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13037V POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS "� �ya AL UNIT# LOT OWNER lSV CONTRACTOR /q F�/% -�"o ^/ INSPECTION DATE INSPECTOR INSPECTIO ECf FOUNDATION - UFER PREGUNITE - PLUMBING ELECTRICAL MECHANICAL I ELECTRICAL FRAMING INSULATION APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED . ROUGH (FRAMING _ I (SAN # I, IN - PLUMBING , MECHANICAL Z -W L COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED* HEAnn G LATH -INTERIOR ELECTRICAL 1 ATH-FXTFRIDR FIRE DEPT. I if - SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVAL FIREWALLS JELECTRIC GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY UCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING I uJ ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE O~� PLEASE GIVE JOB ADDRESS WHENUPHONINGPIRED ECTION. P `Z -SEE PERMIT FOR EXPIRATION DATE - PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION, OFFICE COPY - PERMIT NUMBER 13037 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. F/L BUILDING USE HESINO CON PR Olnei ❑ ❑ ❑ ❑ ❑ ZONING - ENG, SITE NO. FIRE SPRINK Y ❑ NC] ENERGY T 24 Y ❑ N ❑ FLOOD ZONE •Y❑ No ALM C. Y0 N FEE SUMMARY BUILDING PLAN CHECK FEE SEISMIC FEE i .-- MICROFILM ELECTRIC �.- PLUMBING MECHANICAL J. CONST. TAX TOTAL - w¢Z Foo QUU DON -Z o _ Z 4„�W It y fez It ¢ w U W;e.F FU0< i w�0 a to �y r z ¢ 110 ar i3 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION &PERMIT -ELECTRICAL- PLUMBING- MECHANICAL PERMIT NUMBER I 0 BUILDING AopREss 11.�7,1BUILDING OWNER'S�� /D� ""M ✓� PHONE DTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION �% A 'D / g 2-'�-r^ G -/ U \\ CONTRACTORS NAM UTLETS -SWITCHES-RECEP 10.00/1,00 LIGHTING FIXTURES 10.00/1.00 ' C. No. CONTRACTOR5 AD E S..0'//�) �l ��fliAT lT / eJ �..GJ ppLIANCES-RESIDENTIAL 4.00 PANELS 70.00 r YOR/ ✓ !/C/ /(/ DATE OF APPLICATION ARCHITECT OR ENGINEE LIC. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS: 3.00 ARCH, OR ENG. _ ADDRESS SPECIAL CIRCUIT S.00 PERMIT VALIDATION TEMP. METER OR POLE INS. ' 20.00 ZIP l.�LaJ'Cl.tia APPLICANTS ADDRESS ' MOTORS SEE FEE $CH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION �LNZ. /17,q e L 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cod < m lie rs in full force a ffcCt- License Clyss ¢. Number ISSUANCE DATE BLDG. ELECT. PLG. MECH. Date - Contractor OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's Pre License Law for the ityowingreason.(h requires a Business tocnd Professions CodeimprovAny mulish county which structure, o its i shucLaaeq requires prior imprOVe, demolish, or repair any structure, prior to its issuance, also 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 BUILDING PERMIT INFORMATION MISC. - REFER TO ORD VALUATION SIFT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. N0. ELEC. TOTAL V PERMIT TO pp'� &U/ /,VG PRO ' ! QTY. PLUMBING PERMIT FEE STORIESPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ALTER -DRAIN & VENT- WATER (EA.) 5.00 9/w ❑ I, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND. 5.00 - Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work FIXTURES - PER TRAP 5.00 so. FT FLOOR AREA TOTAL ACREAGE (.himself or through his own employees, provided that such improve vents are not intended or offered for sale. If, however, the building GA$-EA.SVSTEM-11NC.40UTLETS 6.00 1- improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or ii- prove for purpose of sale.). ❑ 1, as owner of the property, um exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business GAS - EASYSTEM -OVER 4 IEA.) 2.00 . BULLRING USE RES IND CON PB Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6,00 ASSESSORS PAHCEL NO. and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS - OVER 5 (EA.) 1.00 x contracts for such projects with a contractorls) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 ❑ I am exempt under Sec.., BAP.C. for this reason Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORKERS' COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate ofconsent to self -insure, or a certificate of Workers' Com pen on Insu ce, ora cell fed (Sec. 3800, Lab C.) Policy o. Company ZONING ENG. SITE NO. _ FIRE SPRINK ENERGY T-24 ❑ Certil'iedcopyis eby furnished. El Certified co R d wit the cit i ct' ivi Applicant Y ❑ N❑ Y ❑ N❑ MISC. - REFER TO ORD. CERTIFICAT'EOFEXEMPTIONIeROMWORK ERS' PERMIT ISSUANCE 10.00 C) - FLOOD ZONE A.L.U.e. PLG. CONTR. LIC. NO. - PLG._ TOTAL U COMPF-NSATION INSURANCE. (This section need not he completed if the permit is for One Y [3N C] v ❑ N ❑ CITY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars (S 100) or less.) 1 certify that in the performance of the work for which this per- mit is issued. I shall not employ any person in any manner sn as to become subject to the Workers' Compensation LuwsD '' m, ate Applicant BUILDING Y- ALTER OR ADD TO MECH. 5,00 NbTfl!% TO APPLICANT': If, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shell be deemed revoked CONSTRUCTION LENDING AGENCY APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10=41F.M.) 4.00 AIR HANDLING UNIT (OVER 10MC.F.M.) 6.00 SEISMIC FEE G� EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM 1 hereby affirm that there is a construction lending agency for the performance of the work for w ich this permit is issued (Sea 3091, Ch C.). HEATING UNIT (TO 100,000 B.T.U-1 8.00 H EATI N G UN IT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Lenders Address I certify that I have read this application and state that the above o rInation is correct. I agree to comply with all city and county q nces and state laws relating to building construction, and .y authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to Save, indemnify and keep harmless the City ofMISC. Cupertino against liabilities, judgments, costs and expenses which may in any way accrue, against as i yin consequence of the VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER-COMP13 H.P. Or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000BTU) SEE FEESCH.1 MECHANICAL - sf REFER TO ORD. CONST. TAX PERMIT ISSUA E 10.00 d MECH. CONT. LIC. NO. MECH. TOTAL _9 �1 TOTAL dZ 401 ., grand o this permit Signature of Applicant/Contractor Da (`� OFFICE COPY