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12445 POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER CITY OF .CUPERTINO 12445 INSPECTION DIVISION JOB'-INSPECTION RECORD PERMIT EXPIRATION o� a- k- JOB ADD SS NIT# LOT# /'� PERMIT EXPIRES IF WORK OWNER (/`/ CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR V wINSP O RE O 180 DAYS OF PERMIT ISSU- FOUNDATION - - ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER PREGUNITE - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ti,g UNDERGROUND /SLAB �7 2 PLUMBING / _ / 1 ELECTRICAL ISSUANCE DATE MECHANICAL . - - BLDG. ELECT I PLG."- MECH. LA ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED RIDING PERMIT WOOD FLOOR INFORMATION , VALUATION $/FT. PLUMBING. MECHANICAL _ U - ELECTRICAL �, PERMITTO V..� FRAMING . _ \V, - A INSULATION � - I STORIES I TYPE CDNSTH . OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF 50.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM RES IND 1LDCON USEPB Oise, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑,` ❑ ❑ ❑ .. �D ' ROUGH .. ASSESSORS PARCEL'NO. PLUMBING GAS TEST - TRACT NO. !PARCEL NO. MECHANICAL ELECTRICAL -j FINALS DATE IN ACC-DATE ACC FILE NO FRAMING _ SAN IF ZONING ENG.SITE NO. INSULATION." -'j �g'7 PLUMBING GAS MECHANICAL FIRE SPRINK ENERGY Th 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NE] Y ❑ N❑ ELECTRICAL LATH-INTERIOR .y./ FLOOD zoNE. A.L.U.0 YN❑ Yo NE] _ ❑ LATH-EXTERIOR FIRE DEPT. r' SHEETROCK - . GRADE FEE SUMMARY SHEAR INTERIOR. BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS%7. BDILDrrvG i _:.....- FIREWALLS ELECTRIC PLAN CHECK y i GAS FEE, NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE_ OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY'BUILDING INSPECTOR. 'MICROFILM ARRANGE FOR INSPECTION BY PHONING. 252-4505, ELECTRIC •:� o� ONE•WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS,WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! coNsr.rnx 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 FY NG PROJECT IDENTIFICATION PERMIT NUMBER APPLICATION & PERMIT 12445 11 �, }- v�3 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL PLAN CHECK VALIDATION TV. ELECTRIC PERMIT FEE CONTRACTORS /r�� NAME V /A�C / OUTLETS-SWITCHES-RECEP 10.00/1.00 (J O L/ C S ruC.Nn A2411..(E LIGHTING FIXTURES 10.00/1.00 COINTRACTORS APPLIANCES-RESIDENTIAL 4.00 0)0 E55_G /A� '/ /'7 G��L,}/r� 1�"PHONE-25'1 /l�J lr PANELS 10.00 DATE OF APPLICATION RRCNITECT PANELS (OVER 200 AMP) 20.00 . PLAN CHECK FEE P.C.NO. OR ENGINEER LIC NO, SIGNS TRANS. 3.00 ADDRESS ENG. SPECIALCIRCUIT ,5,00 PERMIT zip TEMP.METER OR POLE INS. 20.00 P APPLICANT MOTORS SEE FEE SCH. fis37 J SERVICE CHANGE P 20.00 cfr pit w 00 LICENSED CONTRACTORS DECLARATION rt v w I hereby affirm that I am licensed.under provisions of Chapter 9 (�.j]� 4N9U1CNCE DATE y a (commencing with Section 7000)of Division 3 of the Business and -- BLDG. EL1�EClT. PLG. MECH. ,-, N i Professions Code,a my license is in full for f ect.� Y� ❑ ❑ z 0 m - License Class Lia Number // , Date �5 Contractor A U ofrpertino rc Y X a `OWNER-BUILDER DECLARATION CdY BUILDING PERMIT Oi0 MISC.- REFER TO ORD ' INFORMATION w ; a-y 1 hereby affirm that 1 am exempt from the Contractor's License VALUATION $/FT. H u 0 j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE '10.00 Code:Any city or county which requires permit to construct,alter, Q a a p improve,demolish,or repair an structure,prior to its issuance,also ELEC.CONTR. LIC.NO. p P Y P ELEC. or a u requires the applicant for such permit to file a signed Statement that TOTAL PERMIT TO X m he is licensed pursuant to the provisions of the Contractor's s License ($ Fi> Law.(Chapter 9(commencing with Section 7000)of Division 3 oflhe i 0 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE the basis for the alleged exemption.Any violation ol'Section 703 L5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant too civil penally ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($500).): ❑ I,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 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 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 / 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 WASTE INTER. 30.00 ❑ 1,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 docs 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(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft 10.00 the Contractor's License Law. / TRACT NO. PARCEL NO. ❑ lam exempt under Ser.-,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 1 hereby affirm that I have a canificarc of consent mself-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Company O ❑ Certified opy is hereby tarnished FIRE SPRINK ENERGY T-24 Z Z ❑ Cerlifi o is fie Ilh F city inspection division. O Applicant MISC.- REFER TO ORD. Y ❑ N E] Y ❑ N❑ p: vaPERMIT ISSUANCE 10.00 � - CERTIFICATE OF HXF.MPTI PROM WORKERS' FLOOD ZONE A.L.U.C. LU a COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG, v❑ N❑ v ❑ N❑ CL 0 (This section need not be completed if the permit is for one - TOTAL hundred dollars IS 100)or less I U O 1 certify that in the performance of elle work for which this per, CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL f is issued,I shall not employ any person in any manner so as to U mit become subject to the Workers'Compensation Laws of California. BUILDING �SZ 0. Datc Applicant ALTER OR ADD TO MECH } Go NOTICE. TO APPLICANT: If,after making this Certificate of E.- . 5.00 ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEEr,�s� U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 ��ss CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE J !1 1 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. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name - HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC .4 , LTi Lender's Address �g 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 ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 41hereby authorize representatives of this city to enter upon the ubove-mentioned property for inspection purposes. BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL (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 may in any way accrue,against said City consequence of the PERMIT ISSUANCE 10.00 grant' Of lhi ennit. J MECH.CONT. LIC.NO. MECH. �.G 3 /z - TOTAL TOTAL (p� Signal re of pplicant/Contractor Date OFFICE COPY