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11590 POST THIS CARD NEAR FRONT OF BUILDING ' PERMIT NUMBER s' CITY OF CUPERTINO INSPECTION DIVISION _ 590 JOB INSPECTION RECORD , �T '(�) Hny� PERMIT EXPIRATION JOB ADDRESS 1066 ce /0��,5 � '-tee'""`& UNIT# LOT# I 1 77�� C PERMIT EXPIRES IF WORK OWNER N CONTRACTOR .I/: J(A) _rD IS NOT STARTED WITHIN INSPECTION DATE T INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE.OR 180 DAYS FROM FOUNDATION ��J Ak AST CALLED INSPECTION. UFER d PERMIT VALIDATION PREGUNITE - •4 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB g� PLUMBING ELECTRICAL ISSUANCE DATE BLDG. ELECT. , PLG. MECH. MECHANICAL ❑ 0 1:1 0 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT _ INFORMATION WOOD FLOOR vnwnnoN SIFT, PLUMBING ,. MECHANICAL _ PERMIr ro ELECTRICAL j>LTjCK, .w/I G� FRAMING STORIES ,TYPE CONSTR. INSULATION OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I ROOF 'SO.FT.FLOORAREA TOTALACREAGE DIAPHRAGM BUILDING USE ' - RES IND CON PB Otlmr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ' ❑ ED ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING . TRACT NO. PARCEL NO. GAS TEST MECHANICAL , ` ELECTRICAL - - FINALS DATE INSP. t ACC.DATE ACC.FILE NO. FRAMING - SANif - INSULATION PLUMBING orvwc END SITE No. GAS FIRE SPRINK ENERGY T-]A MECHANICAL .Y "� v [D. NF) COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH-INTERIOR ELECTRICAL - --FLOOD ZONE A.L.u.c. LATH-EXTERIOR FIRE DEPT. - v N[:] v 0 "� SHEETROCK - GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVAS L FIREWALLS • ELECTRIC PLAN CHECK NJ GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM i ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC • F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING.. " 2 MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - 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 PERMLT NUMBER 1 e'ILotNu APPLICATION & PERMIT ^ ^ 59� nooness �1 d I I `J Sr ��.c/IA7ZR BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S V PLA CK VALIDATION rvAmE QTY. ELECTRIC PERMIT FEE i Tjl1 PRD IE I PHGNE S/JSJ �� CONTRACTOR'S ' NamE OUTLETS-SWITCHES-RECEP 10.00/1.00 V StL7 OiV IiC.No. LIGHTING FIXTURES 10.00/1.00 -� CONTRACTOR'S APPLIANCES•RESIDENTIAL 4.00 ADDRESS . /�) 9 vEw 1411 PHONE(/ aNOD IPANELS 10.00 DATE OF APPLICATION ARCHITECT PLAP.C.NO. OR PANELS (OVER 200 AMP) 20.00 N CHECK FEE ENGINEER LIC,No. SIGNS TRANS. 3.00 ADD'Ess ENG' SPECIAL CIRCUIT 5,00 - PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 _ - J ADDRESS is MOTORS SEE FEE SCH. 414x ✓�-W�s�'� ADDRESS SERVICE CHANGE 20.00 w o o LICENSED CONTRACTORS DECLARATION- (� p is Q v I hereby affirm that I am licensed under provisions of Chapter') 1I55N�E'ATE N (commencing with a h Section 7000)of Division 3 of the Business and BLDG. ELECT. PLO. MECH. F w z Professions Co-, d ose is in full r e e n p (IQ ❑ Li-to Class Lic.Number 33 � ®V Date Contractor BUILDING PERMIT ic ¢ w u OWNER-BUILDER DECLARATION INFORMATION wo 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD 3 U.1q VALUATION E/FT. v = o j Law for the following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE 10.00 G Cade:Any city or county which requires a permit to construct,alter, o Ec ¢ Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. / P. -0 a, requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w$ he is licensed pursuant to the provisions of the Contractor's License r t i Law(Chapter 9(commencing with Section 7000)of Division 3 of the a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE r the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of nor more than five hundred dollars($500).): ❑ 1,as owner of rhe property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNfrS 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 Cade:The Contractors 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 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. mems are not intended or offered for sale.IL however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM•OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that lie did not build or im- RES IND CON PB 011ie. prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 RE El❑ I,as owner of the property,am exclusively contracting with licenseEl 1:1 11 d 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 contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.20011/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec..,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACL.FILE N0. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of Consent to self-insure, 20NING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy thereof(See.3800,Lab.C.). FAX Policy No. Company___ 11 Z ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 ❑ Certif copy is filed wNh th ity insp n division. MISC.- REFER TO ORD. O Applicunr tt Y N Y N F- y PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U:C. CC j CERTIFICATE OF EXEMPTION FROM WORKERS' UJ _ COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG. CL o fThis section need not be completed if the permit is for one TOTAL Y❑ NC] Y [] N❑ ::) Z hundred dollars(SI00)Or less.) U O I certify that in the performance of the work for which this per, OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not employ any person in any mannerso as to OU become subject to the Workers'Compensation Lows of California. r,j-b w 7 Do NO Applicant BUILDING ALTER OR ADD TO MECH. 5.00 l0. } m NOTICE TO APPLICANT: If,ober making this Workers' Compensation sa Iix- L.. Z eruption,you should become subject Mthe Workers'Compensation qPP LIANCE 5.00 PLAN CHECK provisions io the labor Code, you muss forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M) 4.00 CONSTRUCTION LIiNDING AGCNCY AIR HANDLING UNIT(OVER I0,000GEM.) 6.00 SEISMIC FEE %.ZC- 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC . 1 certify that I have read this application and ,are that the above VENTILATION FAN (SINGLE) 4,00 info minion is correct. 1 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction,and BOILER-COMP(3H.P.or100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL I above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep hurniless the City Of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which _ CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 gra i goflhisp rmit. MECH,CONT. LIC.NO. MECH. I ��. 77--g TOTAL TOTAL �C , 7b Signature of plicnnt/Contractor Dare / OFFICE COPY