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13084POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOBADDRESS 10211 D6.A41son Avenue UNIT# LOT# • OWNER Schmitz -Salve CONTRACTORFred Smith Termite PERMIT NUMBER 13084 . • 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 LIFER PREGUNITE - PERMIT VALIDATION �J r SSUANCE}DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED fjp UNDERGROUND/SLAB PLUMBING ^ It1� \�� ELECTRICAL MECHANICAL tW A CiDQ BLDG, �� ELECT, ❑ PLG. MECH. ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION .+- - U S/FT. ' PLUMBING - MECHANICAL - ELECTRICAL PERMIT TO FRAMING INSULATION � ' STORIES TYPE CONSTR. - UCC. GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO. FT, FLOOR AREA TOTAL ACREAGE DIAPHRAGM - ' BUILDING USE HES NO CON PB Ohne C:] ❑ '❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH - - ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL , NO. MECHANICAL ELECTRICAL FINAL$ DATE INSP. ACC.DATE ACC. FILE NO. FRAMING SAN # - ' INSULATION PLUMBING . ZONING ENG, SITE NO. GAS • MECHANICAL FIRE SPRINK Y ❑ NEI ENERGY 1 2 v E] NF] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH -INTERIOR ,,Ltveri - 9ZI 7 54k,5 ELECTRICAL - FLOOD ZONE Y ❑ N❑ 0.LU.C. v �] N❑ LATH -EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING, SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS 'ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR -INSPECTION BY PHONING 252-4505, o�ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 13084 Bu .ING ADcm Es Oat a u�. OWNE 'S NAME i� �+ l ET I -&L 1 U PHON. I -O 0 QTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION CONTRACTOR NAME �M s ZeM•*, LIC. N0.s%S3 UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS 4DORS AAR ,S '2 " PHONE ?U�IQO APPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 OR RCHRECT O ENGINEER uc, No PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH Ess ENG, ^_ SPECIAL CIRCUIT 5,00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 ZIP ,�E F�'tn dq°y_( �✓" - APPLICANTS AODRESs MOTORS SEE FEE SCH. p 1U 90.17 *W? SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Lmenssions Co nd my license is in full fur'c ect. Licen a I' s Lia Numb p tl4TrE / a IEL CL ❑ PLG. MECH. ❑ ❑ Date Contractor, �1I�/� OWNER -BUILDER DECLARATIONe I hereby affirm that 1 um exempt front the Contractor's License Law for the following reason.(Sec.703 1 uires a,Basin essand Putt, alter, Code Any city or county which requires permit to construct, atleq BUILDING PERMIT INFORMATION MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION a 30 s SIFT. ELEC. CONTE. LIC. NO. ELEC. TOTAL improve, demolish, or repair any structure, prior to its issuance, also structure, 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 PERMIT TO QTY. PLUMBING PERMIT FEE the basis for the alleged exemption. Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ALTER -DRAIN -WATER IEA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do Ore work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR, Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenotintendedoroffered for sale. If, however, the building FIXTURES - PER TRAP 5.00 30. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - I INC. 4 OUTLETS 6.00 or improvement is sold within one year of completion, the owneo- builder will have the burden of proving that h e did not build or im- prove for purpose of sale.). O as owner of the property, exclusively contracting with GAS EASYSTEM -OVER 4 IEA.1 2.00 - . BUILDING USE RES IND CON PB Other ❑ ❑ ❑ Q ❑ INDUSTRIAL WASTE INTER. 30.00 d he to Construct the project (See. 71144, Business licensed contractors Code: and Professions Code: The Contractor's s License Law docs not apply to owner of property who builds improves thereon, and who LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. tr tr contracts for such projects with a colamctorts) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.., B &P.C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC, FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'COMPF-NSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self-insmre' or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE N0. copy thereof (Sec. 3800, Lab.C). Policy No. Company FIRE SPRINK vC] N ENERGY T 24 v❑ N❑ ❑ Certified copy is hereby furnished. Cer}ified c py �s fiwthe ci y msctimt Aivision. pe pphcanttl' -hath 1..i�G. _ MISC.- REFER TO ORD. CE RTI F ICATE OIs EXEMPTION FROM WO RK Ii RS' PERMIT ISSUANCE 10.00FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE, 1'Flux section need not be completed if the permit is for one v N v N PLG. CONTE. LIC. NO. PLG. TOTAL hundred dollars ( S I00) or less.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner vs as to QTV. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. DBtc Applicant ALTER OR ADD TO MECH. 5.00 NOTIC17 TO APPLICANT: If, after making this Certificate of Ex- APPLIANCE 5.00 AIR HANDLING UNIT (TO 10MC.F.M.) 4.00 PLAN CHECK FEE 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. AIR HANDLING UNIT(OVER 10MC.EM.)6.00 SEISMIC FEE l ' CONSTRUCTION LENDING AGENCY 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 IS". 3097, Civ.CJ. - MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Plant Lender's Address HEATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authenticed representatives ec this city to enter upon the above-mentioned property for insp ofpurposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgment's, costs and expenses which may in any way accrue against said City in consequence of the MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX grantingof this permit. Z_& NO. MEC. MECH. CONT. LIG H TOTAL TOTAL J7 Signature of Applicant/Contractor Date OFFICE COPY