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12364 POST THIS CARD NEAR FRONT OF BUILDING PFFIVIT NUMBER CIT , OF CUPERTINO 12364 INSPECTION DIVISION • JOB INSPECTION/RECORD V/ (� PERMIT EXPIRATION JOB ADORE b/` L/'CT/ UN LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN PECTI N < DATE INSPECTOR I INSPEC ION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING - ELECTRICAL ISSUANCE GATE MECHANICAL BL G ELECT. PLG. MECH. ❑ El ❑ ..DO NOT,POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED, BUILDING PERMIT F' WOOD FLOOR R - INFORMATION PLUMBING VALUATION SIFT. Z-�?_$� MECHANICAL ELECTRICALPERMIT TO FRAMING .2A'7-V7 - 'JJ• . INSULATION sioRlEs rYPEcoNSTR. OCC.GROUP RES.UNITS FPLACE'NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED: ROOF 50 FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB O,he, APPLY,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El ❑ ❑ 1:1 ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICALFINALS ACC.DATE ACC.PILE NO. DATE INSPa ' FRAMING SAN * INSULATION PLUMBINGZONING ENG.SITE NO. GAS MECHANICAL q-2-FIF F IRE SPRINK ENERGY T 24 ❑ "❑ ❑ "❑ T Z>COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED IX HEATING LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.0 C. LATH-EXTERIOR FIRE DEPT. Y ❑ NY ❑ N❑ SHEETROCK 'y'2.07 GRADE FEE SUMMARY . SHEAR INTERIOR BUILDING (—f( VL — SHEAR EXTERIOR TEMPORARY APPROVAL BUILDING „_- FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC • o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING _ Z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL CONST.ONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICECOPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONILY .' PERMIT NUMBER BU I LDING PROJECT IDENTIFIC! N APPLICATION & PEI .IT a"no""s 12364 ADORES � �e BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 0 Ni,i, T. +• PLAN CHECK VALIDATION �� "AME "' QTY. ' ,�',w; ' ELECTRIC PERMIT. .. kEE" PHONE NAMERACTORs OUTLETS-SWITCHES-REECEP 10.00/1.00 LIC.No. LIGHTING FIXTURES 10.00/1.00 ADDRESS R's PPLIANCES-RESIDENTIAL 4.00 CONTRAPHONE PANELS 10.00DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No. SIGNS TRANS. 3.00 ADDRESS ENG. PERMIT CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APn¢ANrs MOTORS SEE FEE SCH. Q„altGsaa �. SERVICE CHANGE PPIIm 20.00 Ae(� Woo LICENSED CONTRACTORS DECLARATIOhR� •JAN/ ©D �' < w u 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE N a. (Commencing with Section 7000)of Division 3 of the Business and BLDG. ECH. _ ,Us Professions Code,and my license is in full force and effect. ❑ El vw - License Class Lie.Number Z=w Date Contractono r p��guIr VaV of copg BUILDING PERMIT., MW a OWNER-BUILDER DECLARATION - "-INFORMATION`'.;;.'; - O A U MISC.- REFER TO ORD u N 1 hereby collo that I .n exempt from the Contractor's License vgLUAT10N $/FT. u0 J Law for the following reason.fSec.7071.5.Business and Professions PERMIT ISSUANCE 10.00 a Code:Any city or County which requiresa permit to construct,alter, . a <O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. qq / - 0 n requires the applicant for such permit to file a signed statement that TOTAL L)U PERMIT TO w$m he 4 Ecensed pursuant to the provisions of the Contractor's License ?-17074- � �i> Law(Chapter 9(commencing with Section 7000)of Division 3 of the +� - [IAT 4&J)Tr d"1� s z c Business and Professions Code)or that he is exempt therefrom and OTY:'s��+ PLUMBING PERMIT+ _r', _,-FEE } M 1-S thebasisfor the alleged exemption.Any violation of Section 7031.5 . "� £ °L. - STORIES TVP LONSTR. A. i by any applicant for a permit subjects the applicant toa civil penalty of not mole than five hundred dollars(S500),): ALTER-DRAIN IEA.) 5.00 .( - ❑ 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,AR EA,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 Al SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1 6.00 ments are not intended or offered for sale.If,however,the building or improvement is sold within one year or completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder willhave the burden of proving that he did not build or m. RES IND DON p0 O h., prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ Cl ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPR IN KLE 5 V.B. 6.00 ASSESSORS PARCEL N0. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLE F 5 IEA.) 1.00 contracts f.,auch projectswith contraclotls)licensed pursuant to gEWER-SANIT -S 0 OOft/10.00 the Can r'S License TRACT NO. PARCEL NO. ❑ ame rvtu e,S � � .&P.0 fort 's , WATER HEA / 6.00 (r: mai own ale WATER SVSTE 5.00 ACC.DATE ACC.FILE NO. ORKERS'COMPEN ON DECLARATI WATER TR EA UI 5.00 I by affirm Ihat 1 have a certificate of consent to self-insure, ZONING certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Company 0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z D Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. O Applicant Y ❑ IN V ❑ N❑ Cry CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 /U, FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. ?/ V� N� V ❑ N� CL Z (This section need not be completed if the permit is for one TOTAL J C hundred dollars IS 100)or less.) U O I 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 _ O r) become subject to the Workers'Compensation Laws of California BUILDING '•�` y Dale Applicant ALTER OR ADD TO MECH. 5.00 7� } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- F ? conflict,you should become subject to the Workers'Compensation APPLIANCE 5.00 FFE N CHECK provisions of the Labor Code, you must forthwith comply with C.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SMIC FEE G3 1 hereby affiml that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the 3097,performance Cio C,nce of the work for which this permit is issued(Sec.. HEATING UNIT(TO 100,000 B.T.U.) 8.00 ROFILM Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 CTRIC w�Gs Lender's Address • I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct.I agree to comply with all city and county PLUMBING J ` --- ordinances and state laws missing to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.) 6.00 hereby authorize representatives of this City to enter upon the BOILER-COMP (Over t00,IX10 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, inde y and keep harmless the City of MISC.- REFER TO ORD. Cu against Ba gments, costs and expenses which pERM1T ISSUANCE 10.00 CONST.TAX CL" any way cru not said Cily consequence o the ihle "... MECH.CONT. UC.NO. MECH. TOTAL '-TOTAL I �3 atureof AppfiofintWontra r D.V I - / OFFICE COPY