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12371ilk r. POST THIS CARD NEAR FRONT OF BUILDING CITY Of CUPERTINO X371 TPERMIT INSPECTION DIVISIONJOB INSPECTION RECORD XPIRATION JOB ADDRESS 863 Betlin Avenue UNIT# LOT# ' - PERMIT EXPIRES IF WORK OWNER Ponder CONTRACTOR ACe PlumbinIZ IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE`OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION I DATE I INSPECTOR INSPECTION RECORD FOUNDATION • LIFER PREGUNITE PERMIT VALIDATION - 4 ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL BLDG, El ELECT. El P�LO.� MECH, [0\ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - ', BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION PLUMBING MECHANICAL ELECTRICAL - g PERMIT To - `- •�' FRAMING INSULATION ,eJ. B STORIES TIG TYPE corvsTR. i ' OCC.GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - SG FT, FLOOR AREA TOTALAGREAGE i DIAPHRAGM BUILDING USE ' RES IND CON PS ONe• El El ` I El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. ROUGH • , PLUMBING GAS TEST TRACT No. PARCEL No. MECHANICAL ELECTRICAL FINALS DATE [NSP. ACC, GATE-- ACC. FILE NO, FRAMING SAN # INSULATION PLUMBING ZONING ENG SITE NO. - GAS MECHANICAL FIRE SPRINK ❑ N ❑ ENERGY T 24 N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HE0,-4 ER NCC rat G y" -N] i LATH—INTERIOR - - ELECTRICAL zorvE Y ❑ No A.L.0 c. Yo N❑ LATH—EXTERIOR FIRE DEPT. - .�FLooD SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC - PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED loccUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL 'IS SIGNED BY BUILDING INSPECTOR. .MICROFILM ELECTRIC ARRANGE FOR INSPECTION BY PHONING 252-4505, H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. L —.SEE PERMIT FOR EXPIRATION DATE — CONST. TAX IMPORTANT[ TOTAL PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICECOPY AFLD,LICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY OUI L61 NG PROJECT 1 DENTI FICATION `SOl,L APPLICATION & PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 1237 ING ADDRSS /. �L K/ OwNER'S NAMEO O Y. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTOR'S NAME OUTLETS - SWITCHES -RECEP 10.00!1.00 LIGHTING FIXTURES 10.00/1.00 - `, .N . DATE OF APPLICATION CONTRACTORS HO S, flatPNFa, - �� A PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 RROHITFc OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. N0. ENGINEER uc. No. SIGNS TRANS. 3.00 ARCH. OR ENG. ,p :... SS SPECIAL CIRCUIT 5.00 PER MIT VALI DATION EMP. METER OR POLE INS. 20,00 ZIP �( ADDRESS MOTORS SEE FEE SCH, SERVICE CHANGE 20.00 7 LICENSED CONTRACTORS DECLARATION / ' I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the BuSiyneysan Professions Code, d I arse is in full fo C C License Class Number-S�V - ISSUAN E DATE BLDG. ❑ ELECT. Ce PLG. MECH. ❑ Date Co tractor BUILDING PERM T INFORMATION R-BUILDF, DECLARAT N I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Business and Professions Code: Any city or county which re,mi-ciu permit to construct, alter, MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION $/FT. _ ELEC. CONTR. LIC. NO. ELEC. TOTAL OTY. PLUMBING PERMIT FEE improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant m the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and PERMIT TO ¢r� /[/ STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permitsubjects the applicant toa civil penalty of not more than five hundred dollars (85000.): ' ALTER -DRAIN -WATER (EA.) 5.00 ❑ 1, as owner of the property, or my employees with wages as their Sole compensation, will do the work, and the structure is not BACK F LOW PROTECT. DEV ICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA,CON O. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of - FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 50. FT. FLOOR AREA TOTAL ACREAGE property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsare not intended oroffered for sale. If, however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or i m- 'prove for purpose of sale.). O I, as owner of the property, am exclusively contracting with . .. GAS - EASYSTEM -OVER 4 (EA) 200 BUILDING USE RES IND CON PB Omer INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Commclor's License Law does not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 IEA.) 1.00 contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STO Oft/10.00 TRACT NO. PARCEL NO. ❑ l am exempt under Sec.,B.&P.C. for itis reason WATER HEATER W/VENT .00 Owner Dale WATER SYSTEM a '500 ACC.OATE ACC. FILE NO. WATER TREATING UIP. 0 WORKERS'COMPENSATION DECLARATION - I hereby affirm that 1 have a certificate of consent to self -insure, or a ce�1l1ppaaff�r((jjmc�aIt((e of WorkeTS' {'rp peasat' n h sura ce or a clyrl' ierl Polcy �iA.l s ZONING ENG, SITE NO. ❑ aril Copyereby toih ❑ Certified copy Filed ith th sp lin cl'si Applicant FIRE SPRINK Y� N� ENERGY TQ4 vC-] N[] MISC.- REFER TO ORD. CF.RTIFICAT' OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.O.C. CO PF: SATION INSURANCE on ne¢I t. (This sectibe completed If the permit is for one Y ❑ N Y ❑ N❑ PLG. CONTR. LIC. NO. PLG TOTAL hundred dollars(S100) or less.) , 1 certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to CITY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- 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. APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE 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 EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued (Sec. 3097, Civ.CJ. MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 6.00 Lender's Name Lender's Address HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC 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 VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER -COMP (3 H. P. Or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmicss the City of MISC. - REFER TO ORD. Cupertino against liabilities, judgments, costs and expenses which may in a ay accrue, against said City in consequence of the CONST. TAX PERMIT ISSUANCE 10.00 g ting O f permit. off M. MECH. CONT. LIC. NO. MECH. TOTAL TOTAL ig are pp I t c ra or Data V OFFICE COPY