENG. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION T ♦ • OD' 1 zIP EMP.METER OR POLE INS. 20.00 - ADDRESSPLICAN - MOTORS SE F SCH. ADDRESS ` 1 SERVICE CHANGE 0.00 0 0 o LICENSED CONTRACTORS DECLARATIONTEMP.POLE Q u U I hemby affirm that 1 am licensed under provisions of Chapter 9 3 I o I" (cornn encing with Section 7000)of Division 3 of the Business and ISSUANCE DATE BLDG. ELECT. MECH. o i Professions Class Code.and my license is in full force and effect z try License Class�—tic.Contractor l city o _r J Datc .,,,L_,..p�_Contractor_CQ�L rc rt w OWNFk.BUILDER DECLARATION BL F ;'H 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD I M , ION ' r u o a Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE VALUAT��N s 0 Code:Any city orcounty which requires a permit to construct,alter, 10.00AVO ��0a,1, Of ape llo EC U, ¢ p improve,demolish,Or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. TJ/L'V7 l o LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO a w m he is licensed 9(copursuant to the provisions of the Contractor's License ��.-N4}�/T �HAeQ r z < Law(Chapterand Procomon,Code)lhSect ion is 00)exempt there oom and at x o Business and Professions empt or that he is exempt therefrom and DTV. PLUMBING PERMIT Y FEE at I the basis for the alleged exemption.Any violation t to a cion malty STORIES TYPE CONSTR. pW, ?�-- by et app,that for a undrPermit Sr John,,the 0H.): nitOaelVll penalty ALTER-DRAIN -WATER (EA.) 5.00 of net more than five hundred prod dollars(my em): ❑ 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(Sc,. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code.The Con lmctor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.06 50.FT.FLOOR AREA TOTAL ACREAGE • 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-1INC.4 OUTLETS 6.00 or improvement is sold within one year of Completion,the owner- GAS EASYSTEM OVER 4 IEA.) 2.00 builder will have the burden of proving that he d - . -id not build Or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTEI T 30.00 RES IND CON Pa Omer ❑ I,as owner of the properly,am exclusively contracting with '� ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the Project(Sec. 7044,Business LAWN SPRINKLERS- I 5 V.B. 6.66 ASSESSORS PARCEL NO. and Professions Code:I in,Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS•O ( 1.00 contracts for such projects with a contractors)licensed pursuant m the Contractor's License Law. SEWER-SANITAR R NtrA.200ftI10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec..,BAP.C.for this WATER HEATER W/VENTa .00 reason Owner Uute WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORKERS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a Certificate ofconsent to self-insure, or a certificate of Workers'Compensation Insurance,or u certified ZONING ENG.SITE NO. copy thereoffSec.3800,Lab CA Policy No. Company — 0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY TZ4 Z,4 >jf' Cert i fie I w res Bled -With the city inspection division. �'O AX,icanl 4s•'1-- 4,�,` MISC.- REFER TO ORD, y❑ N❑ v ❑ No cCERTIFICATE OF EX17MPTION FROM WORKERS' PERMIT ISSUANCE 10.00 Q FLOODZONE A.L.U.C. LU (704ENSATION INSURANCE PLG.CONTR.CL LIC,N0, PLG. Z (This section need not be completed if the permit is for one TOTAL V❑ N❑ V❑ N❑ U O hundred dollars IS 100)or less.) I certify that In the perfonn:ni.of the work for which this per' CITY. MECHANICAL PERMIT i FEE FEE SUMMARY UL U mit is issued,I shall not employ any person in any manner so as to , y become subject to the Workers'Compensation Laws of California. Ob Dam - Applicant { )'- N NOTICE TO APPLICANT: If,ait,,making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 BUILDING 3b/e- F.. ? 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 U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.1 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER IO .) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH D 5 the performance Of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT TO 100,000 U Lender's Name Lenders Address HEATING UNIT(OVER 1 WSo .U.1B. ELECTRIC /% I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) �.\JIWNJ • information is correct. I agree to comply with all city and countyPLUMBING ordinances and state laws relating to building construction, and 1301LER-COMPI3 H.P.or 100, .U.) 6.00 hereby authorim representatives of this city to enter upon the bovBOILER-COMP(Over 1013,000 BTU)SEE PEE SGH. MECHANICAL I/S ae-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 expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way t a against said City in consequence of the Q grant... o,1 It. MECH.CONT. LIC.NO. MECH. �g TOTAL �`J1 TOTAL Sola. SlgnaR oaf Ap hwnt ontractx Date OFFICE COPY