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8671 (2) POST THIS CARD NEAR FRONT OF BUILDING FRMIT NUMBER 'I CITY, OF CUPERTINO 8671 ; INSPECTION.DIVISION JOB INSPECTION RECORD �/j /y� /^'�/�y�•�� _/C PERMIT,EXPIRATION '. JOEADDRESS jd7o0 N K/7/l G.w� .UNIT CO � PERMIT EXPIRES IF WORK OWNER "'/' /' : - CONTRACTOR Q �•� IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 780 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM', '. LASTCALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ..,,.. , PLUMBING ELECTRICAL 'ISSUANCE DATE ' MECHANICAL - BLDG. ELECT., PLc. MECH, DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT, WINFORMATION WOOD FLOOR VALUATION E/FT. PLUMBING I _ MECHANICAL - - ELECTRICAL FERMI] TO FRAMING •y'/�I•' - �HoA INSULATION - STORIESI OCC.GROUP REUS..UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SD FT'FLOOR AREA TOTAL ACREAGE ROOF DIAPHRAGM BUILDING USE RES IND CON PB O,tt r APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ 1:1 ❑ ❑ ASSESSORS PARCEL NO. ROUGH I PLUMBING -TRACT NO. PARCEL NO. GAS TEST MECHANICAL - . . ELECTRICAL FINALS DATE INSP. ACC.DATE ACC,FILE NO. - FRAMING' SAN # I ' ZONING ENG.SITE NO. INSULATION - PLUMBING GAS FIRE SPRINK 'ENERGY T 24 -- MECHANICAL Y [j NC3 vE] N[j COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH-INTERIOR ELECTRICALFLOOD ZONE A.LU.C. { • —Er ' YE] N❑ Y ❑ N[]LATH-EXTERIOR FIRE DEPT. LJ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING - ' SHEAR EXTERIOR. - - TE Y,A PROVALS BUILDING !' FIREWALLS ELECTRICPLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY 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 F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z� PLEASE GIVE JOB ADDRESS WHEN-PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL y IMPORTANT! CONST.TAX 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 • n � BUILDING PROJECT.IDENTIFICATION I . PERMIT MBER BUILDING APPLICATION & PERMIT 8671 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN HECK VALIOATI ME DTV. ELECTRIC PERMIT FEE ONE ^F�k _10.0n.00 LIC. NAx flNa 4� UTLETS-SWITCHES-RECEP a10.. n.00 uc.No, LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ADDRESS APPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION r ARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR E NGINEEfl uc.No. SIGNS TRANS. 3.00 AR.-O.E.G PERMIT VALIDATION ' ADDRESS SPECIAL CIRCUIT 5.00 ZIP EMP.METER OR POLE INS. 20.00 APPLICANT ADDRESS MOTORS SEE FEE SCH. K l,La/Y71J'" SERVICE CHANGE 20.00 Woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 xIUF./'✓� ��g5 c u=w I hereby affirm that I am licensed under provisions of Chapter 9 Q io ISSUANCE DATE n <N (commencing with Section 7000)of Division 3 of the Business and BLDG. f ryryry�yL��G ,NELH. r D z Professions Code,and my license is in full force and effect. ❑ 1s11118r I Zo i W License ClassLic.Number- 2 umber G LuJ w H Date Contractor JUE a r f BUILDING PERMIT OWNFR-BUILDER DECLARATION ¢o i v I INFORMATION E: ; LL w I hereby affirm that I am exempt from the Contractor's License MISC-- VALUATION S/FT. LL o.¢i Law for the fallowin reason.(Sec.7031.5,Businessand Professions r _ g PERMIT ISSUANCE Code:Any city or county which requires e permit toconstruct.alter, ¢ ¢ Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. n wD M requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO $ he is licensed pursuant to the provisions mf the Contractor's License Hii Law(Chapter 9(commencingwithSection 7000)ofDivision3oftheo -L ¢ Business and Professions Code)or that'he is exempt therefrom and CITY. PLUMBING PERMIT FEE ¢ 1D the basis far the alleged exemption.Any violation of Section 7031.5 STORIE P O i ; by any applicant for a permit subjects the applicant to a civil penalty gLTER-DRAIN& VENT-WATER IEA.) 5.00 ' of not more than five hundred dollars(55001.1: ❑ 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 Jo 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 S0.FT.FLOOR AREA TOTAL ACREAGE himself m through his own employees,fors,provided that such Improve- mems re building himself a through ot or empll feesu e.provided that howeveruche building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or ire RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 [:] E] ❑ ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project ISce.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCEL NO. and Professions Code:The Contractor's License Law does not apply *WORK er of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 fo Os s License Law. i TRACT NO. PARCEL NO. exempt under Sec. ,B.&P.C.for tllis WATER HEATER W/VENT 6.00 Dat WATER SYSTEM 5.00 ACC.DATE ACG FILE N0. ERS'COMPF.NSATION 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(Sec.3800,Lab.L.)` Policy No. Company - Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is fjled with the city inspection division. MISC.- REFER TO ORD. O 'Applicant Yo N❑ V 0 NE] ~ va PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. Lu - CERTIFICATEOFSATIOTINS FROM WORKERS' W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL aZ (This section need not be completed if the permit is for one TOTAL ' Y(] N� V f-] NE] hundred dollars(SI00)orlessJ V O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY W f mit is issued,I shall not employ any person in any monoer so as to U become subject to the Workers'Compensation Laws of California. C„04 a Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 0 } 0 NOTICE TO APPLICANT: If,after making this Cerlil'icam of F-x- ? 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 10,000 CF.M.) 4.00 CONSTRUCTION LENDING AGENCY / AIR HANDLING UNIT(OVER 10 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUC ) 5.00 the performance of Nle work for which this permit is issued(Sec. MICROFILM 3097,Chv.C.L HEATING UNIT(TO 100, .TqU. Q' Lender's Name H EATING UNIT 0 .U-) . Oti Lender's Address ELECTRIC - I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) information is correct. I 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, .00 hereby authorize representatives of this city to enter upon the g01 LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We),agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cu amino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 Q CONST.TAX maY any way ace g 'n mid City in consequence of the gra h^g This P I MECH.CONT. LIC.N0. MELH. AL (� 7� 5/1-7/25 TOT TOTAL a70 Signature Applicant/Conlraclo ate - OFFICE COPY 1