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10094 POST THIS CARD NEAR FRONT OF BUILDING I + PERMIT NUMBER ' 4 CITY OF CUPERTINO ,,* i �•' INSPECTION DIVISION. �9 JOB INSPECTION RECORD JOB ADDRESS ' •r"""" i2�+-iV PERMIT EXPIRATION IT#' i LOT#' ' PERMIT EXPIRES'IF WORK; OWNER CONTRACTOR - �.' IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR I -INSPECTION RECORD ' 180 DAYS of PERMIT ISSU FOUNDATION' Q -I r "ANCE OR 180 DAYS FROM - .UFER LASTCALLED INSPECTION. - PREGUNITE ' ,PERMIT vnclonnoN ; , POUR NO CONCRETE T TIL ABOVE HAS BEEN SIGNED .UNDERGROUND /SLAB , - '. JO l�✓d-I PLUMBING ELECTRICAL ISSUANCE GATE .` MECHANICAL 'x - BLDG. LECT. PLG. . MECH. .. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT' WOOD FLOOR'; ° INFORMATION PLUMBINGvAwATTON , 4 r MECHANICAL - . ` ELECT.RICAL '+ PERMIT To -•• , FRAMING I- I^. _ + ` �iO INSULATION EXPIREDsroRl s r1w`EcoNsrR. 'I OCC,GROUP RESS-UNITSf PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 'ROOF ^ ' ' SO:FT.FLOG ANEA 'TOTAL'_ACREACE i r! DIAPHRAGM - .BUILDING USE 1 ,}A; •,� RES IND CON PB 'Oibtl•j: APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ '❑ ❑.. .❑ ^MI • ROUGH 1 ASSESSORS PARCEL NO. I 'fl PLUMBING. , G4 JZ .,.a . GAS TEST rRAcr rvo. .PARCEL NO MECHANICAL - ELECTRICAL _ Acc.onrE Acc FILE No., FRAMING �v a FINALS 'y DATE- INSP. lt, SAN'# .. INSULATION _ PLUMBING zoNlNcENc.sIrENo. . - - GAS _ MECHANICAL " - PIKE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING El.z' ❑ >' I ❑ N❑ ' LATH—INTERIOR - ELECTRICAL FLOOD ZONE A,L.U.C:, LATH—EXTERIOR . FIRE FIRE DEPT. ^,. ❑' N❑ .• v ❑ .N❑ , " SHEETROCK GRADE - _ - FEE SUMMARY SHEAR INTERIOR IBUILDING . 1 SHEAR EXTERIOR . TEMPORARY APPROVALS ' BUILDING- PNOTAPE ALLS a ' ELECTRIC - PLAN CHECK , GAS FEE • - OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ;. ,• -SEISMIC FEE ANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR; . + '' .1 MICROFILM , ARRANGE FOR,INSPECTION BY PHONING 252'4505;. . ELECTRIC �p ONE WORKING DAY BEFORE REQUIRED INSPECTION:. r I. PLEASE•GIVE JOB ADDRESS WHEN PHONING. PLUMBING z — SEE'PERMIT,FOR EXPIRATION DATE — MECHAN'ICAL' r' . OIMPORTANT!' coNST.TAX ` E PLEASE:READ'REVERSE SIDBEFORE TOTAL !r , . CALLING FOR..FINAL INSPECTION. . " ,. - _ OFFIQE COPY. ' ,' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY PERMIT NUMBER BU I LDING PROJECT IDENTIFICATION -APPLICATION & PERMIT oo(� A IiuuOI NGS ``�-1- 4 BUILDING —ELECTRICAL—PLUMBING—MECHANICAL lJ /r� 6i7 li/dNG PLAN CHECK VALIDATION OWNER'S �, 26 ANE CITY. ELECTRIC PERMIT FEE, p C PHONE 257�� CONTRACTOR'S G - OUTLETS SWITCHES-RECEP 10.00/1.00 J9iry12 /✓ [ % LIc.ND. 5��39 LIGHTING FIXTURES 10.00/1.00 �I roNTRacrons APPLIANCES-RESIDENTIAL 4.00 r ACO ESS' iF/Z PHONEPANELS (OVER AMP) 20.00 10.00 DATE OF APPLICATION PANELS ARCHITECT PLAN CNECK FEE P.C.NO. ONGINEER SIGNS TRANS. 3.00 " LIC.NO. ARCH.OR ENG. 5.00 —PERMIT VALIDATION aooREss SPECIAL CIRCUIT - ZIP EMP.METER OR POLE IN 20,00 APPLICANTS - MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 a U u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE ATE N<N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. O Professions Code d my license is in full for' z o N-f� License C s Lie.Number O Date Contractor �rBUILDI NG PERMIT ><,C.� a ¢ w OWNER-BUILDER DECLARATION '41;: INFORMATION, .? MISC.— REFER TO ORD V LUATION E/FT. 0 H I hereby affirm that 1 am exempt from the Contractor's License - ' iu LLDel Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 � Nv+� Cade:Any city or county which requires a permit to construct,alter, Q Q Q Q Improve,demolish,or repast any structure,prior to Its Issuance,alio ELEC.CONTR. LIC.NO. ELEC. , i - D , requires the applicant for such permit to file a signed statement that TOTAL ERMIT TO X he is licensed pursuant to the provisions of the Contractor's License �T� i> Law(Chapter 9(commencingwilh Section 7000)of Division3of the + L !! a Business and Professions Code)or that he is exempt therefrom and DTV. - PLUMBING PERMIT FEE'p 4 2 D STORIES TYPE CONSTR. ¢ r$ the basis for the alleged exemption.Any violation t nit cion malty ng - by any more fora permit subjects(SSOO licanl unit civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five the prop dollars(my employees ❑ Las owner at the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will the work,and the structure Is not (S intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 5,00 Cade:The Contractor's License Law does not apply to an owner of IT p property who builds or improves thereon,and who does such work FIXTURES-PER TRAP S.00 SD.FC FLDGR AREA TOTAL ACREAGE + himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-1 IN OUTLETS 8.00 IR. merits are not intended or offered for sale.If,however,the building sP. 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. RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTEINTER. 30.00 ❑ ❑ El CD 13❑ 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 contracts for such projects with a contractor(&)licensed pursuant to SEWER-SANITARY-STORMEA.20011/10.00 TRACTNO. PARCEL NO. the Contractor's License Law. ❑ I am exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 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 ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lah.C.).�./{' Policy No. Company vv+0 3� O ❑ Cetlified copy is hereby furnished. FIRESPRINK ENERGY T 24 Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. Y ❑ N[] Y ❑ NC]AO plicant F - PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. TI ,X > CERFICATE OP EX17MPTION FROM WORKERS' , UJ COMPENSATION INSURANCE PLG.CONTR. ❑C.NO. PLG. Y❑ N❑� v❑ N❑ 0- O (This section need not be Completed if the permit is for one TOTAL D Z hundred dollars($100)or less.) - U 0 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT - FEE k 7"A It SUMMA°RY mil is issued,1 shall not employ any person in any manner so as to , +J�� OOu become subject to the Worker&''Compensation Laws of California. BUILDING / Date Applicant ALTER OR ADD TO MECH. 5.00 } y NOTICE TO APPLICANT: If after making this Cenif¢alc of lix- F Z cmption,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 UNIT(TO 10,000GF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE f� + 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. HEATING UNIT(TO 100,000 B.T-U.) 8.00 MICROFILM 3097,Civ.CJ. Lender's Name HEATING UNIT(OVER 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 countyPLUMBING .ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 - e1 hereby authorize representatives this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL i above-menlionnl property for inspecec tion purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER'TO ORD. Cupertino against liabilities,judgments, costs an......nses which PERMIT ISSUANCE 10.00 CONST.TAX may in y way, ay accrue again t said City in conequence of the gmn' this rmi(. MECH.CONT. UC.NO. MECH.' TOTAL TOTAL /61/y/, ignature ofA [ onfrac[or Date `� OFFICE COPY