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14620OFFICE COPY POSTTHISCARD NEAR FRONTOF BUILDING PERMIT NUMBER CITY OF CUPERTINO 14620 INSPECTION DIVISION JOB INSPECTION RECORD ' PERMIT EXPIRATION JOB ADDRESS 10881 BLANEY CT. UNIT# _LOT# _ PERMIT EXPIRES IF WORK OWNER MICHAELLI'N CONTRACTOR ALLEN SIGNS IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION - NOTE:. LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE - -' TO COMPLY WITH THE APPROVED PLANS AND CITY OF PeRnnt Vn i T10N I CUPERTINO STANDARDS. GARAGE SLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB / PLUMBING ELECTRICAL �� ISSUANCE DATE MECHANICAL , BLOcEycr PLa, MBCR ®�, ❑ ❑. ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Bu.NG P RMIT WOOD FLOOR " Q MA ON PLUMBING 'j VALUATION $/FT. /o� J d /,r�u MECHANICAL•' J4 �• ELECTRICAL - � PERMIT TO . FRAMING r, INSULATION STORIES TYPE CONSrn__ n - OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HASBEEN ED ROOF OTE: N FINAL INSP. SHALL BE MADE BEFORE $O. FT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM - HE _ STRUC1 ON TAX IS PAID ' ROOF SHEATHING 6UILDINc USE RES IND CON PB 00", ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIG FIN S DATE -INSP. _ ROUGH ASSESSORS PARCEL NO PLUMBING ELECT. EN GY•' - TUBS &SHOWER PAN PLUMBING ENERGY TRACTNO. PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL.- BUILDING ENERGY ACC OniE ACC FILE No. FRAMING ELECT.FINALTEST INSULATION PLUMBING zoNlNc ENG. SITE No. GAS TEST .. 5 MECHANICAL FIRE SPRINT( r E3 IN ENERGY T.ia v ❑ N[] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED hFATING EXTERIOR SHEAR AL RELEASE FLOOD ZONE Y "❑ A UC -' Y ❑ IN INTERIOR SHEAR F SHEETROCK. - GR FEE SUMMARY EXTERIOR LATH BUIL BUILDING Y '; INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE - .. GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE _ ,)• OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUIL)INGFINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o0 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING z .,. -SEE PERMIT FOR EXPIRATION DATE - MECHANICAL TAX IMPORTANT!S. F�NT PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL i / f. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY -BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT - BUILDING — ELECTRICAL— PLUMBING — MECHANICAL PERMIT NUMBER 146 20 u1LDING A:f REss O NE . rvAHMW' l� ♦♦ PRONE 4 1 " QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION - ' DATE OF APPLICATION CDNTIN NAE RFCTOR' Lie NO. Sb UTLETS-SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES, 10.00/1.00 pDRESSTORS •�P. PHONE tk� ,Q O PPLIANCES-RESIDENTIAL 4.00 PANELS 10.00 OR HITIicT, - ENGINEER- Llc. NO. PANELS (OVER 200 AMP) 20.00 'PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. Ess ENG' ZIP SPECIAL CIRCUIT 5.00 _ PERMIT VALIDATION ,T p.•,/� , lint / 5 ANCE DATE B T. PLG. MECH. ❑ ❑ ❑ ITEMP. METER OR POLE INS. 20.00XI— ADDRESS MOTORS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing will, Settle. 7000) of Division 3 of the Business and Professions Code a I license is in full fore nd IT ct License Cla=s C' Lia Number Date Contractor OWNER -BUILDER DECLARATION Lhfir ereby afm that I um exempt from the Contractor's License Law for the following reason. (Sec. 7031,$, Businva,md Professions Code: Any city or county which requires a permit to construct, alter; improve, demolish, Or repair any structure, prior to its issuance, alsoE requires the applicant for such permit to 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 ofthe- Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption., Any violation of Section 7031.5 by any applicant fora permit subjects the applicant toa civil penalty of not more than five hundred dollars (8500).)'1 ❑ as owner of the property, or my employees with wages as 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 docs such work himself or through his own. employees, provided that such improve- ments are not intended or offered for sale. If, however, the building or improvement Is,sold within one year of completion, the owner - builder will have the burden of proving that he did not build or in prove for Purpose.fsale.). - - .❑ I, aa..acr of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law, ❑ I am exempt under Sec. ,B.dtP.C. for thismoson - p V� BUILDING PERMIT INFORMATION MISC. — flEFER'.TO ORD PERMITISSUANCEVALUATION 10.00' $/FT. LEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO u �V OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. _ ALTER-DRAIN-WATER,(EA.) 5.00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 F IXTUR ES - PER TRAP 5.00 - GAS-EA.SYSTEM-11NC.40UTLETS 6.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - OVER 4 (EA.) ' 2.00 BUILDING USE RES IND CDN PB Other ❑ ID E " ❑ ❑ . . INDUSTRIAL WASTE INTER3000 - LAWN SPRINKLERS -I ,INC 5 V.B. 6.00 ' ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) .1.00 SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER WIVENT 6.00 Owner Date WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (See, 3500, Lab.CJ-- Policy No. • Conn pally WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. . WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. RD. MISC.- REFER TO O ❑ Certified copy is hereby furnished Certified Certified copy is fled with the city inspection division. p FIRE SPRINK Y ❑ N� ENERGY T-24❑ Y 0 N[ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE . (This section need not be completed if tltc Permit Is far one hundred dollars IS 100) or Its,.) I certify that in the performance of the work forwhich this per- mit is issued, I shall not employ any person in any manner so as to hecor�su ect he Workers' C m n aeon /awe t Cali Comia. Date —L Afinbract7 '� `� NOTICE O A (CANT: If, of er making this Certificate oC Ex- emption, you should become subject t. the Workers'Compensation provisions of the Labor Code, you must forthwith comply with Such provisns or this Permit sImm io 11 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, Civ.C.). Lender's Name PERMIT ISSUANCE 10.00 FLOOD ZONE Y E] N A.C.U.C. Y [] N ❑ PLG. CONTR. LIC. NO. PLG. TOTAL QTY MECHANICAL PERMIT - FEE FEE SUMMARY BUILDING 9 r� / ALTER OR ADD TO MECH. _ 500 APPLIANCE r 5.00 - AIR HANDLING UNIT (TO 1O=C.F.M.1' 4.00 PLAN 'CHECK - FEE .3 S AIR HANDLING UNIT (OVER 10.000 C. RM.) 6.00 SEISMIC FEE s �� EXHAUST HOOD (WITH DUCT) 5.00 ' MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Address Icertify that l have read this application and slate that the above information is correct, I agree to comply with all city and county ordinances and state laws relating to building construction, and above -hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. (We) agreedo'save, indemnify and keep harmless the City of upertiho against liabilities„judgments, costs and expenses which may in any way accrue against said City in consequence of the ranting Of this Z'IO- HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC VENTILATION FAN (SINGLE) 4,00 PLUMBING BOILER-COMP13 H. P. Or 100,000 B.T.U.) 6.00 ' BOILER -COMP (Ovei 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. PERMIT ISSUANCE ORD CONST. TAX ” MECH. CONT. LIC. NO, MECH: TOTAL TOTAL C 31 a v� Ignature ppiicant/Contractor Data OFFICE COPY