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12511 i POST THIS CARD NEAR FRONT OF BUILDING. f P6HMIT NUMBER CITY OF CUPERTINO 12511 INSPECTION DIVISION JOB INSPECTION RECORD • PERMIT EXPIRATION JOB ADDRESS 10654 N. BLANEY AVE . UNIT# ' - y LOT#' (CREATIVE PERMIT EXPIRES IF WORK OWNER GIN-LU-SHUE CONTRACTOR DAR-EN-SHU CONST. IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION Q r"d'tl'oAV `26.1 - ANCE OR 180 DAYS FROM UFER _ - LASTCALLED INSPECTION. PREGUNITEPERMIT VALIDATION - a, . POUR NO CONCRETE UNTIL ABOVE HAS BEM SIGNED UNDERGROUND /.SLAB PLUMBING ELECTRICAL - • ISSUANCE DATE MECHANICAL BLDG. ELECT. PLO. mECH. ❑ ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - INFORMATION VALUATION. $/FT. I PLUMBING • . . �.,, f MECHANICAL 3 ELECTRICAL - .. PERMIT TO..E•-,U ,..4• ) FRAMING ,INSULATION sroRlEs TYPE CONSTR. .S' OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED .� ROOF SO FT,FLOOR AREA TOTALACREAGE DIAPHRAGM . 7 BUILDING USE - RES IND CON PB O f"', APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED zo"w' _3_g,� ❑ ❑ ❑. ❑ ❑ ROUGH ASSESSORS PAF CEL NO. ... PLUMBING FIE • GAS TEST TRACT NO. PARCEL NO MECHANICAL ,f•� ELECTRICALACC.DATE ACC.FILE NO. l3 FINALS DATE INSP. FRAMING INSULATION �� PLUMBING zoNlNc ENG.SITE NO. I li- Eiij 1 05 GAS MECHANICAL FIRE$PRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ✓ Y ❑ N❑ Y ❑ No LATH—INTERIOR -Zy— ELECTRICAL _ _ FLOOD ZONE A.L:U.C. LATH—EXTERIOR WUUUUPANCl - v N❑ v ❑ No SHEETROCK FEE SUMMARY SHEAR INTERIOR SHEAR EXTERIOR RARY APPROVALS BUILDINGFIREWALLS - PLAN CHECK FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BsElsMic FEE f OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL13UILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505,. ELECTRIC / f � ONE WORKING DAY BEFORE REQUIRED INSPECTION.. oPLUMBING f Z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — - aR MECHANICAL CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL r` r OFFICE COPY I . 1 APKICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BVI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER mILmNG APPLICATION & PERMIT o NE a 1 f1 � UILDING -ELECTRICAL-PLUMBING-MECHANICAL 12511 OWNER N 1•' «'�T_ PLAN CHECK VALIDATION NAME IN _Cd 5,1yU/c OTY. ELECTRIC PERMIT FEE - PHONE Z�/`/� CONTRACTORS N� �hb' Z UTLETS-SWITCHES-RECEP 10.00/1.00 /41``F� IGHTING = FIXTURES 10.00/1.00 CONTHACTORs 14 APPLIANCES-RESIDENTIAL 4.00 MADD�k{s� �` OV lorum � PRONE Jay- PANELS 10.00 0 ^ DATE OF APPLICATION ARCHITECT art.- PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR � 4fJ VF ENGINEER' Llc.rvo. SIGNS TRANS. 3.00 AARCH.OR DDRESS ENG SPECIALCIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS n '0 SERVICE CHANGE 20.00 Woo LICENSED CONTRACTORS DECLARATION / ¢ .U I hereby affirm that I am licensed under provisions of Chapter 9 , ISSUANCE GATE aHi¢v¢Wi (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH. H,w z Professions Code, d y Iieense is in full force n f t 2 O m- License Cox ass Lic.Number ❑ ❑ ❑ ❑ O w F Wo Date_.?j�7.(yI 'Conlracroh� .F ✓ a ¢ w ¢ OWN R-BUILDER UECLA A'TION BUILDING PERMIT U REFER TO ORD INFORMATION E 3 LL H I hereby affirm that I am exempt from the Contracmr's License MISC.- uo¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. H m Code:Any city or county which requires permit to construct,alter, O ^ ¢ ¢p Improve,demolish,or repair any structure,prior to its issuance,also ELEC.LONTR. - LIC.N0. ELEC. - D¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT T o. w me u. he is licensed pursuant to the provisions of the Contractor's License Hzi Law(Chapter 9(commencing with Section 7000)of Division 3 of the 0 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ F o 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-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars($500).): ❑ 1,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 (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 SD.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-1 1 NC.4 OUTLETS 6.00 /J-:?7 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 200 builder will have the burden of proving ilia(h . . . e did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ 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 does 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 contracmr(s)licensed punumI to the Contractor's License Law. a SEWER-SANITARY-STORM EA.200ft/10.00 O TRACT NO, PARCEL NO. ❑ lemcxcmptunder Sea .B.&P.C.for this WATER HEATER W/VENT 6.00 reason .Owner Date WATER SYSTEM 5.00 s- ACC.DATE ACC.FILE NO, WORK ERS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a eertificate ofei nsert to scIFinsmr,. ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy Cconpany00.Lab.0 �y�� /;(ss rfj Policy N rt Company f �Vt vrr `/' Q � ❑ Certified py is hereby furnished. r �� L to FIRE SPRINK ENERGY T-24 Z Z ❑ Certified op is filed .mitt the city inspection division. MISC.- REFER TO ORD. O Applicant Y❑ IN E] V ❑ N❑ ~ w r PERMIT ISSUANCE 10.00 U '-- - CERTIFI TEi ON ORKERS' FLOOD ZONE A,L.UC. Lu ENSATION INSURAN E PLG.CONTR. LIC.NO. PLG. p EL Z( This' section need not be completed if the permit is for one TOTAL a Y[:] NE] Y E] N❑ hundred dollars($100)ar less) U O 1 certify that in the performance of the work for which this Per, OTY. MECHANICAL PERMIT FEE FEE SUMMARY IL h mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. r ED Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING W NOTICE. TO APPLICANT: If,after making(his Certificate of Ex- F- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCTION LENDINGAGENCY AIR HANDLING UNIT(OVER IQOOOQF.M.) 6.00 SEISMIC FEE 7 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. HEATING UNIT(TO 100,000 B.T.U.) 6.00 MICROFILM 3097,Civ.0.). Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 (� Lender's Address ELECTRIC fJ (� I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 Q information is correct. I agree to comply with all city and county PLUMBING Q 7 ordinances and state laws relating to building construction, and BOILER-COMPOH.P.Or 100,000B.T.U.) 6.00 we Hereby authorim representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL �W above-mentioned property 1'or inspection purposes. -- (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. pp Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10A0 /O CONST.TAX 0 0 nay in any way accrue against Said City in c sequence of the g an[ing of this / �� /_ ^ MECH.CONT. LIG NO. MECH. � TOTAL j� / // // TOTAL 31 Si nature p'" /Cath Actor Date OFFICE COPY