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13677 =� POST THIS CARD NEAR FRONT OF BUILDING PFRMR NUMBER CITY OF CUPERTINO 13677 INSPECTION DIVISION JOB INSPECTION RECORD p� - PERMIT EXPIRATION - JOB ADDRESS !may Lr Dd- (/�- N:26A - 'UNIT# LOT 4t " PERMIT EXPIRES IF WORK OWNER A021c -CONTRACTOR ) (` 1 a IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYSFROM UFER - LAST CALLED INSPECTION. PREGUNITE PE MT�VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS,BEEN SIGNED 1 C UNDERGROUND /SLAB ' PLUMBING I CP►�Y� ELECTRICAL PAID, ISSUANCE DATE MECH. MECHANICAL BLDG ELECT. PLG. ' i I C f I O. 1(AOC! � . ❑ � � ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR +tel CUp@ItIDOs INFORMATION ' I $/FT. PLUMBING VALUATION . MECHANICAL PERMIT TO ELECTRICAL L-I ec, FRAMINGI h INSULATION STORIES TYPE CONSTR. OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED •, ROOF SO,FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB 00,e, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ 0 0 0 ROUGH ASSESSORS PARCEL NO. ' PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ' ACC,DATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING - SAN * ' ZONING ENG.SITE NO. INSULATION PLUMBING - GAS F IRE SPRINK ENERGY T 24 MECHANICAL ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y I]• NO Y [:] NF] LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.uc. LATH-EXTERIOR FIRE DEPT. - Y0. NYo N❑ 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 IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 12•L 'O . z ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE-JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST.TAX IMPORTANT!, PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY ' fwPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION TER13i6 MBER BUIILDIN I �`� 1APPLICATION & PERMIT �� LJ� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 7 U.NER'a. - PLAN CHECK VALIDATION • NAME QTY. ELECTRIC PERMIT FFk AfPLtv iz - VIVA PHONE NAMERacTORs ,O UTLETS-SWITCHES-RECEP 10.00/1.00 j- 6f.szq*(L LIC.NO.Z(u 131 l LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00 Al1gOR.7 __ 1 `/ter ACTEi ST PHONE�j ��j O PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C.NO. OR ENGINEER N a sec.No. SIGNS TRANS. LWO 3.00-- ARCH.OR ADDRESS EN� '� SPECIAL CIRC IT S.00 PERryIZs�LIDATION ZIP EMP.METE O IP LEI 20.00 `7\f1•L•.ftlD0 , J -`0 APPLICANTS MOTORS SEE FEE SCH. /nc,•,IVK�,rE."I ADORESa 6q -4 .r ,$Ia44 J1%t, •QSIu� SERVICE CH 00M 20.00 Woo LICENSED CONTRACTORS DECLARATION X .u 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE Zw (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. oi Professions Code,and my license is in full force and effectr. 41 ❑ ❑ ❑ z 0 w - License C s <-sea Lie.Number '1,(._131 Q o L 0 Date Contractor_8�� ¢ y BUILDING PERMIT ¢ ¢w c OWNER-BUILDER DECLARATION INFORMATION MISC.- .REFER TO ORD F 3 A w I hereby affirm that I am exempt from the Contractor's License VALUATION ' 1/FT. Fy0 J Law for the following mason.(Sec.7031,5.Business and Professions PERMIT ISSUANCE Yfi:00 �-z Code:Any city or county which requires a permit to construct,alter, a 2 Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O u requires the applicant for such permit to rile a signed statement that (- '�(�1313 TOTAL CSL 1 PERMIT TO A w$ he is licensed pursuant to the provisions of the Contractor's LicenseI ,�r rzi Law(Chapter 9(commencing with Section 7000)of Division 3 of the a Business and Professions Code)or that m he is exempt therefroand DTV. PLUMBING PERMIT FEE ¢H the basis for the alleged exemption.Any violation of Sect ion 7031.5 STORIES TYPE CONSTR. i by any applicant for a permit subjects the applicant loo civil penally ALTER-DRAIN -WATER IEA.) 6.00 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.UNlrs their sole compensation,will do the work•and the structure is not intended or offered for sale (Sec. 7044, Business and I'rofessions 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 docs such work FIXTURES-PER TRAP 5.00 SC FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve- mentsarenot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within ane year of completion,the owner. GAS EASYSTEM-OVER 4 IEA) 200 BUILDING USE builder will have the burden of proving that he did not build or am. - . . . RES IND CON PB Omer prove for purpose ofsole.). INDUSTRIAL WASTE INTER. 30.00 . ❑ ❑ ❑ El 11❑ 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 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 comIactor(s)licensed pursuant to the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. ❑ I am exempt under Sec. ,B.&I'.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm(hat I have a certificate ofconsent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.).GL 6, oIJ Policy No. ompany_T T O ❑ Certif copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z ZO PF Ce IC Co is fled with the city inspection division. MISC.- REFER TO ORD- ❑ ❑ ❑ ❑ Y N V N F- y PERMIT ISSUANCE 10.00 FLOOOZONE A.L.U.C. CC j CERTI ICATE OP EXEMPTION FROM WORKERS' LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL O (This section need not be completed if the permit is for one TOTAL Y[DN❑ Y❑ N❑ Z hundred dollars($100)or less.) U O 1 certify that in the perforniamm of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to O w become subject to the Workers'Compensation Laws of California. y Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING >_ W NOTICE 10 APPLICANT: If,after making this Certificate of 17x- ^,. 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 sha11 be deemed revoked. AIR HANDLING UNIT(TO 1Q000C-F.M.) 4.00 CONSTRUC'T'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 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(TO 100,000 B.T.U.) 8.00 Lenders Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 07-2100 . 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 end county BOILER-COMP PLUMBING ordinances and state laws relating to building construction, and (3H.P.or100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 1DO,DDOBTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. c o e, indemnify and keep harmless the City Of MISC.- REFER TO ORD. er[ino against Iia fillies,judgments, costs and expenses which CONST.TAX m' in any way accrue•against said City in consequence of the PERMIT ISSUANCE 10.00 g it. MECH.CONT. LIC.NO. MECH. 2 TOTAL TOTAL pplicant/Contractor Da OFFICE COPY