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11804 POST THIS C NEAR FRONT OF BUILDING • PFRMIT NUMBER CITY F CUPERTINO � � $ � INSPECTION DIVISION ' JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 22162 BITTER OAK - UNIT# LOT# I PERMIT EXPIRES IF WORK OWNER PHILLIP WAXMAN CONTRACTOR' VALLEY HEATING IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 18o DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED a• s� ' UNDERGROUND /SLAB - - PLUMBING - //J ELECTRICAL ISSUANCE GATE i MECHANICAL BLoc. ELEcr. PLG. MECH. ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PEP WOOD FLOOR INFORMATION PLUMBING VALUAT �ION $/FT. - MECHANICAL ELECTRICAL - � PERMIT TO FRAMING - //i� . 11 . };! INSULATION STORIES TYPE CONSTR, OCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - . ROOF SO.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM - BUILDING USE RES IND 'CON PH Omer APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED � E] ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. _PARCEL NO. MECHANICAL ' ELECTRICAL - FINALS DATE INSP. ACD.DATE ACO FILE NO. FRAMING SAN a - ZONING ENG.SITE NO. • INSULATION � PLUMBING � � . i GAS = MECHANICAL" - FIRESPRINK ENERGY T-24- COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y E] "� n ° "El LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C. LATH—EXTERIOR FIRE DEPT. - Y❑ N❑ Y 0 No SHEETROCK GRADE - FEE SUMMARY SHEAR INTERIOR BUILDING ,�_ SHEAR EXTERIOR - TEMPO ARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL.ISSIGNED BY BUILDING INSPECTOR. MICROFILM ' ARRANGE FOR INSPECTION BY PHONING 252-4505, z"' ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! r CONST.TAX ' 4 . , � ' PLEASE READ REVERSE SIDE BEFORE *oil 1 TOTAL• > CALLING FOR FINAL INSPECTION. OFFICECOP.,Y . Air`)LICANT TO FILL IN INFORMTION WITHIN RED LINES - USE BP POINT PEN ONLY BU LD1 NG PROJECT I DENT[FICATIO PERMIT NUMBER aDtLDIjN�c APPLICATION& PERM A°DR"ra� a VD� Oak +. 11804 BUILDING - ELECTRICAL-PLUMBING--MECHANICAL ..NNLH'S PLAN CHECK VALIDATION xV"hA\ QTY. ELECTRICPERMIT FEE CONTRACTOR'S A ^`1� OUTLETS-SWITCHES-RECEP 10.00/1.00 rl ( ua No. O LIGHTING FIXTURES 10.00/1.00 AGGRESS TOR n, 1 S-i--. APPLIANCES-RESIDENTIAL 4.00 C '� PHONE PANELS 10.00 DATE OF APPLICATION ORRGHITEGT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.No. ENGINEER 'uc.NO. SIGNS TRANS. 3,00 ADDRESS ENa SPECIAL CIRCUIT 5,00 PERMIT VALIDATION zlP none EMP.METER OR POLE INS. 20.00 7 SSTs MOTORS SEE FEE SCH. z SERVICE CHANGE 20.00 ��,llll.... Foo LICENSED CONTRACTORSDECLARATION ¢ u u I hereby affirm [hal I am licensed under provisions of Chapter 9 ISSUANC/DATE / a,Q,a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. ME H H i Professions Co EI an 'cense is in full f .t z 00. - License Inns 'Lie.Numb ❑ El El o w w Dale Contour'. M ¢ w et OWNER-BUILDER DECLARATION BUILDING PERMIT ' OLLcMISC.- REFER TO ORD INFORMATION w ; w 1 hereby affirm that 1 am exempt from the Contractor's License u O er Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT. - PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, at K Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. Er O u requires the applicant for such permit to file a signed statement that TORaL a. w m he is licensed pursuant to the provisions of the Contractors License PERMIT TO HiQ Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ' 4 O Business and Professions Code)or that he is exempt(tierefrom and OTY. PLUMBING PERMIT FEE ¢ H m the basis for the alleged exemption.Any violation of Section 703 L5 DRIES TYPE CONSTR. by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(8500)): ❑ 1,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,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- reentsarenotintendedorofferedforsale,If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove 1,as ownerose of sale). INDUSTRIAL WASTE INTER. 30.00 O IND CON 0 Other ❑ d as owner of the property,he exclusively contracting with licensed contractors to construct the project(Sea.7044,Business LAWN SPRINKLERS-1.INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Cade:The Contractor's License Law does not apply to antr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such License projects with a contractol{s)licensed pursuant In the Contractor's License Law. S EWER-SAN ITAR V-STOflMEA.200ft/10.00 TRACT NO. .PARCEL NO. ❑ lam exempt under Sec..,B.&P.C.for this reason WATER HEATER W/VENT 6.00 Owner I Date WATER SYSTEM ` 6.00 ACC.DATE ACC.FILE N0. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent t0 sel6insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy the Policy N Arhbkllyl A11 V.C�f'.t�Tl I,i U ❑ Certified copy is hereby furnished. Z Z �Cerfi b c y (led hW' ��," ",ty� spec hon division: FIRE SPRINK ENERGY T-24 � O pp leant {�� +�C7.Al Ibmt MISC.- REFER TO ORD. Y[ 'N� Y [] N� � T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG IEL C1 (This section need not be completed if the permit is for One TOTAL Y[:] N� Y[D N� U 0 hundred dollars($100)or less.) I certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY IL H mit is issued,I shall not employ any person in any manner so as to U W become subject to the Workers'Compensation Laws of California. a Date Applicant ALTER OR ADD TO MECH. 5.00 : BUILDING } m NOTICE TO APPLICANT: If,after making this Certificate of Ex- 2 emption,you should become subject to the Workers'Compensation APPLIANCE ' provisions of the Labor Code, you must forthwith comply with .5.00 PLAN CHECK U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,OODC.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000 C.F.M.16.00 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(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 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 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 ofBOILER-COW(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives this purposes.is city to enter upon the above-mentioned property forinspectionBOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. - MECHANICAL �� h (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD Cupertino against liabilities,judgments, w .ets and expenses which CONST.TAX may in any way accrue against said City in consequence of[he PERMIT ISSUANCE 10.00 O,� a of th' craft lI MECH.CONT: LIC.'NO. MECH. a TOTAL (�� TOTAL APO i ore ofApp al I IXJ a OFFICECOPY