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13069
' POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER• '.CITY OF CUPERTINO 13069 INSPECTION DIVISION JOB INSPECTION-RECORD, PERMIT.EXPI RATION , JOB ADDRESS ��S OO CA A—s4A/ FC,N UNIT# LOT# PERMIT EXPIRES IF WORK OWNER ,(' t-TjQ_S CONTE! CTOR -ZAV1,11c IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - - Sc Ch 0 K I I 19 1¢7 ANCE OR 180 DAYS FROM LIFER LAST CALLED INSPECTION. PREGUNITE _ PERMIT VALIDATION P. R NO anfJPRFTr UNTIL ABOVE HAS BEEN SIGNED PAID UNDERGROUN^-/SLAB_—_ PLUMBING - ELECTRICAL �`— J "Usls1/A CE DATE MECHANICAL BLDG. ELECT. PLc. MECH. o.. Iq©I UlTyin DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION $/FT. PLUMBING -/9-lF ow MECHANICAL /'f-J'-f PERMIT TO ELECTRICAL FRAMING p STORIES TYPE CONSTR. INSULATION OCC.GROUP. e RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '• r. /fir t�I ROOF Iz-2.(x'(7 LMl -` JUx.� SO.-L FLOOD AREA TOTAL ACREAGE DIAPHRAGM \'Y, BUILDING USE El HES IND CON PB Omer 1 El El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED,; © ,L ASSESSORS PARCEL NO. ROUGH PLUMBING ' GAS TEST TRACT NO. PARCEL NO. MECHANICAL, ELECTRICAL _ ACC.DATE ACC.FILE NO. =br FINALS D INV.- FRAMING CMb- Ta�1,i O.-I -& SAN # ZONING ENG,SITE N0. INSULATION PLUMBING GAS MECHANICALFIRE SPRINK ENERGY Tl24 COVER NO WORK UNTIL ABOVE HAS BEEN GNED HEATING �- Y � N� Y [D No LATH-INTERIOR �,./ ELECTRICAL FLood zaNE .L,u c. LATH-EXTERIOR 2, FIRE DEPT. Y 0 ,"NO Yo ND SHEETROCK 70_lZqlS7 GRADE ,)FEE SUMMARY SHEAR INTERIOR BUILDING: SHEAR EXTERIOR fv TEMPORARN A PROVAL BUILDING 21044 FIREWALLS - .. - ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED' DCCUPANcv SEISMIC FEE 77 OCCUPANCY OF BUILDING IS NOTPERMITTED.UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE —. MECHANICAL IMPORTANT! coNST.Tnx PLEASE READ REVERSE SIDE BEFORE TOTAL pa f 2 CALLING FOR FINAL INSPECTION.— OFFICE COPY . APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER aL.LDING _ T APPLICATION & PERMIT .}1, MOREaS DD_- C�HARSLA E BUILDING-ELECTRICAL -PLUMBING-MECHANICAL 1 301 9 OWN R'S - NAME PLAN CHECK VALIDATION I TY ELECTRIC PERMIT FEE PHONEi -2-41 c s R NAME UTLETS-SWITCHES-RECEP 10.00/1.00 NAME / 2 ,L LIc.No. LI 6 J LIGHTING FIXTURES - 10.00/1,00 CONTRACTORS ADDRESS APPLIANCES-RESIDENTIAL 4.00 Q 395-7 6 PNONE PANELS 10.00 DATE OF APPLICATION OPNLNITF T PANELS(OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGIN ER C.NO, SIGNS TRANS. 3.00 ARC H.OR ENG. PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 ZIP EMP. METER OR POLE INS. 20,00 APPLICANT'S IF, ^ ADDRESS MOTORS SEE FEE SCH. -, f 1 L L o S j SERVICE CHANGE 20.00 FOO LICENSED CONTRACTORS DECLARATION <u W I hereby offimn that I am licensed under provisions of Chapter 9 6 141TE <H (commencing with Section 7000)of Division 3 of the Business and g r w Pro@scions Code,arKmy license is in full force and effect. U L L PLG. MECH. El G i m o License la Lic.Number G ❑ ❑ F v, H J Date Contractor ¢_ x w a OWNER-BUILDER DECLARATIO BUILDING PERMIT wD >" INFORMATION ; u-a,, I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD w O¢ Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION $/FT. L- - alter, PERMIT ISSUANCE 4 w>E Code: e,dery y of countypair any Structur e permit o its issuance.also 10.00 ¢¢Q O improve,demolish,or for such P rmit Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. -O u requires the applicant for such permit to file i signed statement that TOTAL PERMIT TO e w he is licensed pursuant to the provisions of lh0 )ofDivVmr s License eta Law(Chapter ndProcosion$Cde)with Section isexemfttheron3ofthe Sf=�Gu/, M i D Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE ¢r-$ the basis for the alleged exemption.Any applicant oInaction malty STORIES TYPE LONSTR, i3- by any applicant fore hundred subjectsthe$500).licam loncivil penalty ALTER-DRAIN -WATER (EA.) 5.00 y SN L of not more than five the prop dollars(my em: ❑ 1,as owner at the properly,a or 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 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- / - mems are not intendedoroffered l'orsale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 33� vZ-- „_ at improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or im GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pe Diner ❑ 1,as owner of the property,am exclusively contracting with ❑ 11 El C]licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-i INC 5 00 and Professions Code:The Contractor's License Law does not apply V.B.. . ASSESSORS PARCEL NO. to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 36 _� -03 �- y' contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. SEWER-SAN ITARV-STORM EA,200ft/10.00 TRACT NO. PARCEL NO. O lam exempt under Sec. ,B.&P.C.for this mason WATER HEATER W/VENT 6.00 `)999 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insurt, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. a copy thereof(SPe.3800,Lab.C.). 1 Policy No. Company S�-y�e- g k,nk 0 ❑ Certified copy is hereby furnished. Z Z i;L_Cerpy is filed with the 'ty Ospection division. FIRESPRINK ENERGY T-24 F O,� Applicantlificd MISC.- REFER TO ORD. Y❑ N❑ Y❑ No � y CERTIFICATE OI'E OMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL O (This section need not be completed if file permit is for one TOTAL Y❑ N❑ Y❑ N❑ :1 Z hundred dollars($100)or less) U O 1 certify that in the performance of the work fur which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY 0 U mit is issued,e t tool not employ any person in any manner so is to become subject to the Workers'Compensation Laws of California. 0 n Date Applicant BUILDING .rD >_ N NOTICE TO APPLICANT: If,after making this Certificate of fix- AgppPLAN CHECK 7 LTER OR ADD TO MECH. 5.00 Iso F. Z emption,you should become subject to the Workers'Compensation LIANCE 5.00 provisions of the Labor Code, you must forthwith comply with U FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10p00QF.M.) 4.00 V CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER10JMC.F.M.) 6.00 SEISMIC FEE ]7 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. - MICROFILM 603097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC �I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 �,:. rmaiion is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING Ninances and state laws relating to building construction, and hereby authorize representatives for ins inspection this city to enter upon the BOILER-COMP(Over 1G0,GO0 BTU)SEE FEE SCH. MECHANICAL' above-mentioned authorize property forinsp of purposes. (We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD. G Cupertino against liabilities,judgments, casts and expenses which CONST.TAX � may in,.apy way accrue against said City in con' romance of the PERMIT ISSUANCE OIL,, 10.00 granting O this permit. MECH.CONT. LIC.NO. MECH. TOT TOTAL TOTAL gas-427� M \ ' Signature ofApplican-0 ractor Ie �( - OFFICE COPY