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12573 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PFR MIT NUMRER INSPECTION DIVISION • 12573 JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS . 870 BETTE AVE uNIT# LOT# OWNER Goldstein CONTRACTOR ACE Plum' bing PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE'OR 180 DAYS FROM LIFER LAST CALLED INSPECTION. PREGUNITE' PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE 'MECHANICAL RLoc ELECT. PLG. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION g/FT. MECHANICAL ELECTRICAL FRAMING INSULATION STORIES ,TYPE GoN R. OCC,GROUP RES.UN ITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF • SO FT.FLOORAREA TOTALACREAGE DIAPHRAGM BUILDING USE RESIND CON PC J _ ' Ocher APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑' ❑ ❑ ❑ ❑ ROUGH . . ASSESSORS PARCEL NO. PLUMBING GAS TEST - - ; TRACT No. PARCEL No. . MECHANICAL ELECTRICAL - FINALS tINSP, ACC.DATE ACC.FILE NO. FRAMING - 1-GRA., INSULATION - ING - zoNING - ENG.SITE NO. .. -NICALFIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED NG , Y ❑ N❑ YLATH—INTERIOR RICAL \/FLOOD ZONE A.L.U.0 LATH—EXTERIOREPT. Y❑ N❑ Y ❑ N❑ SHEETROCK SHEAR INTERIOR BUILDING FEESUMMARY SHEAR EXTERIOR - TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. -' 'I MICROFILM ARRANGE FOR INSPECTION BY PHONING252-4505, ELECTRIC uJ ONE WORKING DAY BEFORE REQUIRED INSPECTION. r PLEASE GIVE JOB ADDRESS WHEN PHONING. z PLUMBING - SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAz PLEASE READ REVERSE SIDE BEFORE I CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LD1 NG PROJECT I DENTI FICATI ON PERMIT NUMBER BDILDING APPLICATION & PERMIT 1 2573 aDC1�E5 f BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S - PLAN CHECK VALIDATION -� NAME w(f� �'T CELECTRIC PERMIT FEE J �I \V PHON�V - C FIR Nomeacro s - 2 UTLETS-SWITCHES-RECEP 10.00/1.00 %t4 D. \a3 LIGHTING FIXTURES 10.00/1.00 o�oT ACTON s �{�., Q PP LANCES-RESIDENTIAL 4.00 1 \P 5 1 rl76dE =PANE 10.00 DATE OF APPLICATION ARCH ECp DR 5 PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.c.NO. ENGINEER Lie NO. SIGNS TRANS. 3.00 ARCH.OR ADDRESS ENG. SPECIALCIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT'S ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 woo LICENSED CONTRACTORS DECLARATION Mvz I herebY affirm that 1yenlicensed under provisions ofCha ter 9a ISSUANCE DATE (commencing with Se 7000)of Division 3 of the Business and Professions Codf>alad n@xli ense Is in full forcl�Ef c. BLDG. ELECT. w PLG. MECH, Z, o m - License Cl ess 1. VVVV Ic.Number �6yLL O�`T-p�\'t-�p�.^(-) w r w Dale onimctor_-----1R, "'V or w a OWNER.BUIL ER DECLARATION BUILDING PERMIT - INFORMATION X ;w y 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD w O Q Law for the followin reason.(Sec.7031.5,Business and Professions VALUATION � - -' Code:Any city or county whichrequires a permit to construct,alter, PERMIT ISSUANCE 10.00 or Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. DLL requires the applicant for such permit to file a signed statement that TOTAL he is licensed pursuant to the provisions of the Contractor's License PERMIT TO HiQLaw(Chapter 9(commencing with Section 7000)of Division 3 o rthC q D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE I-m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE STR. u ; .- by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($5001.): ❑ I,as owner at the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS inter sole compensation,will(S the work,and the ndProstructure 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 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1 6.00 ments are not intended or offered for sale.If,however,file building or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,BusinessLAWN SPRINKLERS-1 INC 5 VB600 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply V.B. . 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 contractors)licensed pursuant to tSEWER-SANITARY-STORM EA.200ft he Contractor's License Law. /10.00 TRACT NO, PARCEL NO. ❑ lamexemptunder See. ,B.&P.C.forthis WATER HEATER W/VENT 6.00 reason .Owner Date WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affnm that I have a certificate of consent to self-insure, o a ert ificate of Workers'Compensation Insurance, r ac 'f'ed ZONING ENG.SITE NO. c r y ... P o, ny_- O erhfie co S e ) fu s ed. FIRE SPR INK EN ERGV L24 Z Z ❑ Certified 'o leu s I r u ity 'nsp•ch n division. O Applicant VU �- MISC.- REFER TO ORD, y N Y ❑ NQ ~ w+ PERMIT ISSUANCE 10.00' - CERTIF AT AP EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C. W CO PC INSURANCE PLG.CONTH. LIC.NO. PLG. CL Z (This section d not be completed if the permit is for one TOTAL Y❑ N y ❑ N❑ hundred dollars(S 100)or less.) U O 1 certify that in the performance of the work I'or which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mil is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. Date Applicant BUILDING Lu ALTER OR ADD TO MECH. 5.00 } N NOTICE TO APPLICANT: If,after making this Certificate of F.x- F Z coalition,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith complyowith FEE U 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 10=C.RM.) 6.00 SEISMIC FEE 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(See. MICROFILM 3097,Civ.C.L - 4HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name ATING UN IT(OV ER 100,000 B.T.LL)9.50 ELECTRIC Lender's AddressI certify that I have read this application and state that the aboveNTILATION 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, andILER-COMP I3 H.P.or 100,000 B.T.U.) 6.00hereby authorize representatives of this city to enter upon the1 LER-COMP(Over 100,000 BTU)SEE FEE SCR.above-mentioned property for inspection purposes. MECHANICAL(We) agree to save, indemnify and keep harmless the City ofSC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ay In any w accrun against said City in consequence of the b' ting o•lh s mit r `- / TOTAL MECH.CONT. LIC.NO. MECH. .I r a TOTAL �✓O(/A gu ure oi/Contractor Date ' p OFFICE COPY