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12926 (2) POST THIS CARD NEAR FRONT OF BUILDING • PERMIT NUMBER CITY OF CUPERTINO 12926 INSPECTION DIVISION JOB INSPECTION RECORD I PERMIT EXPIRATION JOB ADDRESS f ` ]" �^•y/✓L ' ` �' �" UNIT# LOT# U J PERMIT EXPIRES IF WORK OWNER . P JE CONTRACTOR £ wo IS NOT STARTED WITHIN I SPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 1BO DAYS FROM LAST CALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING F. ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT. PLG. MECH. ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL PERMIT TO ELECTRICAL FRAMING STORIES TYPE CONSTR. INSULATION OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - GO FT,TIE ERR AREA TOTAL ACREAGE DIAPHRAGM auILDI usE ' RES IND CON PB 00,e, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ ❑ ❑ ASSESSORS PARCEL.NO. ROUGH PLUMBING TRACT NO. PARCEL NO, GAS TEST MECHANICAL ,j JA ,3 ACC.DATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING' ENG.SITE NO. INSULATION PLUMBING ' GAS FIRE SPRINK ENERGY T.I4 MECHANICAL v ❑ N[:] v ❑ N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLDOD ZONE - A,L.U.C, LATH-INTERIOR ELECTRICAL LATH-EXTERIOR FIRE DEPT. y❑ N� v 0 N❑ SHEETROCK • ' ' ' GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC - PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR' "MICROFILM 1 LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0' PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.rax PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPV APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY + 6UI LDING I PROJEC DENTI FICATION PERMIT NUMBER BUILDING /�� APPLICATION & PERMIT ADDRESS BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 1292 Owry E ' �1p� PLANCHECK VALIDATION NAMER's s7 2 QTY. ELECTRIC PERMIT FEE z co RA IGoa UTLETS-SWITCHES-RECEP 10.00/1.00 LJC.No.53 LIGHTING FIXTURES 10.00/1.00 r,0 crOp��X APPLIANCES-RESIDENTIAL 4.00 �l..''�JCCJJ PHD F JIJ PANELS 10.00 DATE OF APPLICATION OR ARCHITECTPANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. O ENGINEER LIc.NO. SIGNS TRANS. 3.00 ADDRESS ENaSPECIALCIRCUIT 500 PERMIT VALIDATION ADDRESS , ZIP EMP.METER OR POLE INS. 20.00 MAESS MOTORS SEE FEE SCH. AooSEss - �..J SERVICE CHANGE 20,00 w 0 0 LICENSED CONTRACTORS DECLARATION /�1 /,�/7 rt 0 u 1 hereby affirm that I am licensed under provisions of Chapter 9 SUANCE OATS 2 w (commencing of fit Section 7000)of Division 3 of the Business and BLDG, ELECT. PLG. MECH. N i Professions Cod- and rrly�ycense is in full for fC t ❑ ❑ ❑ Z,0 R,— 5,434�'t_Lic.Num is o G Ua� Contractor a y s meG BUILDING PERMIT 5 a w u OWNER-BUILDER DECLARATION INFORMATION x O n m I hereby affirm that 1 am exempt from the Contractor's License MISC.— REFER TO ORD w 3 u VALUATION $/PT, FL0 < Law for the following reason,(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 Code.Any city or county which requires a permit to construct,alter, s ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. u, 0 ELEC. E O M requires the applicant for such permit to file a signed statement that TOTAL MpER MITT a' $ he Is licensed pursuant to the provisions of the Contractor's License Fit Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe < Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE W_ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. d , by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).1: ❑ 1,as owner of the property,of my employees with wages as BACK FLOW PROTECT. DEVICE 4,00 OCC.GROUP RES.UNITS their solecompensation,will Jo 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 property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1 6.00 mems are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion, the owner, GAS EASYSTEM OVER 4(EA) 200 builder will have the burden of proving that he did not build or im- - . - . . BUILDING USE prove for purpose of sale.). RES IND CON PB Other ❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ 0 ❑ ❑ 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 contrathe Contractor's actor's h License L with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Contractor's h projects Law. ❑ lam exempt under Sec. ,B.&PEC.for this WATER HEATER W/VENT 6.00 tenant Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insum, or a certificate of Workers'Com ensation Insurance,ora certified ZONING ENG.SITE NO. cypy lheof Sec. x,00 Lab,C Ib4 ert 'f9fnpa 11 Z ❑ CCertified copy Is her y ILmished, FIRE SPRINK ENERGY T 24 Z 2 "�/ C d yit ivi' MISC.- REFER TO ORD. E] ❑ I] O AP�,licant v N V N = W CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLO, Z (This section need not be completed if the Permit is for one TOTAL Y E] N❑ Y [:] IN hundred dollars(S 100)or less.) U O 1 certify that in the performance of the work for which this per, OTY. MECHANICAL PERMIT FEE FEE SUMMARY I.L. H mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. 0 y f Ex- Date Applicant ALTER OR ADD 5.00 5, BUILDING >_ N NOTICE TO APPLICANT: If,after making this Certificate o I.. Z 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 UNI),(Txq I QF.M.) 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLINGR10 .16.00 a-O SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD 1 IT 5.00 the performance of the k for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). //� ,yPlid 1/� HEATING UNIT(141100,000 B.T.U.) 8.00 Lender's Name �_�—J HEATING UNIT(OVER 100,000B.T.U.)9.50 Lender's Addrer ELECTRIC I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building canslruction,-and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby tirepresentatives ec this purposes.is city to enter upon the shove-mentioned property for insp ofBOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL h (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX Got m ' any.way accrue against said City in consequent of the PERMIT ISSUANCE 10.00 anti of this permit d� / ECHE CONT. LIC.NO. MECH. L/ TOTAL '7�/� TOTAL a are o Applicant/Con tactor Dale C /, OFFICE COPY