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13670 j POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF . CUPERTINO 13670. INSPECTION DIVISION JOB INSPECTION RECORD ESS y 0 a [S PERMIT EXPIRATION JOB ADDRUf3 UNIT# LOT PERMIT EXPIRES IF WORK OWNER LE Cal CONTRACTOR �F LSC, zG/ C-O.,,- IS NOT STARTED WITHIN INS E TION DATE I INSPECTOR INSPECTION RECORD 1BU DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM UFER �e5 /iM — 'LAST CALLED INSPECTION. PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB //_ PLUMBING Lf �r X{ �6 ELECTRICAL ISSUANCE 04TE MECHANICAL - eLoc, ELECT. PLG, MECR. N 0 ❑ ©. ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED \ pO BUILDING PERMIT WOOD FLOOR J INFORMATION VALUATION S/FT. PLUMBING MECHANICAL .4 u ELECTRICAL - PERMIr ro FRAMING ' INSULATION r sroRlEa rYPE CONSTR. - 1- OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVERAS BEEN SIGNED - SQFLFLOORAREA TOTAL ACREAGE I � ROOF ; DIAPHRAGM BUILDING USE ' RES IND CON PB Olnm APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT NO. .PARCEL'ND. GAS TEST MECHANICAL ACG DATE ACC.FILE NO. ELECTRICAL - •-Z FINALS DATE INSP. FRAMING SAN it - ZONING ENG.SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY T 24 MECHANICALY El- COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I HEATING N[I Y E] NQ LATH—INTERIOR ELECTRICAL PL000 ZONE AL.U.C.. LATH—EXTERIOR ' FIRE DEPT. v NQ v ❑ N[] SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK' GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED. OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM I ?? ,1 ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC J SZvl °2 LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING '• a PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE- IMPORTANT!' CONST.TAX 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 AODHEss BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 13670 1��0 0• OWNER'S PLAN CHECK VALIDATION NAME _ . PHONE CITY. ELECTRIC PERMIT FEE caNTRygTgRS , Ib'L UTLETS-SWITCHES-RECEP 10.00/1.00 N E /1/ p LIGHTING FIXTURES 10.00/1.00 sec.ry J AooRess TORS PPLIANCES-RESIDENTIAL 4.00 'p _ �yf10N PANELS 10.00 O DATE OF APPLICATION ARCHITECT j PANELS (OVER 200 AMP) 20.00 �� L✓pLAN CHECK FEE P.C.NO. NmrvEE W•.P65 0"'1 LIG.No. Q'I p SIGNS TRANS. 3.00 AARCH,OR DDRESS ENG. �.� a 2 SPECIAL CIRCUIT SO() PERMIT VALIDATION O TEMP.METER OR POLE INS. 20.00 'O APPLICANT'S / MOTORS 40A 1PD LG SEE FEE SCH. AooRessd:,� " SERVICE C ANGE 20.00 /& /er w o a LICENSED CONT RAC ORS DECLARATION l <W hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE H Q y (Commencing with Section 7000)of Division 3 of the Business and BLDG. I ELECT. I PLG. I MECH. v D i Professions Code n license is in full for n eJ t -PAM ❑ EJ ❑ p z D License lass Lic.Number - Dale - - Contmcsor a y n(}O BUILDING PERMIT ¢ ¢w¢ OWNER-BUILDER DECLARATION J INFORMATION iL oae' MISC - REFER TO - 4 I hereby affirm that I am exempt from the Contractor's License . uo¢ Law for the following reason.(Sec.703 uires Business to construct, Professions PERMIT ISSUANCE 10.00 y VALUATION 2 W y a Code:Any mulish countypair any requires a permit o its issuance, alter, I IIOO a ¢< improve,demolish,or repair any structure,prior to its issuanec,also EL CO R. ^LIC.Ne. O. ELEC. 1l ta O LL requires the applicant for such permit to file a signed statement that 00&` 3 TOTAL 4 PERMIT TO wog he is licensed pursuant to the provisions of the Contractor's License �•-• FI > Law(Chapmr9(Commencingwith Section 7000)of Divisioe3 ofill, I GLLez'T ¢ o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE 1 ¢s- $ the basis for the alleged exemption.Any violation of Section 703 1.5 1 STORIES TYPE CONSTR. by any applicant for a permit subjeCts the applicant to a civil penalty ALTER-DRAIN -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 (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES,PER TRAP 5.00 eQ FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments arenot,intendedoroffered 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 EASYSTEM OVER 4 IEA1 200 BUILDING USE builder will have the burden of proving that h - . - . . e did not build or im- RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 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 the Cocontracts actor's h projects with a contractorts)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Contractor's License Law. Cl I am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner - Date WATER SYSTEM - 5.00 ACC.GATE ACC.FILE NO. WORK ERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE N0. or a certificate of Workers'Com r« ti n I s ante p�crftlfied copy thereof fSec.3800,LAC.. ��YY���v Policy No. Company - O CeRified copy is hereby furnished. FIRE SPRINK ENERGY T24 Z Z Ce Iifieyjcppy��s fling h c y'in er �q division. O A ph, Cne. >dlC./ -t-�'-� y MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ Fy PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. K - CERTIFICATE OF EXEMPTION FROM WORKERS' W COMPENSATION INSURANCE PLG.CONTR. LIC.N0, PLG. Y Cl N 1-1 Y 1:1 N 1:3CL O (This section need not be completed if the permit is for one TOTAL :D Z hundred dollars IS 100)or less) U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- 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. y Dam Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE TO APPLICANT: If,alter making this Certificate of Ex__ F Z emption,you should become subject to the Warkers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE CJ . such provisions or this permit shall be deemed Tevoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=CEM.) 6.00 SEISMIC FEE 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. HEATING UNIT:(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,r''s N. /f 6ML� 3 Lender's Name -1.CL�L HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC p �" Lender's Address • I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct.1 agree to comply with all city and county PLUMBING BOILER-COMPI3 H.P.or 100,000 B.T.U.1 6.00 ordinances and state laws relating to building construction, and hereby authorize representatives of thi ity to enter upon the BOILER-COMP (ova,100,000 BTU)SEE FEESCH. MECHANICAL above-memioned property for inspecu P rpous. (We) agree to save, indemnify d ep-harmless the City of MISC.- REFER TO ORD. Cupertino ainst Babilitiea,judIt nl costs and expenses which PERMIT ISSUANCE 10.001CONST.TAX may i wa accrue ag ins Cily in conuqu ace o the gran ' his a MECH.CONT. LIC.NO. MECH. k TOTAL TOTAL Signature of Applicant/Contractor Dat OFFICE COPY