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13672 POST THIS CARD NEAR FRONT OF BUILDING PGHMITNUMBER CITY OF CUPERTINO 13672 INSPECTION DIVISION • JOB INSPECTION RECORD p / `� 3'-- � .iPERMIT EXPIRATION JOB ADDRESS /4 C=f d 7 OqNZf4- E�L✓6r UNIT# LOT# PERMIT EXPIRES IF WORK OWNER Aj 4,zi 4­1 - CONTRACTOIS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION /_� - C g, K tijZ ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION: PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED r UNDERGROUND /SLAB / PLUMBING '��� r',� dr' ELECTRICAL ISSUANCE DATE MECHANICAL LOG. ELECT. PLG. MECH. ❑ ❑, DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 3 INFORMATION ILDING PERMIT WOOD FLOOR OC ON SIFT. PLUMBING `•\ty 0 gUP MECHANICAL ' PERMI TO ELECTRICAL - C�sG FRAMING $TORIES TYPE CONSTR. INSULATION OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT.FLOOR PH[A TOTAL ACREAGE ROOF DIAPHRAGM BUILDING USE - HES IND CON PB Otner APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED SP ASSESSORS PARCEL NO. ROUGH PLUMBING N TRACT O. PARCEL NO. GAS TEST - - MECHANICAL ACC.'OATE ACC.FILE NO. ELECTRICAL -Z-W INALS DATE INSP. FRAMING - SAN # ZONING EENG. TE NO. INSULATION - PLUMBING GAS FIRE SPRINK Y T29 MECHANICALCOVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING � ❑ N❑ "� LATH-INTERIOR ELECTRICAL FLM ZONE A.L.u.c. LATH-EXTERIOR FIRE DEPT. v0 NO r IQ N❑ SHEETROCK - GRADE FEESUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR - TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC - PLAN CHECK GAS FEE N0 TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM I ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC /D6 o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE ,TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLIC/XNTILL IN AORMATIGN WITHIN RED LINES — USE BALL POINT PEN ONLY EL DING PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER BUILDINGF III N 1&d BUILDING —ELECTRICAL—PLUMBING—MECHANICAL 13672 OWNER'5 PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE HONE y4 60AMTR Rs le- OUTLETS-SWITCHES-RECEP -44"40F7,00 71471 j r LIc.Na7Yp� / LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'SA PPLIANCES-RESIDENTIAL 4.00 AOOR 55 PH..07 PANELS 2 DATE OF APPLICATION ARCHITECT ]PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR E E I1y D. SIGNS TRANS. 3.00 ARCH.OR ENG. 5.00 PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT ZIP EMP.METER OR POLE�pINS. 20,00 APPLICANTS ADDRESS MOTORS �( SEE FE SERVICE HANGE AO /v � 0 ac o LICENSED CONT �=// ACTORS DECLARATION J ¢U,w 1 hereby affirm 0sat I am licensed under provisions of Chapter 9 ISSUANCE DATE N Q w (commencing with Section 7000)of Division 3 of the Business and , BLDG. ELECT. PLG. MECH. r i Professions Code y license is in full for n� Byte ❑ ❑ ❑ p 0'—'o Lice las Lia Number _!sZ_ p,to Uate Contractor. C 4 y 2 BUILD G PERMIT ¢ ¢wet OWNER-BUILDER DECLARATION INFORMATION MISC.— REFER TO ORD K 3 A.w I hereby affirm that 1 am exempt from the Contractors License VALUATION SIFT. w u o a Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 48:80 f 4 / Code:Any city or county which requires a permit to construct,alter, 2 IS¢ improve,demolish,or repair any structure,prior to its issuance,also E C.CO TR. hC0 0 o¢ requires the applicant for such permit to file a signed statement that j (J( OTAL V PERMIT TO n w m he is licensed pursuant to the provisions of the Contractor's License ri> Law(Chapter 9(commencing with Section 7000)of Division [Ire a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ec r$ the basis for the alleged exemption.Any violation Of Section 7031.5 1 i CT 0 R I-ES TYPE CONSTR. .w by any applicant for a permit subjects the applicant toa civil penalty gLTER-DRAIN -WATEfl (EA.) 5.00 of not more than five hundred dollars(S500). : 111,as Owner of the property,or my employees with wages as BACK F LOW 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 properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR 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 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 he did not build or im- prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ 1,as owner of the property,am exclusively contracting with Cl ❑ ❑ ❑ ❑ licensed contractors to constructthe 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.200ft/10.00 TRACT NO. PARCEL NO. ❑ l am exempt under Sec..,B.&P.C.for this WATER HEATER WIVENT 6.00 reason Owner - Date WATER SYSTEM _5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPEN4))T�jp/N Dslr' I�py/ WATER TREATING EQUIP. 5.00 I hereby affirm that I ve d£<ttiilx'ate`6f eolRerd RS TelGinsure, ora certificate Of WD ars'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof fSec. Lab. /•�.L;� s/1—e PDN Company 0 �--r-- Q Certified copy i5 hereby furnished. � FIRE'SPRINK ENERGY T-29 Z Z VL Certified opy file�yy�th�tl�Frty sp n division. 0 ApplicantJIXL`:—("LLGZLb2' � MISC- REFER TO ORD. v ❑ N❑ v❑ N❑ Fy PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. LU 1 CERTIFICATEEXEMPTION FROM WORKERS' LU _ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. d o (This section need not be completed if the Permit is fur one TOTAL Y❑ N❑ Y C] INC] :) Z hundred doluni($100)or less.) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY mit is issued,I shall not employ any person in any manner su as to U' W become subject to the Workers'Compensation Laws of California. Date ApplicantALTER OR ADD TO MECH. 5.001BUILDING } N NOTICE TO APPLICANT: If,after making this Certificate of Ex- Z emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE I hereby affirm that them 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.). I HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name�lA0'1ki HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC Q676 Lender's Address I certify that I have read this application and state that rhe above VENTILATION FAN (SINGLE) 4.00 information is correct.I agree to comply with all city and county BOILER-GOMP13 H.P.Dr 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMPIOver 1D0,000 BTU)SEE FEE SCH. MECHANICAL 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 CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 9>9l,ing of this permit MECH.CONT. LIC.NO. MECH. TOTAL TOTAL atureof Applicant/ ontractor Date ' OFFICE COPY