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11036r l POST THIS CARD NEAR FRONT OF BUILDING _ CITY OF P ,.. -. CU ERTINO.�, • `- INSPECTION DIVISION PCRM1,ITNUM1;HEH.. 11036 JOB INSPECTION RECORD 50 PERMITIEXPIRATION - JOB.A'DDAESS /oA&INIT4t _LOT#k • f-�"'-�- ' ---'�.---- :PERMIT EXPIRES`IF WORK OWNER ao'o—As CONTRACTOR IS NOT'STARTED WITHIN #' �1 INSPECTION—' -' ATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. ANCE OR 180 DAYS FROM FOUNDATION•,T-Z`( Ge.uxr_`Ir_ S e p . - LIFER- LL-9.7-�/ �- LAST CALLED INSPECTION. u PREGUNITE pl4Ati PERMIT VALIDATION O15 ArLidGfLAT POUR NO'CONCRETE UNTIL ABOVE HAS BEEN SIGNED 6-16 -�,t UNDERGROUND /,SL B E.Lt> g( P—*" ale Lf. PLUMBING SAqtlkl yr Kan ELECTRICAL S�•G%71 ✓.�• OK`G T \ A• itl SOANCE`DATEMECHANICAL D:L�7 BSO - d ;EN BLDG.., gLBCT. PLG. MECH. El DO T POUR FLOOR NTIL ABOVE HAS BIGNED lIOL ZOr6N7iCUMMe+6 to/�pr BUILDI G PERMIT WOOD FLOOR 6 9/j'%6(�, INFORMATION PLUMBINGVALUATION DN.'f SLAB ARth3 0K b J9 ,P7 , , , ' $/FT. ,., , •. MECHANICAL _ - 1 - PERMIT TO ELECTRICAL FRAMING STOr(Sini PT'flI&'AUjig) INSULATION Z-l7d'7 >ro i li�J UJ• c 2 ' �[ uRr NC p. ✓ _ I jf� DCC. GROUP - RES. UNITS ;lP,L'ACE NO SUBVE FLDOR UNTIL ABOHAS BEEN SIGNE -($! - SO, F, O 4HE4 TO REAGE ROOF -T et• ��� DIWOHRAGM % 9'v-% .%ru.�i�L.� 3 BUILDING USE ' TIES INO CON. PH ' Other " APPLY NOROOFING UNTIL ABOVE HAS BEEN SIGNED )T*0FS,(4AT/l1vi' 114114 A" �• ❑ • ❑ ❑ ❑ ❑ ROUGH 9%i+-�%. F,(/A/L/NG LDG pNt nssessoas PARCEL No. PLUMBING OK 369-02-4122' GAS TESTTRACT J3LnG•TNR.a ouGN PGUHp N0. PARCEL NO. MECHANICAL., : ..z'7vio0wr, #K .3 FLo10;<S ELECTRICAL ' FINALS DATE INSP. aca DATE Acc: PILE No. FRAMING '1 - SAN # - INSULATIONPLUMBING,. ZONING ` ENG. SITE No. N 7Niprr LDd l3' GAS 1/-, - ECNANICAL -i%= • FIRE'SPRINK v ❑. NE] ' ENERGY TjE Y. NE] NO WORK UNIT;IL*A- ,VE,HASjBEEN•SIG _E -:4 HE-A.T*G .� CATH-INTERIOELECTRICAL -�( .� - t FLOOD ZONE • v ❑ N ❑� '• ATU c. •° ❑ ❑ LATH -EXTERIOR 1.0 RE DEPT. FI SHEETROCK. - -- GRADE I 'FEESUMMARY SHEAR•INTERIOR BUILDING BuICDiNG PLAN CHECK FEE ' 'On QlAqACI SHEAR EXTERIO '"' �+ TEMPORARY APPROVAL FIREWALLS ; !' ELECTRIC fR,TOAJ t 9- ' S - - NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIUNED •I OCCUPANCY SEISMIC FEE OCCUPANCY,OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BV�ILDI, INSPECTOF!... MICROF.ILPoi, J"I A .'RRANGE FORJ NSP,.•EPTION B,Y PHONING 252.4505, ELECTRIC � w ONEWOR•KING'DAY:BEFORE REQUIRED INSPECTION. ©� `= PEIGIVJOBA LEASEbD,RESSIWHEN PIHONING, •Ir PLUMBING' "ALii MEGHANIC ;I_ Z r J 1 /U ''=' " SEE PERMIT FOR EXPI'RATIOI DA�f E i - %-n Y ,1•, . Yf "V : Ir„ir • r CONST. TAX . 7,._!- • ..�I .. - 1,•. 1 'ImpOFi- T A[kl Ff PLEASE R�Ad REVkgKSE SIDE BEFORE CALLING FbFt FINAL INSPECTION.' _TOTAL 11.643.45-1 ! 'r - OFFIFEDOPY wC2 FOO QUU a 2 w Baa �yz Z y_ W n Q Q w U X3: w LL o j ny sago 6wm u ISt -z a 9 i o IS r $ R: O _Z2 I"' cc N� LU - 0. 0 ::) Z U O LL U Ow } y F- u APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER I O 36 a,,,N,NG _s ADESS Dls�mBUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER 3 AO CRs E ASE�y�%J .Uo- ACTDRs / ,, NAME LIC. No. QTYELECTRIC PERMIT FEE .LE PLAN CHECKVALIDATION 3-/ 7 V 'J� 7k� / OUTLETS-SWITCHES-RECEP 10.0011.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ADDRESS APPLIANCES -RESIDENTIAL 4,00 PANELS 10.00 PHONE DATE OF APPLICATION ARCHITECT R 41 A/ ENGINEC-4441 W 1' UC.NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.L. NO. SIGNS TRANS. 3.00 noDDREss ENG. f 51e � Ad•`• ZIv ,0 SPECIALCIRCUIT 5.00 PERMIT VALIDATION qqq 1J [/ _J/ f� EMP. METER OR POLE INS. 20.00 APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class I.S. Number ISSUANCE DATE BLDG. © ELECT. ❑ PLG. MECH. ❑ ❑ Date Contractor BUILDING PERMIT OWNER.BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the follor commywhichng reason. c. requires a permit tocnd Profession' u tune permit it t0 construct, alter, heq Cede: e, demo or cor my whiny structure, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for Such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 0(the Business and Professions Code) or that he is exempt therefrom and INFORMATION MISC.- REFER TO ORD VALUATION T O OU Q Da Q / $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTE. LIC. NO. ELEC. TOTAL PERMIT TO R%L9,27"M�1/TS OTY. PLUMBING PERMIT FEE the basis for the alleged exemption. Any violation of Section 7031.5 STO by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars ($500).): 2 V 1 Hr. ALTER -DRAIN -WATER (EA.) 5.00 O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND. 5.00 intended or offered for sale (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 does such work himself or through his own employees, provided that such improve- lments are not intended or offered for sale. If, however, the building It improvement is sold within one year of completion, the owner. builder will have the burden of proving that he did not build or im- p for purpose of sale.). qi� I, as owner of the property, am exclusively contracting with R_1 169 F IXTUR ES - PER TRAP 5.00 SO. FT, FLOOR AR A /7S /03 a,Ov OOOr TOTAL ACREAGE ppit Cf7 M, - GAS-EA.SYSTEM-11NC.40UTLETS 6.00 GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 a LDING USE RES IND CON PB Omer 1:1❑ ❑ El INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORSPARCEL NO. 369-02-022 E lic aced contractors to construct the project (Sec. 7044, Business and Professions Code TheConlractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law, SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt and ec. ,BAP.C. for this reason WATER HEATER W/VENT 6.00 ' Owner_ nate .WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION 1 e y affum that I have a certifmate ofc.niCDt to self -insure. or a certificate of Workers' Compensation Insurance, or a cerlil'ied ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab.C.). Policy No. Company FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city inspection division. Applicant MISC.- REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG. CONTE. LIC. NO. PLG. TOTAL } COMPENSATION INSURANCE ITh{s section need not be completed if the permit is for one Y ❑ N ❑ Y [:]N ❑ MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per -QTY. mit is issued, 1 shall not employ any person in zany manner so as to become subject to the Workers' Compensation Laws of California Date ApplicantALTER NOTICE TO APPLICANT: If, after making this Certificate of Ex- _ T - BUILDING 0,24, .4� OR ADD TO MECH500 . . APPLIANCE 5.00 PLAN CHECK emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT (TO 10)000C.F.M.) 4.00 FEE AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE 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 HEATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Lender's Address I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to Comply with all city and rounly ordinances and state laws relating to building construction, and PLUMBING BOILER-COMPI3 H.P. Or 100,000B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC.-REFER TO ORD. CONST. TAX (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 PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MOETAL TOTAL (1-'643.45 g ntingofthispermi[ Ci r7 U _?Tgrpture of Applicant/Contractor OFFICE COPY