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14215POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION, RECORD JOB ADDRESS iOSd 1%.Q�72TA.UpGJ hl1T# LOT# G �.a;Z 4' a-ZA" /� OWNER Sfef/G %(tel. CJ>QLL CONTRACTOR Kf2 /Sa PERMIT NUMBER 14215 .PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180.DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION - UFER - PR EGUNITE PERMIT VALIDATION.{ J IS DANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDD Oa UNDERGROUND/SLAB PLUMBING [.V ELECTRICAL MECHANICAL Be�LgpU� PLG. MECH, DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION y-1 GEJJo $/FT. PLUMBING MECHANICAL' ELECTRICAL � , PERMITTO) / � � ��'/:, � \ _• fy;,? l FRAMING INSULATION -STORIES TYPE CONSTR. OCC. GROUP -FLOOR RES, UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.FT,AREA TOTAL ACREAGE DIAPHRAGM _ - BUILDING USE HES IN CON PB Other ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. _ ROUGH � - - `mak GI PLUMBING GAS TEST TRACT NO, PARCEL NO. MECHANICAL ELECTRICAL }FINALS e; DATE INSP. ACC.DATE AcG PILE No. FRAMING ' SAN # INSULATION PLUMBING ZONING ENG. SITE NO. GAS FIRE SPRINK Yo No ENERGY T 24 Y ❑ NC:] MECHANICAL COVERING WORK UNTIL ABOVE HAS BEEN SI ED, HEATING FLOOD zorvE Y[:] N❑ PL.0 c. , Y.0 N❑ LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR -- ILDI NG BUILDING SHEAR EXTERIOR TEMPORARY APPROVALSIJ FIREWALLS ELECTRIC PLAN CHECK FEE GAS SEISMIC FEE q� NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED' OCCUPANCY OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM' ARRANGE FOR INSPECTION BY PHONING 252-450 F ONE WORKING DAY BEFORE REQUIRED INSPECTION. O�' PLEASE GIVE JOB ADDRESS WHENTHONING. Z —SEE PERMIT FOR EXPIRATION DATE - ELECTRIC ELECTRIC PLUMBING MECHANICAL CONST. rax IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION.. ' ' TOTAL f %: (� OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDING PROJECT IDENTIFICATION APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 421 BUILCIN ADORES 105L0 s. W�NZA �vp OWNER'5 11r✓M1�r , NAME STEVE }11TCNF.LL C`RON), 1 b142 QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTOR'S n.- NAM UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 joosl LIC.x 0#24 CONTRACTOR ADDRESS oR's �/! �Ikf 7G_ PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 JJ O / PHONE371 -O DATE OF APPLICATION ARCHITECT yl 7tr Ce /� C'N6o2q ENGINEER Sec. No. PANELS(OVER 200 AMPI 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARLH.OR ENG. 114 STS /,/IF( I'�'1n k�E p�O ADDRESS -1 M it 11 IFWLO-T`A*lrt ,FC140 Z45 SPECIAL CIRCUIT 5,00 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH.ADDRESS SERVICE CHANGE 20,00 SERVICE ' - P✓ /Ey ✓(/ 00 LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 .1 DATE (commencing with Section 7000) of Division 3 of the Business and Professions Code, Send my license is in full force and effect. License ClassLic. Number 0itL PLG. MECH. ❑ ❑ Dale Contructnr ' LDING PERMIT OWNER -BUILDER DECLARATIONNFORMATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Businessand Professions Code: Any city or county which requiresa permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also MISC. - REFER TO ORD VALUATION �'0 p(70 $/FT. PERMIT ISSUANCE, 10.00 ELEC.CONTR. .-I0. NO. ELEC. requires the applicant for such permit to file a signed Statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 TOTAL PERMIT T •�NTr=,C/ AJyQ OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.) 5.00 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): 1 ❑ I, as owner of the properly, or my employees with wages as their sole. Compensation, will do the work, and the structure is m[ intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP �� 2 RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 - Cade: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who does such work FIXTURES - PER TRAP 5.001:E, LOCH AREA TOTAL ACREAGE himself or through his own employees, provided that such improve. meats are not intended or offered for Sale. If, however, the building LJO GAS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that be did not buil) or int- Prove for purpose of scale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING USE RES IND CON PS Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 - LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORSPARCEL NO. and Professions Code: The Contractor's License Law docs 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 conlmctorts) licensed pursuant to the Contractors License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 ❑ I am exempt under Sec. ,B.&P.C. for this reason Owner Date WATER SYSTEM 5.00 ACL. DATE ALC. FILE NO. WORKERS'COMPF.NSATION DECLARATION - WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self -insure, or a cer(ificale of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof(Sec. 3800, LaRC.). Policy NCompy_/1 ✓Ip- FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ ❑ Certified copy is hereby furoklueL'_� O Certified copy is filed with the city inspection division. Applicant MISC. - REFER TO ORD. CERTIFICATE. OF: EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE (This Section need not be completed if the permit is for one y [:] N ❑ V ❑ N❑ .rte OTY ". 'MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars ($100) or less.) 1 certify that in the performance of the work for which this per- mit is issued, 1 shall not employ any person in any nsanner so as to become subject to the Workers' Compensation Laws of Califomia. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex emption. you should become subject to the Workers' Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY BUILDING JG &O JQ ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10,000C.F.M1 4.00 AIR HANDLING UNIT (OVER IQODOCF.M.) 6.00 - SEISMIC FEE �x O' EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM I hereby affirm (hat there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). HEATING UNIT (TO 100,000 B.T.U.) 6.00 HEATING UNIT (OVER 100,000B.T.U.)9.50 ELECTRIC Lender's Name Lender's Address I certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 4,00 PLUMBING BOILER-OOfv1P (3H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEESCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. MISC. - REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which gmsUi gof is mit. L2in way accrue•agailet aid City in consequence of the PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL Q �p - of ApplicantiKontractor ate OFFICE COPY