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11650 POST THIS CARD,NEAR FRONT OF BUILDING L ' A' CITY OF CUPERTINO ERMITNDMBER A INSPECTION DIVISION 11650 JOB INSPECTION RECORD SPERMIT-EXPIRATION JOBADDRESS -/01/3D J• /Y'/QZLL. �J��• UNIT,'* LOT# OWNER 00 coNTRACTOR PERMIT EXPIRES IF WORK INSP TION DATE IS NOT STARTED WITHIN INSPtCTORINSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM UFER !i.�(� -yLy�,�� y'�' LASTCALLED INSPECTION. PR EG UNITE 0 /c, PERMIT VALIDATION c POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ✓ UNDERGROUND /SLAB / PLUMBING - ELECTRICAL - ISSUANCE DATE I MECHANICAL - - BLDG. ELECT. PLG, MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING _ VALUATION g/FT. MECHANICAL - 7 . ELECTRICAL 7'6,f, - PERMIT To FRAMING AV/ ER/OR 'E/LIOD'L INSULATION STORIES TYPE CONSTR. OCC.GROUP RES.UNITS PLACE NO SUBFLOOR VE HAS BEEN SIGNED _ ROOF SO.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE HES IND CON PB 011ier APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ' ' - ❑ ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO PLUMBING GAS TEST - TRACT NO. PARCEL N0. MECHANICAL 'y - FRAMING FFINALS DATE INSP. ^cc.DATE ACC FILE-NO. FRAMING �� SAN # ' INSULATIONPLUMBING zoNlNc gNc.SITENo. . GAS MECHANICAL FIRE SPRINK ENERGY T2< COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED , HEATING Y ElN❑ Y ❑ N❑ LATH—INTERIOR ELECTRICAL - FLOOD ZONE A.L.O.C. LATH—EXTERIOR FIRE DEPT. Y❑ N❑ Y❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS - BUILDING r FIREWALLS ELECTRIC - _ PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. - MICROFILM ARRANGE FOR.INSPECTION BY PHONING 252-4505, ELECTRIC . \ �� ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMew,G / — 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 INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER D ADRESS - 4, 3 p APPLICATION & PERMIT 1, 1650 ADDRESS t. / O/,� O �• ' J BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWN• .s PLAN CHECK VALIDATION t ( AI QTY. ELECTRIC PERMIT FEE �-'� . o« � . s5esrwN /4Qd�6 CONTRACTCIR'S I NAr� LO F/ 7-7-OUTLETS-SWITCHES-RECEP 10.00/1.00 o LIGHTING FIXTURES 10.00/1.00 CONTRAS Offs 37 ADDRESS -Z, ( PPLIANCES-RESIDENTIAL 4.00 J - y PANELS 10,00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. oR1 ^ PANELS (OVER 200 AMP) 20.00 ENGINEEfy/la I� uc.No. SIGNS TRANS. 3.00 ARCH,OR ENG. PERMIT VALIDATION ADDRESS of SPECIAL CIRCUIT 5.00 N' ZIP TEMP.METER OR POLE INS. 20.00 ADDRESS MOTORS SEE FEE SCH.ADDRESS " � �$2dn.�a� 1f d..ypu1L, SERVICE CHANGE 20.00 w 0 9 LICENSED CONTRACTORS DECLARATION (/ a v I hereby affirm that I am licensed under provisions of Chapter 9 y a a (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE BLDG. ELECT. PLG. MECH. F w i Professions Code,an my license. So(sell force� d efle b ❑ z 0 m - License Class Lc.Number Y 4 y F m Data C-moletor ¢ ¢wOWNER-BUILDER DECLAR 'ION BUILDING PERMIT w ;n y I hereby affirm that I em exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION u O ¢ Low for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT. r -a PERMIT ISSUANCE er, 10.00 `Q -7 i b W Code: e,dem y demolish. county whiny requires a permit to construct, also Q ¢ Q Q improve,demolish,or repair any structure,print to its issuance,8150 ELEC.CONTR. LIC.N0. ELEC. �� W / OO ` u m m u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO he is licensed pursuant to the provisions of the Contractor's License r z Q Law(Chapter 9(commencing with Section 7000)of Division 3o1'lhe %N 7eX,(, ,�/ i 0 Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE ¢ H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. c ; by any applicant fora permit Subjects lheapplicant as civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($500).): O 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC,GROUP RES.UNITS their sale compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business onProfessions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contractor's License Law does not Business to en owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenot intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.4OUTLETS 6,00 or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2,00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale,). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PS Other Cl 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,BusinessLAWN SPRINKLERS-1 INC 5 VB600 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply V.B. . to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00 contracts forsuch projectswith a contractors)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C.for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.OA.TE ACC.FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 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 NO. copy thereof(Sec.3800,Lab.C.),,,,..,.� Policy No. CompanyF1•r O ❑ Certified copy ishereby furnished. FIRE SPRINK ENERGY T24 Z Z K Cerlifie copy is filed ith t e city Ss division. p cf � O Applicant MISS.- REFER TO ORD. Y [] NY❑ N❑ T CER IF ATI:OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. DU D COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 9L Z (This Section need not be completed if the permit is for one TOTAL Y N� V N� hundred dollars IS 100)or less. - U O 1 certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California. a Date Applicant BUILDING sa ALTER OR ADD TO MECH. 5.00 >_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex- F ? emption,you should become subject to the Workers'Compensation APPLIANCE� 5.00 PLAN CHECK S provisions of the Labor Code, you must forthwith comply with FEE J' U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=QF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10p00C.RM.) 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,Civ.C.). HEATING UNIT ITO 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 3.Z O✓ I 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(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives this of ths city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP (Over 100,0008TU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. / Cupertino against Rabililies,judgments, costs and expenses which PERMIT ISSUANCE 10.00 Q CONST.TAX may in any way accrueagar st said City ' c nyuence f the grantingo hispermit' MECH.CONT, LIC.NO. MECH, �3 TOTAL p� TOTAL /60 S na[ureo Applicant/Contractor Dat OFFICE COPY t