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C 8189 POST THIS CARD NEAR FRONT OF BUILDING PlmMlr UMRFII 1 CITIAOF CUPERTINO /� ' i - INSPECTION DIVISION 1 '/Y n a7, a ( �189 B INSPECTION RECORDj��/W�� 7 /J ,// CC PERMIT EXPIRATION - JOB ADDRESS ��_Z�S�/ y1N1T" LOT# 4/(/ .PERMIT EXPIRES IF WORK., OWNER CONTRAC R IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT•ISSU- . FOUNDATION ANCE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PREGUNITE - r PERMIT VALIDATION e POUR NO CONCRETE UNTIL ABOVE HAS BE SIGNED' UNDERGROUND /SLAB PLUMBING - /SUAN ELECTRICAL - EOATE MECHANICAL - 80 ELECT, PLG. MECH. ❑ ❑ . ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT' WOOD FLOOR " INFORMATION PLUMBING V WATION $/FT. - /l MECHANICAL ELECTRICAL PERMIT TO FRAMING +, INSULATION STORIES - TYPFCONSTR. OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED w ROOF I SO FT.FLOOR AREA (TOTAL ACREAGE . ko DIAPHRAGM - BUILOING USE ' T RES "IND CON PB Orner APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ,❑ ROUGH - ASSESSORSPARCFL NO. PLUMBING _ GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICALFINALS DATE (NSP. ACC,DATE ACD.FILE No. FRAMING SAN # INSULATION ,PLUMBING - zoNlNc ENG.SITE No. GAS MECHANICAL FIRE SPR INK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ •N❑ ,' Y ❑ N❑ FLOOD ZONE A,L.U.C. LATH—INTERIOR I ELECTRICAL LATH—EXTERIOR FIRE DEPT. - Y❑ N❑ Y Cj N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING u FIREWALLS ELECTRIC - PLAN CHECK . •' • GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ' OCCUPANCY OF BU I LDING IS NOTPERM ITTED UNTI L BUI LDI NG F INAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. " Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE "9� ; = "' TOTAL CALLING FOR FINAL INSPECTION. _,;. OFFICE COPY • f APPLICANT TO,FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATI PERMIT NUMBEW �i R s /fl zlwe_ APPLICATION & PERF BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 8189 NAME S LAN CH ECK VALIDATION DTV. ELECTRIC PERMIT FEE II ®� d, ^611c.0 PHONE CONTRACTOR'S NAME . -OUTLETS-SWITCHES-RECEP 10.00/1.00 fI LL 6C) V LIC.NO. LIGHTING FIXTURES 10.00/1.00 fONTR ACTOR'S .71 gpoREss 767 APPLIANCES-RESIDENTIAL � 4.00 j( C// �SvrF'NE PANELS 10.00 DATE OF APPLICATION onCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.No. SIGNS TRANS. 3.00 ANDRiSS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION APPLI TS zlv EMP.METER OR POLE INS. 20.00 ADDRESS MOTORS - SEE FEE SCH. SERVICE CHANGE 20.00 Ow 00 !i N r o O LICCNSEU CONTRACTORS DLCLARATIpN TEMP.POLE 30.00 a u LHi I hereby affirm that I am licensed under provisions of Chapter y¢w I SUA CE DATE ¢A (commencing with Section 7000)of Division 3 of the Business and BLD . ELECT. PLG. MECH. H O i Professions Code,and my license is in full fort and c e;L ( ❑ z o License Class Lic.Nwmber i z _ Dmc�•• l�A . _Contractor FyH ecrf ¢ Ic w ¢ OWNER-BUILDER DECLARATION 0 e- D INFORMATION w ; u H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD I Q LL O ¢ Lawlor the following reason.(Sea 7031.5,Business and Professions ION SIFT. E - PERMIT ISSUANCE 10.004 ¢ „r� Code:Any City or county which requires a permit opts issuance,also ¢ ¢ improve,demolish,or repair any shutlUre,prior to its issuance,also ELEC.CONTR. LIC.NO. FLEC. -O u requires the applicant for such permit to file a signed statement that TOTAL / u w m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO FzaLaw(Chapter 9(commencing with Section 1000)of Division 3 ol'the kl�LL f i O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE •��✓a at I-$ the basis for the alleged exemption.Any violation of Section 7031.5 _ STORIES TYPE CONSTR. a ; - by any applicant for a permit subjects the applicant too civil penally of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor'$License Law does not apply to an owner of properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- .cots are mot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 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 int- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IN CON PB Omar ❑ 1,as owner.1 the property,am exclusively contracting with 1:1licensed 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 contractor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-,B.&P.0 for this WATER HEATER W/VENT 6.00 reason Owner Dan, WATER SYSTEM 5.00 ACC.GATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-iosure, 1 or U certificate of Workers'Compensation Insurance.or a certified ZONING ENG.SITE NO. ./�' copy thereof(Sec.3800, ab.C.M,T¢'7iJN !NI Policy No. CompC.mpany tJ a 0 ❑ Certified copy is hereby lumisheJ' FIRESPRINK ENERGY T-24 Z Z ❑ Certifiey is liled�ith a City inspection division. MISC.- REFER TO ORD. Y N Y N ,�,7/k Applicant - � 'a ❑ ❑ ~ �' PERMIT ISSUANCE 10.00 LU CERTIFICATE E EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C. W � COMPENSATION INSURANCE PLG.CONTR. LIG NO. PLG. CL O (This section need not be Completed if the permit is for one TOTAL Y N Y NF] 0 2 hundred dollars 1$100)or less.) - U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY W H mit is issued,I shall not employ any person in any manner so asto Q W become subject to the Workers'Compensation Laws of California,s CL Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING .fa �- 0 NOTICE TO APPLICANT: If,after making this Certificate of Ex- F 2 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 he deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0AWCF.M-) 6.00 SEISMIC FEE s•T7 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 HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address - ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 x information is correct. I agree to comply with all city and comity BOILER-COMP(3 H.P,or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter ,on the above-mentioned properly for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said CC in consequence of the PERMIT ISSUANCE 10.00 granting of this permit }} ,r MECH.CONT. LIC.NO. MECH. ��- I !J n"; I--//` _ �r t TOTAL TOTAL ?l° Signa arc of Applwamt onlractdr Date OFFICE COPY