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09689 POST THIS,CARD NEAR FRONT OF BUILDING, - PERMIT NUMBER , `A 'CITY OF CUPERTINO INSPECTION DIVISION '` JOB INSPECTION RECORD. 1! + _ •.'. PERMIT EXPIRATION , - -JOB ADDRESS 7 eQ!tQ G�YIC..L� UNIT# ' LOT# ' ' '',^,,^I PERMIT EXPIRES41E WORK , - 'OWNER.' I f�i + CONTRACTOR e��Oh L`� eo �/; .'IS' NOT STARTED-WITHIN,: INSPECTION DATE INSPECTOR INSPECTION RECORD 180 Dnvs of PERMIT Issu= FOUNDATION / Q, T. '-ANCE OR 180 DAYS FROMLTFER R � LAST CALLED INSPECTION.' PREGUNTE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - UNDERGROUND /SLAB PLUMBING ELECTRICAL' - - _ ISSUANCE GATE MECHANICAL , - BL G. ELECT. ;PLG. MECH. .. E DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - - INFORMATION PLUMBING r VALUATION SIPr, MECHANICAL { . / C"t'' ELECTRICAL 'PFjRMIT TO FRAMING x - INSULATION - 'STORIES Ty? CONSTR.> ' � � � ' �� .4 ' OCC.GROUP •RES.UNITS ` PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF -SO.FT.FLOOR AREA TOTALACREAGE DIAPHRAGM , BUILDING OKI- RES IND' CON PB 00 , APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED Z 'Q ❑ '.❑ ` ❑o. RO GH �/ 'ASSESSORS PARCEL NO. PLUMBING IJ GAS TEST . +TRACT NO. PARCELNO MECHANICAL* ACC.DATE ACC,FILE NO. ELECTRICAL FINALS DATE, INSP. . . FRAMING SAN tl - �• PLUMBING ZONING ENG,SITE NO, INSULATION _y F'S _ tv GAS • MECHANICAL• FIRESPRINK ENERGY 7-2E' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' c " Y 0 N ° [:) IND " `FLOOD ZONE A.LU.C. LATH-INTERIOR - ELECTRICAL' / :7 LATH-EXTERIOR FIRE DEPT. Y❑ N'❑ ,Y'❑_ �N❑ GRADE - - - - SHEETROCK r FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR ' ' TEM RARY APPROVALS" '" '• BUILDING' FIREWALLS - ELECTRIC .PLAN CHECK > - GAS' .. FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE , r ' . OCCUPANCYOF BUILDING I SNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. -MI ♦ 1 ARRANGE FOR•INSPECTION BY PHONING252-4505, ELECTRIC UL 11J ONE WORKING DAY BEFORE REQUIRED INSPECTION. OPLUMBING .PLEASE GIVE JOB ADDRESS WHEN PHONING. -- • . ' Z - MECH ANIC "�I s SEE PERMIT,FOR EXPIRATION DATE ALr IMPORTANT!' CONST.rnz". 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 - , FERMI NUMBER a nnING APPLICATION & PERMIT n O ADDRESS x7 0 L/Lh7 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S (✓J PLA HECK VALIDATION NAME- TY. ELECTRIC PERMIT •FEE - CONTRACTOR - OUTLETS-SWITCHES- RECEP. 10.00/1.00 NAME LIC.No. r LIGHTING FIXTURES' - 10:00/1.00 CONTRACTOR'S APPLIANCES-RES ADDRESS IDENTIAL 4,00 Y+D I Z ` 15PHONE Zq-S7 PANELS '10.00 DATE OF APPLICATION ARCHITECT - - PANELS (OVER 200 AMP) 20.00 CKFEE P.C.NO. OR ENGINEETrtM_ F IC.No. SIGNS TRANS. 3.00 PLAN CHE ARCH.OR ENG. SPECIAL CIRCUIT S.00 PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS. -20.00 SCH. ADDRESS MOTORS' SEE FEE SCH. ' .ADDRESS SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 <U u I hereby affirm that I am licensed under provisions of Chapter 9 5 �CE DATE 1-z (commencing with Section 7000)of Division 3 of the Business and BL ELECT. PLG. MECH. - rw Professions Code,a ny license is in full force a `7Oz- '1 E P •1 Z 0 y License Cl Lie:Number., Y�� [,r_; G I El 2w Date �'�'� Contractor- !'. - s'w¢ OWNER-BUILDER DECLARATION. BUILDING PR�IT DaU - MISC.- E TO ORD C1LFrRr` w3 e � 1 hereby affirm that I am exempt from the Contractor's License - VALUATION $/FT. Fu Oa Law for the following reason(Sec.7031.5,Business Professions PERMIT ISSUANCE 10.00 ,a w Code:Any city or county which regmi ve a permit on construcpalter, / f Z 'ELEC.CONTR. LIC.NO. II: ¢ ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.-�I rFEE i - D requires the applicant for such permit to file a signed statement that TOTALtJ� MIhe is licensed pursuant to the provisions of the Contractor's License QLaw,(Chapter 9(commencing with Section 7000)of Division 3 ofthe Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT$ the basis for the alleged exemption.Any violation ofSection 7031.5 TYPE CONSTR. by any applicant for a permit subjects the applicant toachdipenaltyALTER-DRAIN&VENT-WATER (EA.) 5.00Of not more than five hundred d011ara(5500).):-❑ I,as owner of the property or my employees with wages as. BACK FLOW PROTECT. DEVICE 4.00 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,CONE). 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 re through his own employees provided that such improve- ments mprove- himself enol intended or employeeffered for salc.lf,ed that such building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year Of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 I. BUILDING USE builder will have the burden of proving that he did not build or am- - E IND CON PB Other 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-qpgMAJP 1.00 contracts for such projects with a contractors)licensed pursuant t0 SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO. PARCEL N0. ❑ 1 am exempt under Sec.-,B.&P.C.for this WATER HEATER WTI G 198 6.00 - reason Owner - Date WATER SYSTEM ' '5.00 ACC,-DATE ACC.FILE No. WORKERS'COMPENSATION DECLARATION - WATER TREATING*Iff.GUpeiIL05.00 r I hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0. copy thereof(Sec.3800,Lab.CJ. Policy No. Company ^ O ❑ Certified copy is hkebyfurnished. FIRE SPR INK ENERGY T 24 Z Z ❑ Cert" N a .with t 1 pection division. - O Applican m' � r-� MISC.- REFER TO ORD. Y � N�" Y � N� . CERTIFICATE OF EXEMPTION FROM WORKERS' y PERMITISSUANCE 10.00 O - FLOOD ZONE A.L.U:C. - LU COMPENSATION INSURANCE PLG.CONTR. . LIC.NO.. PLG. /OZ ❑ ❑ ❑ ❑ CL a (This section need not be completed if the permit is.for One TOTAL Y N Y N D Z hundred dollars(S 100)or less.) - U O I certify that in the performance of the work for which this per CITU. MECHANICAL PERMIT FEE FEE SUMMARY LL E mit is issued,1 shall not employ any person in any manner s0 as to ' O W become Subject to the Worker Compensation Laws of California. BUILDING y Data Applicant - ALTER OR ADD TO MECH. _"5.00 } to NOTICE TO APPLICANT: If,after making this Certificate of Ex- emption,you'should x-emption,you'should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK* x• provisions of the Labor Code, you must forthwith'Comply with FEE U such provisions or this permit shall be deemed revoked. _ AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE - 1 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,Civ.CJ. -7 Lenders Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC X60 Lender's Address 1 certify.that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 • information iscorrect:1 agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.I 6.00 PLUMBING - -y ordinances and state laws relating to building construction, and hereby.authorize representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL 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 which CONST.TAX may in any.v(iy accru.ee/y/_s,'�y�J_',t said City in consequence of the PERMIT ISSUANCE , 10.00 _ grand Ih' rmi[ _��� MECH.CONT. ^ LIC_NO. MECH. TOTAL U f .«�+�✓p`^"'�i7p TOTAL / ignature of Applicant/Contractor Date OFFICE COPY'