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12496 (2) ' POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO , ° PF'RMIFN„MRER „ INSPECTION DIVISION ��g" � JOB INSPECTION RECORD ' J - 1011'1, WESTMINSTER CT 17 PERMIT EXPIRATION JOB ADDRESS UNIT# _ LOT# pE41MIT.EXPIREs IF WORK OWNER THRUST IV„ SNC CONTRACTOR THRUST IV INCIS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION_ ),2$T 1' In+ �• OWNS Er5 LASTCALLEED INSPETLIFER U �ON. PR EGUNITE PERMIT VAODATION,L. "1Y POUR NO CONCRETE UNTIL ABOVE HAS BEM SIGNED ,' •' ^7» UNDERGROUND /SLAB el L�•n, PLUMBING �•y ELECTRICAL ISSUANCE DATE MECHANICAL RLDG. ELECT. PLO. MECH. ❑ 1 ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED . BUILDING PERMIT WINFORMATION WOOD FLOOR VALUATION SIFT. ' PLUMBING efllo-,F7 RO „ MECHANICAL 10-1`7 - ZUSA PERMIT TO ELECTRICAL FRAMING — 1<7P STORMS TYPE CONSTR. INSPLATION 2 ' �'9- I•II N 1 OCC.GROUP RES.UNITS a $'3 PLACE NO SUBFLOOR UNTIL AB VE HAS BEEN SIGNED ckv Ofv 1 SD.FT FLOOR AREA TOTAL ACREAGE -ROOF n, 3383 DIAPHRAGM NL ClI•' DUILOINc use RES IND CON PB om -APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 El ❑ nSSESSOR SPARCEL NO. ROUGH PLUMBING Pt 9 T O. ARCEL NO, GAS TEST 2• `J, . MECHANICAL RIATE ACC. ILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO. INSULATION . PLUMBING -11-13 GAs FIRE SPRINK ENERGY T 20 MECHANICAL -Q- COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N0 T ED NEI LATH-INTERIOR ,}qj ELECTRICALS FLOOD ZONE A.L.u.c. LATH-EXTERIOR �❑ N❑ SHEETROCK u'cLP .Y 1 19 7 GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR .-� TEMPORARY APPRO AL BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS I T FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 14.91 OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDI G _IN.LS'�GI'ED BY BUILDING INSPECTOR• MICROFILM i ARRANGE FOR INSPECTION BY PH Iki9sm6R{�}�05, ELECTRIC " H ONE WORKING DAY BEFORE REQUIRED INSPE TION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX 280.00 _ PLEASE READ REVERSE SIDE BEFORE TOTAL - ?j/p 4/ CALLING FOR FINAL INSPECTION. OFFICE COPY �" CERTIFICATE OF COMPUTION BUILDING INSPECTORS OFFICE oLDT(7 CITY OF CUPERTINO G DATE19 BLDG. PERMIT NO. THE BLDG. LOCATED AT OWNED BY � I l HAS BEEN (COMPL FOR USE AS j (ALTERED) i I IL'DING INSPECTOR APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT I DENTIFICATIO /y PERMIT NUMBER A BUILDING APPLICATION & PERMIT 12496 ADDRESS 10111 WESTMINSTER CT �jBUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWrvER'a ^ PLAN CHECK VALIDATION "AME ''II QTY. ELECTRIC PERMIT FEE k sr 77 MG. PHONE r NAMERAcroRsOUTLETS-SWITCHES-RECEP 10.00/1.00 t^ LiC.No.319146576 LIGHTING FIXTURES 10.00/1.00 ca.2 10 - t` �/ / ADDRESS Rs -2 PPLIANCES-RESIDENTIAL 4.00 - '�"S/cf CONTRA Q/S CSr lO. c..sMaV'PHONE '172'ZA PANELS 10.0 DATEOF APPLICA?ION ARCITECTgORP'ry RQ1{ PANELS (OVER 200 AMP) 2O.OD PLAN CHECK FEE P.C.NO. OR l ►1V/ Ery eYe.RLV44/ E E LIC.NO. SIGNS TRANS. 3,00 ARCH,OR ENG' SPECIALCIRCUIT h _ 5.00 PERMIT VALIDATION t SS 3A me ZIP frEMP.METER OR POLE INS7--11 20.00 ADDRESS rS (� MOTORS !'•) SEE FEE SCH. 6 - -KrJ �.-, _- AOORE55 ,N., `-o w I^+-�-+ 3 �,AW ¢O -3 SERVICE CHANGE L2000 moo LICENSED CONTRACTORS DECLARATION ni{+ r 3lv u U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE N G w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. DR z Professions Code and/my license is in full force n(I f�. ❑ ❑ ❑ ❑ o Z v'Ai W License Class Co Number/ Date Contractor ¢ x BUILDING PERMIT ¢ Q IS ¢ OWNER-BUILDER DECLARATION - oam MISC.- REFER TO ORD INFORMATION w ; H 1 hereby uffirm that I or exempt from rhe Contractor's License - u VALUATION S/FT. o¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE - 10.00 � - Code:Any city or county which requiresapermit toconstrucl,alter, Q A.� 213,00 Q2¢p Improve,demolish,or repair any structure,prior to Its Issuance,also ELEC.CONTR. LIC.NO. ELEC: p yr a a m u requires the applicant for such permit to file a signed statement that TOTAL p PERMIT TO w m w he is licensed pursuant to the provisions of the Contractor's License r Law(Chu ter 9(commencin with Section 7000)of Division 3 of the j r o Business end Professions Code)or that be is exempt therefrom and OTY. PLUMBING PERMIT FEE SFDWL is v- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 2 of not mora than five hundred dollars($500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or,offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R-3 1 Code:T1ic'Commetor's License Law does not apply to an owner of - property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 O r 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- / mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEf_)= INC.,4 OUTLETS 6.00 3385 or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Other prove for purpose of e.), INDUSTRIAL,WASIjE INTERS 30.00 CI Las owner of the property,am exclusively contracting with ® Cl ❑ ❑ ❑ licensed contractors to construct the Project (Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCEL NO. and Professions Code:The Contractor's License Law does not apply zip to an owner of property who builds or improves thereon,and who LAWN SPRI IE KR$ ,y UIR)(EA.) 1.00 342-12- contracts for such projects with a contractorls)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00 C1 - the COnlractoi5 License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec. .B.&P.C.forthis WATER HEATER W/VENT 6.00 8016 reason $01(7 Owner Date WATER SYSTEM 5.00 - TE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofconsent to self-insure, ZONING or a certificate of Workers'Co .10 Insyysrag r a certified ENG.SITE N0. copy thereof(Sec.3600,Lab.C.).-2fW4 / � Policy No. Company_46.► 0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 , Z Z - ❑ Certified copy Is filed with the city inspection division. MISC.- REFER TO ORD. O Applicant Y ❑ N❑ Y ❑ N❑ CC CERTIFICATE OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 ,4' ^ FLOOD ZONE A.L.U.C. LL > .COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. /�� In Y❑ NE] V❑ N❑ CL Z (This Section need not be completed if the permit is for one TOTAL hundred dollars(S 100)or less.) U O 1 Certify that in the Permrmance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,1 shall not employ any person in any manner so as to U become subject to the Workers'Compensalion laws of California. y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 715.50 } W NOTICE TO APPLICANT: If,after making this Certificate of IN- 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 slmll be deemed revoked. AIR HANDLING UNIT(TO 10SMCF.M.) 4.00 CONSTRUCTION LENDINC AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 14.91 I hereby affirm that there is a construction lending agency for EXHAUST HOOD( 1 CT) 5.00 the performance rof the work for which this permit is issued(See. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.L 1 X t (7 Lender's Name /_ HEATING UN LOVER 00,0 B,T.U.)9.50 Lender's Address_�3Q5[-� rs Ii. - I. -" ELECTRIC L� I certify 0ml I have real this application and stole that the above VENTILATION FAN (SINGLE) 4.00 d. /�� information is correct. 1 agree to comply with all City and county PLUMBING f/ ordinances and state laws relating to building construction, and BOILER-COMP r p q'81T.U.1 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 BCH. MECHANICAL (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 V -^ CONST.TAX 280.00 may in any way accrue against said City in consequence of file ranting of this permit. I MECH.CONT. LIC.NO. MECH. dire. jaw, i�ai�d� 5*97 TOTAL -f4J 6 TOTAL / Signature of Applicant/Contractor Date OFFICE COPY I