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14178 POST THIS CARD NEAR FRONT OF BUILDING .• arFRMIT NUMBER 'CITY OF CUPERTINO ea "INSPECTION DIVISION JOB INSPECTION RECORD 'PERMIT EXPIRATION JOBADDRESS 6693 CLIFFORD UNIT# _LOT# PERMIT. EXPIRES IF WORK OWNER DAVID HERBERG CONTRACTOR ALL WEATHER HEATING IS NOT STARTED WITHIN INSPECTION DATE I INSPECTORINSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LIFER LAST CALLED INSPECTION. PREGUNIT.E PERMIT VA UOATION I POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG, ELECT. PLG. MECH. ❑ ❑ ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR � VALUATION $/Fr. PLUMBING' MECHANICAL ELECTRICAL PERMITT•TO FRAMING STOVIEH TYPE CONSTR. . ' INSULATION OCC.GROUP HES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF I SO.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB Olhr, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED cl ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO, ROUGH PLUMBING GAS TEST !)L TRACT NO. PARCEL NO. MECHANICAL ACC,DATE ACC.FILE NO. ELECTRICAL FINALS DATE`' , INSP..•" FRAMING SAN n ° INSULATION ZONING ENG.SITE NO. ` PLUMBING (/ GAS FIRE SPRINK ENERGY R2< MECHANICAL COVER NO WORK•UNTIL ABOVE HAS BEEN SIGNED, ; HEATING LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.u.C. LATH—EXTERIOR FIRE DEPT. v� N Y cl IN 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 ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM i 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.TAX PLEASE READ REVERSE.SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATIONWITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER is BUILDING APPLICATION & PERMIT Aimll%a 6693 cfAo(-ABUILDING-'ELECTRICAL-PLUMBING-MECHANICAL - 14178 OWNERS I ' PLAN CHECK VALIDATION NamE• Fj/1QTY. ELECTRIC PERMIT FEE ` PHONE`J�IS CONTRACTOR SM WQ UTLETS-SWITCHES-RECEP 10.00/1.00 NAME Ic1` LICNO. LIGHTING FIXTURES 10.00/1.00 Gs EGRESS APPLIANCES-RESIDENTIAL 4.00 x P•a'HOme --•17/ PANELS 70,00 GATE OF APPLICATION, OR RCHITEC PANELS (OVER 200 AMP) 20.00 'PLAN CHECK FEE P.C.NO. ENGINEER ' LIC.NO, SIGNS TRANS. - - 3.00 ARCH,OR ENG. SPECIAL CIRCUIT 5.00 _ PERMIT VALIDATION ADDRESS - ' ZIP TEMP.METER OR POLE INS. 20.00 - PEERESSrs MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 j 00 LICENSED CONTRACTORS DECLARATION 1 U U I hereby affirm that I am licensed under provisions of Chapter 9 _ISSUANCE DATE uHi¢w (commencing with Section 7000)of Division 3 of the Business and BLDG: ELECT. PLG. MECH. H N Z Professions Code license is in full tor�•,pge��ff { Zz w D. License Class Lie.Number o Data Contractor �.~ J ¢ ys BUILDING PERMIT ¢ 0= w OWNER-BUILDER DECLARATION _ INFORMATION E 3 u w I hereby affirm that I am exempt.from the Contractor's License MISC.- REFER TO ORD VALUATION ,S/FT. HUN J Law for the following mason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE ,10.00 Code:Any city or county which requiresa permit m construct,alter, ¢ w<2 Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO., ELEC. ea , m LL requires the applicant for such permit to file a signed statement that _ TOTAL PERMIT wons he is licensed pursuant to the provisions of the Contractor's License ��[--�/'' HZ> Law(Chapter 9(wmmeneingwilh Section 7000)of Division 3oflhe - ¢ Business and Professions Code)or that he is exempt therefrom and QTY.' - PLUMBING PERMIT FEE M the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant tea civil penalty gLTER-DRAIN&VENT-WATER IEA.) 5.00 of not more than five hundred dollars(8500).): ❑ 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 I 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 SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. ' ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 . or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that he 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 - ❑ ❑ ❑ -El ❑ 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 contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sea ,B.&PC.for this WATER HEATER W/VENT 6.00 reason 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 m self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,ora certified copy thereof(Sea 3800,Lab.C.. Policy No. Company. (IY7P n� 1�Yttl.l 0 ❑ Certified copy'is hereby Ned FIRE SPR INK ENERGY T-24 Certifi c filed wyyryh t cHv ms etion division. z0 APPPlicmI ,4hA�U' /& / �'1/Me-'E¢M(f!L MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ ' ~ w CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C. Q: - - LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG. D' o (This section need not be completed if the permit is for one TOTAL n' Y❑ N❑ Y [:] N❑ Z hundred dollars Ci 100)or less.) U O 1 certify that in the performance of the work for which this per QTY. MECHANICAL PERMIT" FEE FEE SUMMARY LL 1- mit is issued,1 shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. i Date ApplicantALTER OR ADD TO MECH. 5.00 wt• BUILDING } to NOTICE TO APPLICANT: If,after making this Certificate of Ex- . - F-, Z em tion,you should become subject to the Workers'Com ensatian 5 1 Y T p y p APPLIANCE 4.00 0 PLAN CHECK provisions the Labor Code, you must forthwith comply with FEE ' U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10pODGF.M.) '4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)=C.F.M.) 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,Civ.0.). Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address Icertify that l have read this application and stale that the above VENTILATION FAN (SINGLE)' 4.00 " information is correct.1 agree to comply with all city and county PLUMBING ' ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or 100,000B.T.U.) 6.00 hereby autlmrin.representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL ( D OV above-mentioned properly 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 n. CONST.TAX may iPER n any way accrue against said City in consequence of the MIT ISSUANCE 10.00 V granting of this permit. /' MECH.CONT. LIC.NE MECH. /� TOTAL TOTAL Signature of Applicant/Contractor Date OFFICE COPY