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13833 I POSTTHIS CARD NEAR FRONT OF BUILDING - PFRMIT NUMBER CITY OF'. CUPERTINO -INSPECTION DIVISION 13833 JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS22445 CUPERTINO ROAD UNIT# LOT# PERMIT EXPIRES IF.WORK OWNER SUNNYVIEW LUTHERAN. HONPE,ACTOR CAL ACACIA CORP IS NOT STARTED WITHIN INSPECTION - DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. LIFER PREGUNITE PERMIT VALIDATION - ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB p PLUMBING G,' ELECTRICAL - Ip EISSu NCETE BLDG. EIECT.- PLG. MECH. MECHANICAL - 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBOtl ING PERMIT WOOD FLOOR Pity ' lmel INpORMATION VALUATION $/FT. PLUMBING MECHANICAL PERMIT TO ELECTRICALTA,1 � ' - . ' FRAMING /"C STOPIES TYPE CONSTR. INSULATION '' OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF 50.IT FLOOR AREA TOTAL ACREAGE DIAPHRAGM _ BUILDING USE ` RES0 IND0 CON PB Olney 0 psAPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ASSESSORS PARCEL NO. ROUGH . PLUMBING TRACT NO. PARCEL NO, GAS TEST MECHANICAL ELECTRICAL R .._E� FINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING SAN u ZONING ENG.SITE NO. INSULATION PLUMBING GAS :FIRENERGY T 24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. YC) N❑ ' SHEETROCK GRADE - FEE SUMMARY SHEARINTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN`SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM , ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC I" ONE WORKING DAY BEFORE REQUIRED INSPECTION., PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. ` Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.rnx PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. " J`-- OFFICE COPY. - ,-�-�- .FA,pPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER 4, BUILGING APPLICATION & PERMIT AOOREss � , / Z Y4om!' BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 1 383 OWNER'S p PLAN CHECK VALIDATION " E NE2 CITY. ELECTRIC PERMIT FEE HONE n CONTRACTOR UTLETS-SWITCHES-RECEP 10.00/1.00 ME T fik� uc.NO. LIGHTING FIXTURES 10.00/1.00 11. EDINTH sT095 T / PPLIANCES-RESIDENTIAL 4.00 -L1A0 PRONF PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLANCHECK FEE P.C.NO. FOR -flitm•rvO. SIGNS TRANS. 3.00 ARCH.Os ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESZIP TEMP.METER OR POLE INS. 20.00 i� APPLICANT'S MOTORS SEE FEE SCH. .7J ADDRESS _/c SERVICE CHANGE lr� Y 20.00 o foo LICENSED CONTRACTORS DECLARATION ac L,u I hereby affirm that I am licensed under provisions of Chapter 9 C;\', ISSUANCE DATE w a (commencing with Section 7000)of Division 3 of the Business and \Q BLDG. ELECT. PLG. MECH. H,w iO Professions Cod d my license is in full fo d c[ Ct ❑ ❑ ❑ z O x o Data Clas Lir. racIorNmb� - p 1 o H w Date Lie moor s y f BUILDING PERMIT 0 w a OWNER-BUILDER DECLARATION INFORMATION woae' - - MISC.- REFER TO ORD ; y I hereby aflinn that I am exempt from the Contactor s License L VALUATION g/FT. as a. Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 „aCude:'Anycity orcounty which requires a permit to construct,alter, a ¢<G improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. D w requires the applicant for such permit to file a signed statement that - TOTAL PEEMIT TO 0.$ he is licensed pursuant to the provisions of the Contractor's License i he 4 Law(ChapterProcessions Codeng )or Section is 00)exempt erefrom and G Business and Professions Code)or that lie i is exempt therefrom end DTV. PLUMBING PERMIT FEE r by basis for[he alleged exemption.Anyviolationof t tooSection malty STORIES TYPE CO TR. i ;� by any applicant for a permit subjects the 0).): ant too civil penalty ALTER-DRAIN SE VENT-WATER of not more than five hundred Jolters(my em: ❑` I,as owner at the property,or my employees with wages as ggCK FLOW PROTECT.DEVICE 4.00 oCe.GROUP RES.urvrts their sole compensation,will(S the work,and the and Pr re is not intended or offered ntract for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 56 FT.FLOOR AREA TOTAL ACREAGE himself or through his awn employees,provided that such improve- GAS- EA.SYSTEM-I INC.4 OUTLETS 6.00 1 mems are not intended or offered for sale.IL however,the building or improvement is sold within one year of completion, the owner. ILD GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUING 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.). liNDUSTRIAL WASTE INTER. 30.00 ❑ I,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 Cade: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 contmetsforsu LiceneLwithacontractor(s)licenud pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. the tracts Ef r su License Law. ❑ I am exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. Qe7r��'�' I'j SAT�N WATER TREATING EQUIP. 5.00 I hereby a rm that I hav 'erg reale af,.a.n,to self-insure, ZONING or a certificate of Workers .empen lion Insurance,or a certified ENG.SITE NO. copy tlu,V (Sec.3800,Lub.CJ. g Policy NdJQ=Company E+�-y O ❑ Certified copy is her by ffi 1 `�r FIRE SPRINK ENERGY T 24 Z Z/ A❑/ of s h ity ti division. MISC.- REFER TO ORD. ❑ ❑ - �❑ ❑ O F< Y N V N Xw PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. Lu > CfiRTI FICATE E EXEMPTION FROM WORKERS' QJ _ COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. C O (This section need not be completed if the permit is for one TOTAL Y[:] N❑ Y E] N❑ :) Z hundred dollars IS 100)or Ic..) U O 1 certify that at the performance of the work for which this per. CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers Compensation Laws of California. BUILDING y Dula_Applicant ALTER OR ADD TO MECH. 5.00 } to NOTICE TO APPLICANT: If,alter making this Certificate of Ex- L.. ? 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 (.J such provisions or this permit shall be dremed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.EM.) 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. MICROFILM 3097,Ci+.C.). HEATING UNIT ITO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC ��' I certify that l have read this application and stale that theabove 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(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this ity to enter upon Elie BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-men iored property forinspection rpcars. (W ) tee to sa indemnify d ep harmless the City of MISC.- REFER TO ORD. Cup tin a ainst I' ilities,jud nt costs and expenses which CONST.TAX may in n wr rue-ugai t sai ity onuquance of the PERMIT ISSUANCE 10.00 gra li of I it, MECH.CONT. LIC.NO. MECH. TOTAL TOTAL ignature of Applicant/Contractor to OFFICE COPY