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13933,0 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION I JOB INSPECTION RECORD JOB ADDRESS PUMPKIN PATCH - UNIT# LOT# OWNER N.E. CORNER STEVENS GJBNZKToA TANTAU PERM IT NUMBER 13933 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU -' ANC. OR 180 DAYS FROMy�. LASTCALLED INSPECTION T. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION UFER PREGUNITE - PERMIT VALIDATION �I�p "• GL- °�'�fl' ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL MECHANICAL BLDG. ELECS,, PLG. M�ECK DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $ /Fr. PLUMBING MECHANICAL ELECTRICAL PERMIT TO FRAMING INSULATION STORIES TYPE CONSTR. OCC.GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF 50 FT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM ' - BUILDING use RES IND CON PB Olney ❑ ❑ El ❑ ❑ 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 .4 ACC. FILE NO.JrJ,J FRAMING SAN u INSULATION PLUMBING ZONING EN G, SITE NO. GAS MECHANICAL FIRE SPRINK Y ❑ NC] ENERGY T24 I Y ❑ NE:l COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH — INTERIOR ELECTRICAL ' FLOOD ZONE Y ❑ N❑ . A.L.0 C. Y ❑ No LATH — EXTERIOR - FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC V- % PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEISMIC FEE OCCUPANCY OF BUILDING ISNOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252 -4505, F ONE WORKING DAY BEFORE REQUIRED INSPECTION. 00 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC )..- PLUMBING MECHANICAL CONST. TAX ' IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL / t OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION !�!a APPLICATION & PERMIT BUILDING — ELECTRICAL— PLUMBING — MECHANICAL PERMIT NUMBER q �^�� I `�' BUHLCHNG qLj ADDRESS OWNER'S gN E r] B, PHGN.25� -x/33' PTY. ELECTRIC PERMIT FEE PLAN CHECK VALIOATION GATE OF APPLICATION CONTRACTORS LID. No. OUTLETS -SWITCHES - RECEP 10.00/1.00 LIGHTING FIXTURES 10,00/1.00 CONTRACTORS ADDRESS PHONE PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT on CNITECT ENGINEER NO. PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADDRESS TING. ' ZIP SPECIALCIRCUIT 5,00 PERMIT VALIDATION 11 I � I ISSUANCE DATE) TEMP. METER OR POLE INS. 20.00 gPPLICANT'6 ADDRESS n '�JQp'''/)� " /�_/�'/,/� �� MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 U(ENSeD CONTRACTORS DECLARATION I hereby affirm (hat I am licensed under provisions of Chapter9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. Number Date � Contractor BLDG. I ELEC . FILE. MECH. ❑ ❑ ❑ OWNER- BUILDFR DECLARATION 1 hereby affirm that I um exempt from the Contractor's d License Code: Any city r county which requires penninessand Professions Code: Any city or county which requirese p prior to constant alter, improve, demolish, or repair any structure, prior n its issuance, also requires the dp pursuant t t such permit to file a signed statement that he is d pursuant to the provisions of the Contractor's License Law w(Chapter nd Professions Code) or Section is exempt therefrom of the Business and Professions Code) or that he is exempt therefrom and by beds for the alleged exemption. Any appllon oto action malty by any applicant Tani permit subjects (500).licunttoacivil penalty of not more than five hundred dollars (my em): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions (S Code: The h Contractor's uilds or License Law does not apply to an owner of property who builds or improves thereon,vid who does such work for Sale. If, ho ever, the improve- memsfor through intends own employees, menu are not intended or offered for sale. IL however, the building 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 an. prove 1, aso owner of sale.). ❑ d as owner of the property, he exclusively contracting with licensed contractors to construct the project La does Business nod Professions Code The Contractor's o License Law does not apply to tr owner of property who builds tr improves thereon, and who the Contractor's to for such projects with a contracmrls) licensed pursuant to the License Law. ❑ Iemexemplunder Sec. ,B. &P.C. for this reason BUILDING PERMIT INFORMATION MISC. — REFER TO OR D VALUATION $ /FT. PERMIT ISSUANCE 10.00 Q ELEC. CONTR. LIC. N0. ELEC. TOTAL �J(/ PERMIT TO rJA I QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER- DRAIN - WATER(EA.)5.00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS-FLOOR, ROOF, AREA, CON D. 5.00 FIXTURES - PER TRAP 5.00 50. FT. FLOOR AREA TOTAL ACREAGE GAS- EA.SYSTEM- 1 6.00 - . . . GAS EA SYSTEM - OVER 4 (EA) 200 BUILDING USE RE5 INO 11 PB Om.r ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 (EA:) 1.00 ASSESSORS PARCEL NO. SEWER - SANITARY -STORM EA. 200ft /10.00 TRACT NO, PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORKERS'COMPE-NSATION DECLARATION 1 hereby affirm that I have a certificate ofconsent to self- insure, or a certificate of Workers' Compensation Insurance, or a certified copy lhereof(Sec. 3g W, Lab.C.). Policy No. Company • Certified copy is hereby furnished. • Certified copy is filed with the city inspection division. Applicant WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. FIRE SPRINK N ❑ ❑ ENERGY T 24 V N ❑ ❑ MISC. - REFER TO ORD. CERTIFICATE OP EXEMPTION FROM WORKERS' COMPENSATION INSURANCE. (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this per Init is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE. '170 APPLICANT: If, after making this Certificate of Ex- emption, you should became subject to the Workers' Compensation provisions of the Labor Code, you most forthwith comply with such provisions or this permit shell be deemed revoked. CONSTRUCTION L17NDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). Lender's Name PERMIT ISSUANCE 10.00 J_� OOD ZONE Y ❑ N❑ A.L.U.C. Y ❑ N❑ PLG.00NTH. LIC. NO. FLG. ' TOTAL OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10MC.F.M.) 6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC JO �-r Lender's Address I certify (list I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to Save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the gm(nt�in Of this permit TJ / 91 /it a,lpl�l VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER- OOMP(3H.P.of100,000B.T.U.) 6.00 BOILER -COMP (Over 100,000BTUISEE FEESCH. MECHANICAL MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL oO bignutUre of Applican [/Con tractor Date OFFICE COPY