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14122POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOBADDRESS 1088/BLANEY UNIT# LOT# - - OWNER TIN TIN SUPER MARKETCONTRACTOR , ALLEN SIGNS PERMIT NUMBER �1�'"2 PERMIT EXPIRATION PERMIT EXPIRES IF -WORK IS NOT STARTED, WITHIN 180 DAYS OF PERMIT ISSU ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION - LIFER PREGUNITE PERM IT VA LIGATION -- ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED» UNDERGROUND /SLAB PLUMBING ELECTRICAL MECHANICAL - L.. ❑ ELECT ELECT. ❑ PLG. MECH. ❑ ❑ - 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR W VALUATION fr} -- $JET. ° PLUMBING - MECHANICAL ELECTRICAL PERMIT ro FRAMING - INSULATION STORIES TYPE CONSTR. ' OCC GROUP HES. UNITS ' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF ' SO. FT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM - • BUILDING USE RES IND CON PR Other 11 0 ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL - ELECTRICAL FINALS DATE INSP. ACC. DATE ACG FILE NO, FRAMING SAN * INSULATION - PLUMBING - ZONING ENG. SITE NO. - GAS ' MECHANICAL FIRE SPRINK Y [:] N ENERGY T 2 Y ❑ ND COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL FLOOD ZONE YE N[]' AL.U. C. Y ❑ N LATH—EXTERIORFIRE DEPT, SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS - ELECTRIC PLAN CHECK FEE. f.. ` GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. r ' MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, 0� ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL ' '?' OFFICE COPY ,APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING.PROJECT IDENTI FIC TION APPLICATION & PERMIT I BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMB ER 14122 aGDRES RES L(_1A)ACJZ OWNER T- I S� MKT NAM -r(/ IJ/V r-� /',,{/1 i I r�s r V C/,✓R E OTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION NAM e "croRs LL (�/�..�/ sw/ S uc. No. t -WIT OUTLETS -SWITCHES -RECEP 10.00/1.00 - LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S Rss �j d P �i �b rHONE .?j A3 'J APPLIANCES- RESIDENTIAL 4.00 PANELS 10.00' ARCHITECT OR ENGINEER LIC. No. PANELS (OVER 200 AMPI 20.00 PLAN CNE K FEE P.C. N0. SIGNS TRANS. 3,00 ARCH. OR ENG. ADDRESS iIPEMP. SPECIALCIRCUIT 5.00 PERMIT VALIDATION / r- (, O�E' x� .. SSUANCE'dATE-SV METER OR POLE INS. 20.00 Ara _ ADDDRESSDRESS 9 /- MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and ons Co ted my license is in full force n rofessied ��[[(( pp��SC License Class Lic. NumberO S Data Contract.,- OWNER-IfUILDER DECLARATION 1 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 requiresapermit to construct, alter, improve, demolish, o'r repair any structure, prior to Its issuance, also requires [tie applicant forSuch permit t0 file a Signed Statement that he is licensed pursuant to 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 the basis for the alleged exemption. Anyviolation of Section703L5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500L) : ❑ I, as owner the property, or my employees with wages as myem their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenotintendedorofferedforsale. If, however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that h e did not build or im- prove for purpose of theJ. ❑ as owner of the property, exclusively contracting with licensedd contractors to construct thehe project (Sec. 7044, Business and Professions Code: TheeContractor's License Law does not apply to antr owner of property who builds to improves thereon, and who contracts for such projects with a contracmr(s) licensed pursuant tothe Contractor's License Law. ❑ I am exempt under Sea. ,B&P.C. for this reasonOwner BLDG. ❑ (,ELECT" -••PLG. ❑ ❑ MECH. ❑ BUILDING PERMIT INFORMATION MISC. - REFER TO ORD PERMIT ISSUANCEVALUATION 10.00 >._ $/FT: ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMITTO CITY. PLUMBING PERMIT FEE ALTER -DRAIN & VENT -WATER (EA.) 5.00 STORIES TYPE CONSTR. BACK F LOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM -1 INC.4 OUTLETS 6,00. GAS EA - . SYSTEM -OVER 4 (EA.) 2.00 so. Pr. FLOOR AREA rorgL ACREAGE BUILDING USE RES IrvO CON Pa Omar ❑ ❑ ❑ ❑ ❑ INDUSTRIALWASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 6.00 - V.B. ASSESSORSPARCEL NO. -OVER 5 (EA.) ' 1.00 ' Y -STORM EA. 200tt/10.00 TRACT NO. PARCEL NO. W/VENT 6.00 Date ESPRINKLERSRS 5.00 WORKERS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.C.). Policy No. Company ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city inspection division. Applicant ACC.DATE ACC. FILE NO. NG EQUIP. 5.00 ZONING - _ ENG. SITE N0, IMISC. - REFER TO ORD. FIRESPRINK y 0 N ENERGYT24 v E]No CERTIFICATE OF EXEMPTION FROM WORKERS' ION (This section need not be not Rif thepermitis for one hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per. mit is issued, I shall not employ any perso y manner so been l s c t the Workers' Com win rnia. Dutc Applicant NOT TO AP LICAN making this Certificate of Ex- mption, you sit old 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit -is issued (Sec. 3097, Cia,C.), s Lender's Name Lender's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and representatives of this city to enter upon the hereby above-mentioned above-mentioned property forinsp ofth i purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way ac a against said City in consequence of the granting of t �.7G1 PERMIT ISSUANCE 10.00COMPE FLOOD ZONE Y [J N0 A. L. u.C. V [] NE] PLG. CONTE. u6 NO. TOTAL TY MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 PLAN CHECK FEE_ AIR HANDLING UNIT(OVER 10=11EM.) 6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATI NG UNIT(OV ER 100,000 B.T.U.) 9.50 ELECTRIC VENTILATION FAN (SINGLE) 4.00 BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 PLUMBING - BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL TOTAL tgn Applicant/Contractor Date OFFICE COPY