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12978 POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER CITY OF CUPERTINO 12978 ' INSPECTION DIVISION JOB INSPECTION RECORD ,. PERMIT EXPIRATION JOB ADDRESS .22445 Cupertino Road 'UNIT# 7 LOT# / PERMIT EXPIRES IF WORK OWNER Sunri view Lutheran Home CONTRACTOR Anchor Electric 41 IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD " 180 DAYS OF PERMIT ISSU. FOUNDATION - ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. LIFER PREGUNITE - PERMIT VALIDATION. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ` PLUMBING - •' iI ELECTRICAL ISSUANCE DATE MECHANICAL ^ BLDG. ELECT. PLG. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT W - INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING - MECHANICAL ELECTRICAL PERMIT To FRAMING STORIES TYPE CONSTR.. INSULATION - OCC.GROUP RES.UNITS . 2REACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED AROOF SO.FT,FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB Ome, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 0 ❑ 0 0 ASSESSORS PARCEL NO, ROUGH PLUMBING _ TRACT NO. PARCEL NO. GAS TEST - MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # ' ZONING ENG.SITE NO. INSULATION PLUMBING - GAS MECHANICAL ' FIREsPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN`SIGNED HEATING Y ❑ NE] Y ❑ N� LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C. LATH-EXTERIOR - FIRE DEPT. Y❑ N[-] Y ❑ No SHEETROCK GRADE FEESUMMARY 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 IS NOTPERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC \ hW- ^� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z�� PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! covsr.rnx PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. . OFFICECOPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ~' - -' BUILDING PROJECT IDENTIFICA ON PERMIT NUMBER UILDING APPLICATION & PERMIT r, JavE ADDRE59r✓1BUILDING - ELECTRICAL-PLUMBING-MECHANICAL NPU•/,/ (/�� /✓�BNQ�' QTYELECTRIC PERMIT FEE PLAN CHECK VALIDATION . mom, PHONE CO TRACTORS NAy47c�� A�/x �1 y. s�.3 UTLETS-SWITCHES-RECEP 10.00/1.00 33 ,b I�1l�C kovL-Of LIC.NO3 O1 /q.ZLIGHTING FIXTURES � 10.00/1.00 /9/'2.01 CONTRACT R's e`0 ,-- 2 PPLIANC ES-RESIDENTIAL 4.00 �O O ADDRESS a -6L(L ANELS 10.00 0.6 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. DR ENGINEER S. sl. uc.No. SIGNS TRANS. 3.00 ARCH.OR ENG, SPECIALCIRCUIT 5.00 PERMIT VALIDATION ADDRESS a,p TEMP.METER OR POLE INS. 20.00 ^ - - , APPLICANTS MOTORS SEE FEE SCH. 7p.0O 1a10.."."1-P� ADDRESS SERVICE CHAN 20.00 / L O o o LICENSED CONTRACTORS DECLARATION ¢u W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUAN DATE (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F o i Professions Co an I my license is in full farce a d effect. �QD , C)H License Cl us Lic.Number I Cti�Y ❑ �„ ❑ ❑ q as Date - Conlmcmr 7� V•7 BUILDING PERMIT ¢ ¢ ,¢a ¢ OWNER-BUILDER DECLARATION INFORMATION wo U MISC.- REFER TO ORD ;u y I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. Hu0 J Law for the following reason.(Sec,703 1.5,Business and Professions PERMIT ISSUANCE 10.00 'Q- Code:Any city or county which requires a permit to construct,alter, Q Ua Q 0 Improve,demolish,or repair any structure,prior to Its Issuance,also ELEC.CONTR. LIC NO. EL EC. -DLL requires the applicant for such permit to file a signed statement that TOTAL 77 PERMIT TO w$ he is licensed pursuant to the provisions of the Contractor's License r z i La..(Chapter 9(commencing with Section 7000)of Division 3 of the ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE (C the basis(or the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).): ❑ I,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 Code:The Contractor a License Law does not apply to an owner of property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 90.FT.FLOOR AREA TOTAL ACREAGE himself or through'his own em0loyees,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-EASYSTEM-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 Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 El 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 A$$ESSORSPARCELNO. 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 contractor(s)licensed pursuant to the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ 'l am exempt under Sec. ,BAP.C.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 to self-insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.CJLq��O1 Ig Policy No. Company f= 0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z B^Certified copy is filed with the Ci npl ecbi�n divi ion. p ppliC@nJ�- Kti MISC.- REFER TO ORD. Y [3' N❑ y ❑ NC]Hy t%d-"F PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U,C. IY CERTICATE OF EXEMPTION FROM WORKERS' W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG, y C1 N❑ Y❑ N❑ CL 0 (This section need not be completed if the permit is for one TOTAL D Z hundred dollars($100)or less.) U O I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY $L I- mit is issued,I shall not employ any person in any manner so as to 0 W become subject to the Workers'Compensation Laws of California. BUILDING OL Date ApplicantALTER OR ADD TO MECH. 5.00 >_ 0 NOTICE TO APPLICANT: If,after making this Certificate of Ex. F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 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 10p00C.F.M.) 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.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. MICROFILM 3097,Civ.CJ. t HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address 1 certify that I 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 ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.Dr100,000B.T.U.) 6.00 hereby authorize representatives of this city no enter upon the BOILER-COMP(Over 100,000 STU)SEE FEE SCH. MECHANICAL above-men. ned property for inspection purposes. (We agr to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupar no ainst liabilities,judgments, costs and expenses which CONST.TAX - may I y IwBy accrue against said City in consequence of the PERMIT ISSUANCE 10.00 gm mg ofjt spyrmit / MECH.CONT. 'LIF NO. MECH. �/ L,,`„' ( TOTAL TOTAL gnature of Applicant/Contractor Dyfaf OFFICE COPY