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11050POST THIS CARD NEAR FRONT OF BUILDING ...:;. CITY OF CUPERTINO -. ' PFRM+T NUMBEH, . INSPECTION DIVISION 11050 JOB INSPECTION`REC RD ' • PERMIT' EXPIRATION JOB ADDRESS I +,# LOT# - 'i,.. _ PERMIT EXPIRES IF, WORK OWNER - CONTRACTOR AS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180, DAYS FROM LASTCALLED INSPECTION. INSPECTION . DATE INSPECTOR >I SP CTION RECORD FOUNDATION- . - - • " ' •. PR EGUNITE ' - - - � - PERMIT VALIDATION • 1 ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - UNDERGROUND /SLAB PLUMBING ELECTRICAL MECHANICAL e a ELECT:' PLG: MECR. o o 00 NOT POUR•FLOOR UNTIL ABOVE HAS BEEN SIGNED - , I BUILDING PERMIT INFORMATION - • - WOOD '.FLOOR VALUATION s /FT. PLUMBING '•' • MECHANICAL ELECTRICAL q •, +� I '- } �, PERMIT TO, F FRAMING INSULATION ; . . -, STORIES -TYPE CCINSTR DOC, GHOUR ', IRES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED' . p00F ROOF , , SO, FT. FLOOR AREA .TOTAL ACHEAOE - DIAPHRAGM ' '• _ - BUILDING USE _ +, I ES 'IND CON PB Olne, •0'� APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED- - ROUGH '. _ /' D0 - / 1% �(O W!/ r –/7i�• ASSESSORS NO. - ... .. PLUMBING _ GAS TEST - _ .PA A C No 1� urctn P�NO0 ` MECHANICAL' ELECTRICAL - DATE ACC. FILE —INSP. FRAMING - -i0� Z SAN #' INSULATION PLU NG. - ZONING ENG SI TE NO , . I " GA f - ` ME HANK L I .FIRE SPRINK Y �' "� ENERGY T-24 "� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HE TIN LATH — INTERIOR " 3.'' - ELE ICAL FLOOD ZONE v o "O A.L.uc. Y �] - N� LAT '" XTERIOR I ED EPT:-� SH' ROCK • - .3 _ "r.lF RADE' " FEE SUMMARY SHEAR INTERIOR BUILDING'' , SHEAR'EXTERIOR ' `- TEMPORARY APPROVALS FIREWALLS - ELECTRIC .PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. �,jICROFILM ARRANGE FOR INSPECTION BY PHONING 252 4505, ELECTRIC ONE WORKING DAY-BEFORE REQUIRED INSPECTIO," N O� `' z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING MECHANICAL' =SEE PERMIT FOR EXPIRATION DATE -,' ;CONST. TAX' `IMPORTANT! TOTAL .. PLEASE READ REVERSE SIDE BEFORE - CAL LING.FOR'FINAL INSPECTION: ' •' 11 OFFICE COPY' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BU I LDING PROJECT I DENTIFICATION APPLICATION & PERMIT PERMIT NUMBER , aUi DIrvG / BUILDING —_ ELECTRICAL— PLUMBING — MECHANICAL 1100 5 OWNER PLAN CHECK VALIDATION NaME PHONE OTY. ELECTRIC PERMIT - FEE ' GATE OF APPLICATION CONTRACTOR oNTRacTDRs - ']• _ U 'LIG NO 'OUTLETS- SWITCHES - RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 roNTHacTOfls a RE55 �j H/r f �p� E / {V V PPLIANCES- RESIDENTIAL 4,00 PANELS 0.00 ARCHITECT eve - OR ENGINEER uc. rvo. PANELS IOVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. - 3.00 ARC"".OR END. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS.: 20.00 nP ADDRESS .. ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 - /��`,�����-V`^� � J- P q /O P LICENSED CONTRACTORS DECLARATION I hereby affirm that I on licensed under provisions of Chapter 9 ISS6ANCE DATE (commencing with Section 7000) of Division 3 of the Business and Professions Codynlmrly,y license is in full fore ufO�Tf License Class_L -J Lic.Numher Date Commcto�� ���� EL Cl, PLG. MECH. I- •' - _ INF RM IT RMAT RM ,OWNER - BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following mason. (Sec. 7031.5, Business and Professions Cade: Any city or county which requires a permit tDCOnstnm(,alteq MISC. —' ' REFER TO ORD 'PERMIT ISSUANCE' 10'00 VALUATION S /FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL' improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file n signed statement that he is licensed Pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Sect ion 7031.5 by any applicant for a pem+il subjects the applicant to 3 civil penalty of not more than five hundred dollars (5500).1: /•�OA,• ' pEHM1T40 (� J •y' G[tk.�L. X� •��i OTY. PLUMBING PERMIT FEE STORIES , TVPECONSTH. ALTER- DRAIN -WATER (EA.) 5.00' ❑ 1, as owner of the property, or my employees with waxes as their sale compensation, will do the work, and the structure is not —BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of DRAINS- FLOOR, ROOF, AREA, COND. 5,00 ' F IXTUR ES - PER TRAP 5.00 GAS - EA. SYSTEM -1INC. 4 OUTLETS 6.00 property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenotintendedorofferedforsale . If, however, the building SO. FT. FLOOfl AREA TOTAL ACREAGE or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or ins- prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB owe, ❑ ❑ '❑ ❑ ❑ INDUSTRIAL WASTE INTER 3000 . . licensed contractors to conslruo the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply LAWN SPRINKLERS - 1 INC 5 V.B. � 6.00 - ASSESSORS PARCEL NO. to an owner of property who builds or improves (hereon, and who LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projects with a contrucmrts) licensed pursuant to the Cnntracmr's License Law. ❑ lam exempt under Sec. ,B. &P.C. for this anon SEWER - SANITARY -STORM EA. 200ft /10.00 TRACT NO. PARCEL NO. WATER HEATER W /VENT - -6.00 Owner DYIC WATER SYSTEM S.00 ACG DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 ' WORK FRS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to sel &insure, ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, or it certified copy I hereof(Sec. 3800, LIIh.C.) Policy No. CompunY e6 • Certified copy is hereby furnished. • Certif• copy is Bled with the city inspection division. ' APPlicnm - FIRE SPRINK v ❑ N❑ ENERGY T-24 ,Y ❑ N❑ MISC. - REFER TO ORD. //•y Ch TI -IC E I' Z710N FROM WORKERS' '. COMPENSATION INSURANCE (This section need not he completed If the permit is far one PERMIT ISSUANCE 10.00 FLOOD ZONE V ❑ N❑ A.L.U.C. y ❑ N❑ PLG.CONTR. LIC. NO. PLG. TOTAL hundred dollars (S 100) or less,) I certify that in the performance of the work for which this per. out is issued, 1 shall not employ any person in any manner so as to CITY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING SC) 6'?) become subject to the Workers' Compensation Laws of California: Dam Applicant NOTICE TO APPLICANT: If, after making this Certificule of Ex- I ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE ' emption, you should become subject to the Workers' Compensation Provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there is.a construction lending agency for the performance of the work for which this permit is issued (Sea 3097, Civ.C.L EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Na - HEATING UNIT 100,000 B.T.U.) 9.50 ELECTRIC VENTILATION FAN (SINGLE) 4.00 - I certify that I have read this application and stale that the above information is correct. 1 agree to comply with all city and county Ordinances and state laws relating to building construction, and hereby authrrim representatives of this city to enter upon the above - mentioned property for inspection purposes. PLUMBING . BOILER• COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (0vef100,000BTU)SEEFEESCH. MECHANICAL. (We) agree to save, indemnify and keep harm_less the City of Cupertino against liabilities, judgments, costs and expenses which may ny way accrue against said City in consequence of the MISC. - REFER TO ORD. PERMIT ISSUANCE t 10.00 CONST. TAX am ng if this pejrriiL �A•f MECH. CONT. LIC. NO. MECH. TOTAL TOTAL o2/ 0 of Applicant/Contmct Date OFFICE COPY