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14092 POST THIS CARD NEAR FRONT OF BUILDING j PERMIT NUMBER CITY OF CUPERTINO 14092 INSPECTION DIVISION •, JOB INSPECTION RECORD 10201 BUBB ROAD - PERMIT EXPIRATION JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK , OWNER APPLE.' COMP CONTRACTOR EAST BAY AIR COND, IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LIFER - _ LASTCALLED INSPECTION. PREGUNITE - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ff ^! UNDERGROUND /SLAB •,0 ? PLUMBING I ELECTRICAL a ISSUANCE DATE' BLDG. ELECT. PLG. MEGH. . MECHANICALS ' ❑ ❑ ❑ ©... 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT WOOD FLOORINFORMATION VALUATION SIFT. PLUMBING MECHANICAL - PERMIT TO ELECTRICAL - �/ :• :yL , FRAMING STOgIE51V TYPE CONSTR. INSULATION • Cid,] OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO,FT,FLOOR AREA TOTAL ACREAGE-AGE .. DIAPHRAGM _ BUILDING USE ' ' HES IND CON PB Olhe, ' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ Cl ❑ ❑ ASSESSORS PARCEL NO, ROUGH PLUMBING • TRACT NO. PARCEL NO. GAS TEST MECHANICAL ACC.OATE ACC.FILE NO. ELECTRICAL - a"FINALS DATE INSP. , FRAMING SAN # I ,ZONING ENG.SITE NO. INSULATION PLUMBING GAS • MECHANICAL FIRE SPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N E] Y ❑ N❑ FLOOD ZONE A.L.0 C. LATH-INTERIOR ELECTRICAL LATH- EXTERIOR FIRE DEPT. ' I Y❑ N,❑ Yo NEISHEETROCK - GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS 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 LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - MECHANICAL .. — SEE PERMIT FOR EXPIRATION DATE CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. • OFFICE COPY , , APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT ADOREss FIR- - BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 14092 O 'BPLAN CHECK VALIDATION • " E +^ _ QTY. ELECTRIC PERMIT FEE PHONE CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 MK COAI:;� ' LIC.No. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S I"j 1:51`72 JAPPLIANCES-RESIDENTIAL 4.00 ADDRESS 7D //�'g7. ONE 64VO 1PANELS 10.00 DATE OF APPLICATION ARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No. SIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS ZIP rEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS - SEE FEE SCH. Qom) ADDRESS SERVICE CHANGE 20.00 p�7 Woo LICENSED CONTRACTORS DECLARATION `d/a 2`�/O < U I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. D z Professions Code,aJJµµ����mYY license is in full fo% f Z 0 - License ClaLic.Numb O w Date1 A f]LE_Contracto BUILDING PERMIT ¢ ¢w¢ OWNER-BUILDER DECLARATION - INFORMATION ooA" MISC.- , REFER TO ORD X ; LL I- I hereby affirm that I am exempt from the Contractor's License VALUATION E/FT. O¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 'Fy0J Code:Any city orcounty which requires a permit to construct.alter, _ a <0 Aimprove,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O, requires the applicant for Such permit to file a Signed statement that TOTAL PER T uxi m he is licensed pursuant to the provisions of the Contractor's License I I FZ > Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE X ¢O STORIES TYPE CONSTR. ¢ H$ by basis for the alleged exemption.Any violation of Section en L$ by any applicant fora permit Subjects $500).applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 - of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE himselfthrough ownemployees,prdedthatsuch improve- . mems arere provided not intended or offered for sale.ovi,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA) 200 BUILDING USE builder will have the burden of proving that he did not build or am. . . . RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with licensed Contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCELNO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contrathe Contractor's ctor'sor hcenects Lwithacantraaorts)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Contractor's License Law. ❑ lam exempt under Sec,-,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 6.00 ACC.DATE ACG FILE NO. WORKERTCOMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self-insure. ZONING- ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified C here 0,Lab.G an 0 ❑ Certified copy l5 hereby famished. FIRE SPRINK ENERGY T-24opy Z Z ❑ Certif is riled 'fp t ily s�p'mion division. REFER TO ORD. O Applicant MI$C. N[ ~ m CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. !r - LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.AL y� N ] V� N� 0' Q (This section need not be completed if the permit is for one TOT D Z hundred dollars($IOD)or less.) U 0 1 certify that in the performance of the work for which this per. OTY MECHANICAL PERMIT FEE FEE SUMMARY LL 1- . mit is issued,I shall not employ any person in any manner so as to U become subject to the Workeri Compensation Laws of California. y Date Applicant ALTER OR ADD TO MECH:" - 5.00 BUILDING } m NOTICE TO APPLICANT: If,after making this 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 E..1 such-provisions or this permit shall be deemed revoked. AIR HANDLING UNIT,(TO 16MC.F.M.) 4.0 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p000.FMa 8.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT)Vl e..,. 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.C.). - Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that l have read this application and slate 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 BOILER-COMP(3 H.P.or 100,0008.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SEE. MECHANICAL 3 above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses whichCONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE, 10.00 ming oftit. MECH.CONT. LIC.NO. MECH. 3 �_ TOTAL {6 2 _ TOTAL SigRalu ofACo actor Dale_ OFFICE COPY '