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10074 (2) POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER CITY OF CUPERTINO 100174 INSPECTION DIVISION JOB INSPEC ION RECORD PERM IT EXPI RATION JOB ADDRES IT#` L PERMIT EXPIRES IF WORK OWNER �WVCONTRACTo &S IS NOT STARTED WITHIN ' INSPECTION DATE INSPECTOR I INSPECTION RCORD 180 DAYS OF PERMIT ISSU- FOUNDATION li- 6YC J 'ANCE OR 180 DAYS FROM UFER - 3�Z.S� Y�"z!AT/ ntwni STCALLED INSPECTION. PREGUNITE ( PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED dE`/ ) Or UNDERGROUND /SLAB [ ((( PLUMBING � ' ELECTRICAL - ' '- ISSUANCE DATE MECHANICAL BL ,ELE PLG. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING � � ' VALUATION SIFT. { 7• J u MECHANICAL � G��P � + � —" ELECTRICAL PE IT O FRAMING. . INSULATION STORIES Tvae cONSTR. OCC GHOUP� RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF So.FT,F LOOR AREA TOTALACREAGE DIAPHRAGM tar1P �., BUILDING USE R IND CON PEI Ome. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑- ❑ ❑ ' ROUGH A SSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL. ELECTRICAL �j,�6, FINALS DATE INSP. ACC.DATE ACC.FILE NO, FRAMING pe c(. SAN # - - INSULATION PLUMBING ZONING ENc.SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑' LATH—INTERIOR ELECTRICAL - PL000 zuNE .'A'.L,u.c. LATH—EXTERIOR - _ FI RE DEPT. Y❑ N❑ • v❑ No SHEETROCK GRADE SHEAR INTERIOR FEE SUMMARY BUILDING SHEAR EXTERIOR - TEMPORARY APPROVALS BUILDING z FIREWALLS ELECTRIC . PLAN 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: - \1 MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. �1z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANTI CONST.TAT( 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 ,.. .: ,BUI':DING PROsIECT IDENTI FICATION gppLICATION & PERMIT PERMIT NUMBER BVILGING ADpRE55 / 10074 Of ,0/ C Ve BUILDING -ELECTRICAL-PLUMBING-MECHANICAL �+SWNtH v PLAN CHECK VALIDATION /�E j�I k_o CITY. ELECTRIC PERMIT FEE r OG PHONE /V NAMERAcraRs UTLETS-SWITCHES-RECEP 10.00/1.00 LIC NO. _ G LIGHTING FIXTURES 10.00/1.00 rorurRAcrORs s� LerAN�w PPLIANCES-RESIDENTIAL 4.00 A RE55 c ,�� LC O /^ v ♦ PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMPI 20.00 GINES EN �w ,I,l SIGNS TRANS. 3.00 ARCH.OR ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION C16 OLc e N �0 EMP.METER OR POLE INS. 20.00 oo ie sTa MOTORS SEE FEE SCH. C' p✓c SERVICE CHANGE 20.00 '02¢ TEMP.POLE �U / LICENSED CONTRACTORS DECLARATION 30.00 ��JJ a u o I hereby affirm that I am licensed under provisions of Chapter 9 Z w ISSUANCE TE m a m (commrncmg with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H L z Professions CoJy�J my license is in full for fed. ❑ ❑ ❑ z o m - License Class-Lie.Number F w:_w Date�/ �Contraeto a y �'JPAZ ¢ ¢ w a OWNfi R-BUILUfiR UF:CLARATION BUILDING PERMIT G ca u INFORMATION X ;A N 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD ¢ Oj Law for the following reason(Sec.703L5,Business and Professions VALUATION S/FT. H - PERMIT ISSUANCE 10.00 � ka Code: e,dem y demolish, coumy it any structure, requires une,prior t o is issuance,also,alter, � = < 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG NO. ELEC. G 0, requires the applicant for such permit to file a signed statement that TOTAL A w m he is licensed pursuant to the provisions of the Contractor's License q,1PERMIT TO HiQLaw(Chapter 9(commencingwith Section 7000)of Division 3 ofthe rI'FIJD/TLO 4 o Business and Professions Code)or that be is exempt therefrom and QTY- PLUMBING PERMIT FEE ¢ H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR, a ; _ by any applicant for a permit subjects the applicant tot civil penalty of nut more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 / fyp�0 7CR 62 ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and Ole structure is not OCC.GROUP RES.UNITSOq� intended or offered for sale'(Sce. 7044. Business and Professions DRAINS-FLOORROOFAREA,CON D. 5.00 Code:The Contractor's License Law does not apply to an owner of , , property /- who builds or improves thcrcon,and who does such work FIXTURES-PER TRAP 5,00 SQ FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such imProve- memsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 � %�.ep^ or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 C builder will have the burden of proving that he did not build or im- BUILDING USE Prove for purpose of sae.l. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ L as owner of the property,am exclusively contracting with ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 16.00 and Professions Code:The Contractor's License Law does not apply ASSESSORB PARCEL NO. to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with u contractorls)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under See.-,- B.&P.C.far this easonWATER HEATER W/VENT _ 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO. WORK ERS'COMPIiNSATION DECLARATION WATER TREATING EQUIP, 5.00 I hereby affinm that 1 have a certificate ofconscnt to scirmsure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished, Z Z ❑ Certified Copy is filed with the city inspection division. FIRE SPRINK ENERGY T 24 Applicant MISC.- REFER TO ORD. Y❑ N❑ v 11 NEI ~ NO PERMIT ISSUANCE Lu CERTIFIGOT F EXEMPTION IONFROMWORKISRS' 10.00 FLOOD ZONE A.L.u.c. W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. CL 0 PLG. Z hundred section need not he completed if the permit is for one TOTAL v N v N V O hundreA dollars lb 100)or less.) I certify that i [he perlar Act of the work for which this per- QTY. MECHANICAL PERMIT FEE LL H mit is iss�dn note to cr n in any manner so as to FEE SUMMARY Ohewnle she Wors' ' i n t. o Cu'or/ Applican ALTER OR ADD TO MECH. 5.00BUILDING 6 ��, ICANTa g .co I icatc of h:C- ? empti n, d become subject to he Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith Comply with U such provisions or this permit shall be Jcemed revoked AIR HANDLING UNIT(TO 10=CF.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY 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,nder's .C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name Lender's Add rees - HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 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 will)all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes, BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless tike City of MISC.- REFER TO ORD. Caped against liabilities,judg cuts, costs and expen s which may n way accru CONST.TAX agains aid City in couseque e of the PERMIT ISSUANCE 10.00 MEC ITS t is Penh' MECH. ON T. LIC.NO. H. o TOTAL TOTAL �� ' nature of Applicant/Contract r he OFFICE COPY