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13337 }.� POST THIS CARD NEAR FRONT OF BUILDING PERMIT CITY OF CUPE RTINO NUMBER INSPECTION DIVISION 13337 JOB INSPECTION RECORD JOB ADDRESS 10302erKshire C " UNIT# LOT# I PERMIT EXPIRATION y/� II' /' PE RMIT'EXPI RES I F WORK IN / yvS� J—V CONTRACTOR T ru_,-;7 IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU- ATION ANCE OR 180 DAYS FROM - LASTCALLED INSPECTION. NITE PERMIT VALIDATION NO CONCRETE NTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLABNG - .�- fICALISSUANCE DATENICAL � � � eGgc ELECT. PLc. MECR. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �- WOOD FLOOR' - �I•( SIN ORMATIONT PLUMBING , VALUATION $/FT. MECHANICAL ELECTRICAL _PERMIT 'T{O FRAMING INSULATION - - - .STORIES TYPE CONSTR. �,OC!C.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 9`-�! 3' ROOF SO FT,FLC!ORq:A TOTAL ACREAGE DIAPHRAGM ♦ � • 1 - S ICJ_ BUILDING USE S' IND CON . PB . 0,,, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ❑ �' ❑ ❑ ' ❑ ROUGH - ASSESSORS PARCEL NO PLUMBING /,� `�� l GAS TEST P - - - ?RA PARCEL NO. MECHANICAL - oZ- _ • (i/} // „• ELECTRICAL FINALS DATE INSP. ACC DATE r Acc.FILE No. FRAMING SAN # .I INSULATION PLUMBING � q y ZONING ENG,SITE NO. GAS / (� MECHANICAL FIRE SP4SUMMARY COVER NO WORK UNTIL ABOVE HAS BEEN SI NEO HEATING S $�� Y ❑ ❑ LATH—INTERIOR ELECTRICA ,�,`. (f�� , FLOOD?ONE LATH—EXTERIOR - EIRE DEPT. Y❑ SHEETROCK - GRADE F SHEAR INTERIOR BUILDING _ SHEAR EXTERIOR BUILDIN '�I'S` SH TEMPORARY A PROVA FIREWALLS ELECTRIC PLAN CHECK GAS ,?'� FE E- TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED DCCUPANCY SEISMIC FEE G OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ~�. ONE WORKING DAY BEFORE REQUIRED INSPECTION.' L O PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING 0. Z �,✓ - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANTI CONST.TAX 'It) PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL'INSPECTION. OFFICE COPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY �^ BUILDING PROJECT IDENTIFICATION PERMIT NUMBER V ADDRESS APPLICATION & PERMIT ADDRESS LO.r BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 13337 OWNER'S PLAN CHECK VALIDATION NAMrtEy�� .IV. Tom,., l 2OTY. ELECTRIC PERMIT FEE 1RACTOR 1Y. 114.• PHON 415 969-7722 NAME ACTORS 1,04 OUTLETS-SWITCHES-RECEP 10.00/1.00 16 7}1YLISt N LIC. LIC.N0319115 Q:S LIGHTING FIXTURES 10.00/1.00 zs- CONTRACTOR'S ADDREESSS��] Ty rrAPPLIANCES-RESIDENTIAL 4.00 9$- Lt 3 Ly. PHONE 969-7722 2 PANELS 10.00 TO- DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR Corp.-- Arch. PANELS (OVER 200 AMP) 20.00 r'ia C ENGINEER 19M Van De LIC.N.. SIGNS TRANS. 3.00 1�.q %-r-' ARCH.ORENp�� PERMIT VALIDATION ADDRESS J[LIC SPECIAL CIRCUIT 5,00 . pp 1 ATed DEldr1ICSSOR ZIP r EMP.METER OR POLE INS. 20.00 PL 3 ADDRESS U 7 MOTORS SEE FEE SCH. 2093 Landings'Dr. Mit. View SERVICE CHANGE 4+ " 20.00 1 j�/G O o LICENSED CONTRACTORS DECLARATION 6/ a / a U w I hereby affirm that I am licensed under provisions of Chapter 9 e 1(r r; !x' ISSUANCE DATE w a (commencing with Section 7000)Of Division 3 of the Business and F.`y - BLDG. ELECT. PLG. MECH. r w i Professions Co d my license is in full for f ct. - _4,aq a i w o Date Lin.Number i� O �L[f" I H w r j Dale O Contracmr. ry}h1 �-I a Y J U•] BUILDING PERMIT ¢ ¢ a OWNER-BUILDER DECLARATION - ¢ u, a INFORMATION w ; u I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD Huej Law for the following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE 10.00 //VALUATION $/FT. so Cade:Any city or county which requires a permit to construct,alter, lV Oq-/7 c x¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /��I1� / (/V wCa u requires the applicant for such permit to file a signed statement that TOTAL /!G'� PERMIT TO he is licensed pursuant en the provisions of the Contractor's License �� 1 HiQ I,aw(Chapter 9(commencing with Section 7000)ofDivision3 of theW E 4 c Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ H 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-GRAIN&VENT-WATER (EA.) 5.00 �. �iG ✓�J of not more than five handled dollars($500).): ❑ I,as owner of the property,or my employees with wages as BACK F.LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 K-3 / Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such workJ FIXTURES-PER TRAP 5.00 SQ.FT,FLOOgEA TOTALACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-i INC.4 OUTLETS 6.00 V or improvement is sold within one year of completion,the owner. GAS-EASYSTEM-OVER 4 (EA) 2.00 builder will have the burden of proving that he did not build or in . . h- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTEINTER. 30.00 IND CON PB Omer ❑ 1,as owner of the property,am exclusively contracting with E ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO and Professions Code:The Contractor's License Law does not apply /a� .�� to owner of property who builds improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ✓C, contracts acts for such projects with a mntrlructor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 /dam TRACT NO. 'PARCEL NO. ❑ lam exempt under Sec.-,BAP.C.for this / WATER HEATER W/VENT 4 6.00 on TT Owner Date WATER SYSTEM - ! 5.00 4 ACC.DATE ACC.FILE NO. WORK F.RS'COMPENSATION DECLARATION WATER TREATING EQUIP, s 5.00 - I hereby affirm that I have a certificate of consent to self-insure, �e.n or a certificate of Workers'Compe tion Insurance,or a certified ...C.�`\\ ZONING ENG.SITE NO. copy thereof(Sec 3600,LACI sa t -!RAS s�- Cf� s+ - Policy No. Company �(]- - O ❑ Certified copy is hereby furnished. pa RE$PRhNK ENERGYT 3< Z Z ❑ Certified copy is filed with the city inspection division. 0 Applicant MISC.- REFER TO ORD. v ❑ N❑ Y ❑ N❑ CC W CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 /10- FLOOD ZONE A.L.U.C. LL COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG. 1 0 (This section need not be completed if the permit is for one TOTAL Lo7°�° Y❑ 'N❑ Y ❑ N❑ Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,I shall not employ any person in any manner so as to O become subject to the Workers'Compensation Laws of California. ^�r V a Date Applicant BUILDING 5 S } In NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 (_ Z emption,you should become subject to the Workers'Compensation APPLIANCE _ 5.00 PLAN CHECK provisions of the Labor Cade, you must forthwith complywith - FEE V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD,(WITH DUCT),11( 5.00 5- the performance of the work for which this permit is issued(Sec. s... l - MICROFILM 3097,Civ.C.). F.I.B. I B 12 HEATING UNIT(T0100,0001BET.U.) 8.00 r0 Lender's Name Lender's Addre51� HEATING UNIT(OVER;700,000 B.T.U.)9.50 ELECTRIC ss , I certify that 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 /1- s information is correct.1 agree to comply with all city and county PLUMBING ordinances and state Taws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 �TT , hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL 1 Yv above-mentioned property for inspection purposes. r (We) agree to save, indemnify and keep (harmless the City of MISC.- REFER TO ORD. ny, Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the ' granting of this permit. f�� MECH.CONT. LIC.NO. MECH. �O+►YS• r�r[kt 8/3/87 TOTAL eo TOTAL ��ra/f 17 Signature of Applicant/Contractor Date OFFICE COPY