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12090 (2) POST THIS RD NEAR FRONT OF BUILDING '� �; • •'� PERMIT NUMBER CliT OF CUPERTINO . 12090 INSPECTION DIVISION JOB INSPECTION RECORD y , L I PERMIT EXPIRATION -- JOB ADDRESS/D 1.r2` J VL LOT# ,PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- 1 ANCE OR 180 DAYS FROM FOUNDATION . LASTCALLED INSPECTION. . LIFER - 2 ' PREGUNITE - vERmi$%Qjory POUR NO CONCRETE UNTIL ABOVE HAS BE SIGNED MAR 5'- 1981 UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE ME R. MECHANICAL R EIJ. PLG' DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING INFORM PERMI NFORMATION 'WOOD FLOOR - - VALUATION s/ET. PLUMBING 3- • �P+ i • ',} MECHANICAL �/ro1b-87 _ RMlr ro ELECTRICAL FRAMING _ — 7. INSULATION - — sT jTYPE lcpps�lR.•-'� k -rf Se occ GROUP III,/NITS PLACE NO SUBFLOOR UNTIL ABOVE BEENIGNED '' ' ROOF 50 TFL AREA TOTAL ACREAGE f DIAPHRAGM .. �� BUILDING USE IND CON PR Otlm, 0 0 El 11 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. ROUGH PLUMBING $ TRACT NO. PARCEL NO. GAS TEST MECHANICAL v ACC.DATE ACC.FILE NO. ELECTRICAL _l/- 7 FINALS DATE INSP. r FRAMING -I SAN # - ZONING ENO,SITE NO. INSULATIONypa 6_22 PLUMBING - p. ♦ M♦♦� w/ GAS " Fk SPRINK ENERGY T 24 MECHANICAL f rv� v N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD20NE A.L,U.C. LATH-INTERIOR - - ELECTRICAL - Y❑ NO Y❑ NO LATH-EXTERIOR FIRE DEPT. _ SHEETROCK - GRADE FEE SUMMARY SHEAR INTERIOR - BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING PLAN CHECK FIREWALLS ' ELECTRIC FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I SEISMIC FEE. OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR: MICROFILM Lu ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC / / ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING �1/i. • Z PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - CONST.TAX IMPORTANT! 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 " BUILDING PROJECT IDENTI FC N PERMIT NUMBER auaolNAPPLICATION & PT ADDRESS BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 12090 G R PLAN CHECK VALIDATION NAME QTY, ELECTRIC PERMIT FEE' ! !j`2 �r Care uv -(41 r- p PHONE CONTRACTOR 9 NAME ,� OUTLETS-SWITCHES-R SCEP 10.00/1.00 CCfa LICNO. pJ IIp'� LIGHTING FIXTURES 10.00/1.00 a CONTRACTOR'S ' 1/6 AODREss cy, ,,�.r C���ry.,�t, APPLIANCES-RESIDENTIAL 4.00 S�✓ensCrveJz P NE Q qt, —1q� ` PANELS 10.00 DATE OF APPLICATION on - PANELS (OVER 200 AMP) 20.00 'PLAN CHECK FEE P.C.NO. E NGINEE 4 C,uc.N^� 'SI 10p7 SIGNS TRANS, 3.00 ARCH.OR ENG. P pL{pgTION ADDRESS _ yy�� tt SPECIAL CIRCUIT 5.00 _ `'/1 EMP.METER OR POLE INS. 20.00 ADUREss Ts Q� � �+� � a. MOTORS SEE FEE SCH. C 9p Cx1 - � 5J .vC m&r-61oO CU SERVICE CHANGE 20.00 /MAR 5 "Q� -02 LICENSED CONTRACTORS DECLARATION `R9 OI( � r < i w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE (commencing With Section 7000)Of Division 3 of the Business and DG. ELE T. PL M EC H. N i Professions Code, my license is in full for lI Z i_ O LiceniaLCJa s Lic.Numb Date Contractor ar it a OWNER-BUILDER DECLARATION BUILDING PERMI E o ' er — INFORMATION ;u 1 hereby affirm that 1 am exempt from the Contractor's License MISC. REFERTOORD FUOQ Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT. PERMIT ISSUANCE 10.00 Code:Any city or county which structure permit tocOnsuanc alter, !�.Lix IS .'at improve,demolish,or repair any structure,prior 10 its issuance,also ELEC.CONTR. LIC.NO. ELEC. �- V l/ t� v O IF requires the applicant for such permit to file a signed statement that TOTAL' (/: A. X _ 'PERMIT TO he is licensed pursuant en the provisions of the )ofDivision License ,, S�/N L _i Q Law(Chapterand Professions lodeng)or Section is exempt theref o and 1-O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE w o the basis for the alleged exemption.Any applicant of Section malty 1 Bi ES Tv C n3tO by any applicant fora permit subjectsthe$500)+licant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 ' of not more than five hundred Dollars(5500).): ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT'. DEVICE 4,00 O RES. NITS 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 Contractor's License Law does not apply to an owner of -- properly who builds or improves thereon,and who does such work I FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- - ,ry or ments are not intended or within ed one or year 11,however,[he thebuilding GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRTR IAL WASTEINTER. 30.00 E IND CON PB Other 0 as owner of the property, exclusively contracting with "❑ 1:1 ❑ 13 licensedcontractors to construct thehe project(Sec. 7044,Business LAWN SPRINKLERS- 1'INC 5 VB600 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply V.B. . to anowner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00' Y ' contracts for such projects with a contrtraclor(s)licensed pursuant to the Contractor's License Law. - 1' SEWER-SANITARY-STORM EA.200ftI10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.—,B.&P.C.for this, reasonHEATER W/VENT 6.00 reason Owner - Date I WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sea 3800,Lab.C.l'C`1- .l'�„ ' Policy No. Company L%+112 O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T34 Adp Z Z CerORD tified copy'y5 filed with the city inspection division.'' - ❑ V�Y'(—] NEI licant_ Ig[Rr MISC.- REFER TO . N � y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. ION LU , (This section need not, beTcomple ed Rif heFpermit is for one PLG.CONTR, LIC.NO. TOTAL ,V[:J N El YE] . N❑ Q_ o ::) Z hundred dollars($100)or less.) L) O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued;1 shall not employ any person in any manner so as to _ - O W become subject to the Workers'Compensation Laws of California. y Date I Applicant BUILDING Sa } N NOTICE TO APPLICANT: If,after making this Certificate of Ex- emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK. provisions of the Labor Code, you must forthwith comply with V FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000C.F.M.) 6.00 - SEISM IC FEE . I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performancj(thee�wor for which this permit is issued ISec. MICROFILM 3097,Civ.0 I �- ^fir HEATING UNIT(TO 100,000 B.T.U.) 6,00 Lender's Name - - Lender'sAddne .In 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. I agree to comply with all city and county BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING, ordinances and state laws relating to building construction. and hereby authorize representatives ins inspection this city, to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL 3r, above-mentioned property forinsp ofth i 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 accrue against said City In consequence of the' nn' Of th's per 0 MECH.CONT. LICNO. MECH. (` _ . TOTAL7 ©p . TOTAL Signature A licant/Contractor Date '� OFFICECOPY