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12422 (2) POST THIS CARD NEAR FRONT OF BUILDING CITY .OF CUPERTINO 12422 � ./ INSPECTION DIVISION OB INSPECTION RE ORD PERMIT EXPIRATION JOB ADDRESS LOT# (PERMIT EXPIRES IF WORK OWNER NiR ACTOR NOT STARTED WITHIN IN PECT ON DATE INSPECTOR INSPECTION.RECORD ' 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION LIFER ,LASTCALLED INSPECTION. • I DATION PT • PREGUNITE r rev POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED MAR 9 - 1987 UNDERGROUND /SLAB PLUMBING city of Cupeltlno ELECTRICAL - - - ' ISSUANCE DATE MECHANICAL LBG. ELECT.. PLG. I MECH, 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING VALUATION $JET. � � - MECHANICAL I, ELECTRICAL PERMIr ro ' FRAMING - - - INSULATION ST TYPE C(�NSTR. OCC.GHO P RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT.FLOOR AREA TOTALACREAGE DIAPHRAGM. 'BUILDING USE R6 INO CON PB Other APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ Cl ❑ ❑ ASSESSORS PARCEL NO. ROUGH . IPLUMBING ' TRACT No GAS TEST . . PARCEL NO, _ MECHANICAL ACC.GATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # I •zoNwG ENG.SITE NO. INSULATION PLUMBING GAS MECHANICAL - FIRE SPRINK ENERGY T.24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING. ❑ "❑ ° F] "❑ FLOOD ZONE A LATH—INTERIOR ELECTRICAL - - .L.0C. . LATH—EXTERIOR FIRE DEPT. Y❑ NE) Y ❑ Nr] ' SHEETROCK - - GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRICPLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z' MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - 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 Z- BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING . APPLICATION & PERMIT •'/` ADDRESS /O 1 3C 1 2 GG [pJ� ✓ ��L BUILDING-ELECTRICAL-PLUMBING-MECHANICAL �I ZTZ � OWNER'S PLAN CHECK VALIDATION / NAME I A� 140 - QTY. ELECTRIC PERMIT FEE Ill/I P 5, CONTRACTORS NAME CJ�G; UTLETS-SWITCHES-RECEP 10.00/1.00 I / � t// NV ilc.;No. 756 7z-? LIGHTING FIXTURES - 10.00/1.00 - CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 ' ' ADDREss / ////��lrrry�EE.ry��L oY A, eA PNDNE 7 7 PANELS 10.00 GATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.G.NO, OR ENGINEER LIC.No. SIGNS TRANS. 3.00 ARCH.OR ENG. - - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS ZIP EMP.METER OR POLE INS. - 20.00 - APPLICANTS MOTORS SEE FEE SCH. ADDRESS f1 SERVICE CHANGE 20.00 MAR 9 - 1987 woo LICENSED CONTRACTORS DECLARATION ¢v w 1 hereby affirm that I am licensed under provisions of Chapter 9 I re (commencing with Section 70 0)of Division 3 of the Business and �E] G � BLD ELECT. PL MECH. H w i Professions Code a is in full for d 2, Z o m - License CIS Lia Number � �qf=-�-�11 E - ❑ E] 9 H w / Date Can act J4�� - ✓ ¢ y s�7` BUILDING PERMIT ¢ ¢u¢I aY7 OWNER-BUILDER DECLARATION /"` 0 0 - MISC.- REFER TO ORD INFORMATION wa-H I,hereby affirm that 1 am exempt from the Contractor's License u o 4 Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION $/FT. _ PERMIT ISSUANCE 10.00 Code:Any mulish countypair any structure, requires tune,prior o Construct,alter, 0 � 2 ¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. ''LIC.NO. ELEC. �• (,/. C ¢ requires the applicant for such permit to file signed statement that TOTAL - PERMIT TO A'w LL he is licensed pursuant to the provisions of the )offractor's License iii Law(ChapterProfessions CngwBh Section is exempt therefrom anditle a Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE ¢r 0 by basis far[he alleged exemption.Anye applicn ofSection703l.5 malty STO 5 TVP CONSTR. i ; � by any applicant fora permit subjects tire applicant Pan civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not mom than five hundred dollars($500)J: ' ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE - 4.00 their sole compensation,will do the work,and the structure is not Dec.GROUP RES.UNITS 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 'SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 mre mems are not intended or offend for sale.If,however,the building or improvement is sold within one year of completion,the owner- GAS--� EA.SYSTEM-OVER 4 (EA.) 2,00 BUILDING USE builder will have the burden of proving that he did not build or im- IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 - ❑ I,as owner of the property,am exclusively contracting with licensed contractors,to construct the project(Sec.7044,Business LAWN SPRINKLERS-1`INC 5 V.B. 6.00 .ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply, to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 G contracts for such projects with a contractort s)licensed pursuant to ---' -- the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec._,BAP.C.for this WATER HEATER WIVENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 ' I hereby affirm that I have a certificate of consent to self-insure, ZONING or a certificate of Workers'Comp; ton Insurance,or a certified ENG.SITE NO. asa copy thereybJvyc.3800,Lab.C.). � Policy No.(. I LW Company Q D Certified copy is ereby urnished. FIRESPRINK ENERGY T 24 � p ❑ C y Ble h e 'ty s actio ivlslo at MISC.- REFER TO ORD. v[] N❑ Y ❑ N[3D: E/< --- ERTIFIC EOF EXEMPTION FROM WORKE PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.D. LU'> C MPENSATION INSURANCE PLG.CONTR. ❑c.NO. PLG. a- Z (This section need not be completed if the permit is for one TOTAL - Y❑ N Y❑ N❑ hundred dollars IS I OG)or less.) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manners..,to U become subject to the Workers'Compensation Laws of California. �j QQ 0 y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 6 I )- N NOTICE TO APPLICANT: If,after making this Certificate of Ex. F-, Z emption,you should become subject to the Workers'Compensation4AIR PLIANCE 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. HANDLING UNIT(TO 10,000C.F.M,) 4.00 - CONSTRUCTIONLENDINGAGENCY HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEEI hereby affirm that there is a construction lending agency forHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). - HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name • HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC 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 county PLUMBING t ordinances and stale laws relating to building construction, anJ BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the OILER-COM! (0 at 100,000BTU)SEE FEESCH. MECHANICAL above-mentioned property for inspection purposes. (We)-agree to save, indemnify and keep harmless the City o1' MISC.- REFER TO ORD. Cupertino,against liabilities,judgments, costs and expenses which 'CONST.TAX i� may in any way accrue against said City in conseyue Ce o the PERMIT ISSUANCE 10.00 Br ling thisp mit. yMECH.CONT. LIC.NO. MECH, TO749TAL Signa[u of Applicant/C � � TOTAL ontractor Date OFFICE COPY