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8652 POST THIS CARD NEAR FRONT OF BUILDING 'Cl iS OF CUPERTINO . PE RMITNUMRER. :4' I INSPECTION DIVISION P652 JOB INSPECTION RECORD • JOB ADDRESS w /Y1 "VVI(/Q N(�� 'PERMIT EXPIRATION rI —UNIT �Z�'�'I•�LOT# o - ' PERMIT EXPIRES IF WORK OWNER CONTRACTOR�Ree�' Sa-!h2�1 IS NOT STARTED WITHIN ' INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 1 `z • UNDERGROUND /SLAB �- PLUMBING 1 / its 1 ELECTRICALISS - f ' UANCE DATE MECHANICAL y 9LDG., ELECT. PLG. MECH. ❑ ❑ ❑ ❑ ^ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION r PLUMBING VALUATION ' 'MECHANICAL ELECTRICAL /PERMIT TO ' FRAMING 1F-'. INSULATION ' �,• STORIES TYPE CONSTR. - - OCC.GROUP RES.UNITS' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' r� 'ROOF •• SO.FT,F 40OR AR EA TOTAL ACREAGE DIAPHRAGM _ BUILDING USE HES IND CON PB Olner APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ' ❑ ❑ El Cl ROUGH ASSESSORS PAR CEL NO, PLUMBING GAS TEST TR ACT NO. 'PARCEL NO. - , . MECHANICAL ACC.DATE ACC.FILE NO, ELECTRICAL FINALS DATE INSP. FRAMING SAN # INSULATION PLUMBING ZONING ENG.SITE NO: GAS MECHANICAL FIRE SPRINK ENERGY.T-24 ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING I E] "O Y ❑ "o LATH—INTERIOR ELECTRICAL cLoaD ZONE A.L.u.c. . LATH—EXTERIOR FIRE DEPT. Y❑ "� Y "❑ SHEETROCK - -yf GRADE FEE SUMMARY SHEAR INTERIOR BUILDING - „r• SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING -o rte, FIREWALLS ELECTRIC PLAN-CHECK GAS • FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC-FEE, J-z OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. - :MICROFILM 4 LU ARRANGE FOR INSPECTION BY PH=INSPECTII ELECTRIC. ONE WORKING DAY BEFORE REQO PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN- SEE PERMIT FOR EXPIRAMECHANICAL 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 PRO ECT I DENTI FI ON \ PERMIT NUMBER 'Ess & P�AIT a DREss D BUILDING - ELECTRICAL-PLUMBING-MECHA AL 8652 PLAN CHECK VALIDATION+ OTV- ELECTRIC PERMIT FEE AO A f PNONF NO9MERACTo s 1 OUTLETS-SWITCHES-RECEP 10,00/1,00 UR / qJ 1..Nqg#Z LIGHTING FIXTURES .10.00/1.00 r,ONTRACTOR 77 ADDRESS 6s3 Cr PM�ff_ g�f171 PPLIANCES-RESIDENTIAL 4.00 :xy-ccon kNELS 10.00 DATE OF APPLICATION OR PANELS PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.-No. SIGNS TRANS. 3.00 ARCH.ORFNc . SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20,00 APPLICANT'S ADDRESS MOTORS SEE FEE SCH, SERVICE CHANGE 20.00 o O LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 ¢i w 1 hereby affirm that 1 am licensed under provisions of Chapter 9 U NCE d 7 s- n¢ ( ommemmng with Section 7000)of Division 3 of the Businessland r D. rofessions Code d my license isin full fo an a BLDG. ELECT. PLG. MECH. x 0. C Lic.NumbernEl - 9 z - D Date Contractor_ `a f BUILDING PERMIT ¢ w OWNER-BUILDER DECLARATION INFORMATION E ;' h 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD r a_ a. Law for the following reason. 7031.5.Business and Professions PERMIT ISSUANCE 1D.DD VALUATION $/FT. my Code:Any city or county which reyuiresa permit to construct,alter. �© iy0� Q Q ¢0 Improve,demolish,or repair any structure,prior 10 its Issuance,also ELEC.CONTR. LIC.NO. ELED. (/ i xc¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO u,m a- he is licensed pursuant to the provisions of the Contractor's License H i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe i o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE /.V;r -t�(]BL M s-$ the basis for the alleged exemption.Any violation u(Seclion 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATEfl (EA.) 5.00 of not more than five hundred dollars(8500).): O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 . OCC.GROUP RES.UNITS 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 Code:The Contractor's License Law does not apply to an owner of property who builds or improves!hereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE I� himself or through his own employees.provided that such improve- Rents amno(intended oroffered for sale.if,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completionthe owner- builder will have the burden of proving that he did not build or am- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other ❑ 1,as owner of the property,am exclusively contracting with licensed contractors t0 construct the project(Sec.7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 600 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 forsuch projects with a contmctons)licensed pursuant to (lie Contractor's License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec..,BAP.C.for this - reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofconsent to self-insure, r a certificate of Workers'Compensation Insurance,ora certified ZONING ENG.SITE NO. upy thereaf(Sec.3800,Lab.C.)f Policy No. Company d_ O ❑ Certifie 'op is hereby fu ish (1 P FIRE SPRINK ENERGY R44 Z Z y filed !h a city specNon rasion. O Applicun MISC.- REFER TO ORD. v� N� v ❑ No ~ vaFLooD zorvE A.L.u.c. LU CERTIFICATEM E ION FROM WORKERS' PERMIT ISSUANCE 10.00 CL COMPENSATION INSURANCE PLG.CONTR. LIC.No. PLG. ❑ ❑ ❑ ❑ 1 O (This section nee.) not be complete) if the permit is for one TOTAL Y N Y N 0 2 hundreddollarsIS 100)pe less.) LL O I certify that h the to mployn ce of person work for which this per. FEE SUMMARY LL F unit is issued,I shall not employ any person in any manner so as to QTY' MECHANICAL PERMIT FEE O W become subject to the Workers Compensation Laws of California. S� y Date-Applicant - BUILDING (J } N NOTICE TO APPLICANT: If,after making this Certificate of fix- ALTER OR ADD TO MECH. 5.00 Z emPtion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 1- provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.Nt0 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10AWC.F.M.) 6.00 SEISMIC FEE DQ 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.L + HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.M.50 ELECTRIC 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 infan.reas a correct.I agree to comply with all city and county PLUMBING ordinances and state laws relating m ybuilding construction, and BOILER-COMPO H.P.or 100,000 B.T.U.) 6.00 I BOILER-COMP !Over lOO,000 BTU)SEE FEE SCH. MECHANICAL ereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. \ Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX [maymway accrue ego st said City in consequence of thehis i[ MECH.CONT. LIC.NO. MECHTOTAL TOTAL Af ice n actor C? OFFICE COPY