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10019 POST THIS CARD NEAR FRONT OF'BUILDING CITY OF CUPERTINO PERMTNDM"`" INSPECTION N 0 DIVISI is ;J JOB INSPECT ON RECORD PERMIT EXPIRATION JOB ADDRESS D ' , UNIT •LOT# PERMIT EXPIRES IF WORK OWNER j CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSP CTION RECORD - ' 180 DAYS OF PERMIT ISSU- • FOUNDATION V ANCE'OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PREGUNITE JPERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - {. UNDERGROUND /SLAB f II)x ' PLUMBING � - �� ELECTRICAL IssuANde DAT MECHANICAL a Da E ECT PLG. MECH, - DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING _ VALUATION $SFT, MECHANICAL I ELECTRICAL vER UT rO FRAMING r INSULATION - sTORiE TYPE COAST R, , r OCC GROUP{ _ RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF, 70 AREA TOTALACREAGE' DIAPHRAGM - BUILDING USE RE$ IND -CON PB 0".., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED F ❑ , ❑ ❑ ❑ ROUGH ASSESSORSPARCELNO, ' PLUMBING GAS TEST - - TRACT No. PARCEL NO, MECHANICAL - ELECTRICAL ' FINALS DATE INSP. ACC.DATE ACC FILE NO, /&. — J FRAMING SAN # INSULATION Z PLUMBING ZONING ENG,SITE NO. GAS MECHANICAL FIRESPRtNK ENERGY T 24 - COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED .HEATING Y ❑ ". ❑ ` ❑ N❑ LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.uc. LATH—EXTERIOR FIRE DEPT. - v❑' "❑ Y ❑ No SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR. TEMPORARY APPROVALS 'BUILDING - FIREWALLS ELECTRIC PLAN CHECK GAS - FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE / OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM uJ ARRANGE FOR INSPECTION BY.PHONING 252-4505, ELECTRIC �! _ SI-- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL r CALLING FOR FINAL INSPECTION. OFFICE COPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY I BUILDING PROJECT IDENTIFICATION PERMIT NUMBERAPPLICATION & PERMIT uuG.mrvr. A o s BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 10 019 NAMFR R v D o4 -, II / �FF/a OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHONE CONTRACTOR In UTLETS-SWITCHES-RECEP 10.00/1.00 LIC.NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR roes - APPLIANCES-RESIDENTIAL 4.00 vgorvE PANELS 10.00 DATE OF APPLICATION ARCHITECT %PLANCH'SESCJK P.C.NO. on PANELS (OVER 200 AMP) 20.00 ENGINEEF LIC.NO. SIGNS TRANS. 3.00 Aooe'E°s ENc' SPECIAL CIRCUIT 5.00 �` LIDATION ZIP EMP. METER OR POLE 2 L19CADDRESSTs MOTORS SEE FEE SCH. JSERVICE CHANGE I Y Pwoo LICENSED CONTRACTORS DFCLARA'I'ION TEMP.POLE 30.00, w1 hereby affirm thal I am licensed under provisions of Chapter9 AIN 1 )_< IcommvnCing with Section 7000)of Division 3 0l'the eusinrtss and . T. PLO. MECH.. F n i Professions Code,and my license is in full force and effect. z o m - License Class Lic.Number m - Dale Contractor IB F _ H aY F ¢ ¢ w a OWNER-BUILDER DECLARATION B LDIRM PERMIT °a MISC.- REFER TO ORD INFORMATION w S ¢a fherebythe affirm that I am exempt from the Contractor's License F LL o j Law for the following reason.(Sec.703 LS,Business Professions PERMIT ISSUANCE VALUATION S/FT. vT Cade:Any city or county which requires permit to<nnstnml,altee 10'00 ar 2 Q o improve,demolish,or repair any srocture,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. o LL requires the applicant for such permit to file a signed statement that TOTAL 1 A w m he is licensed pursuant to ing provisions of Iha )of Division s License PE �M IT TO I r z Q Business (Chang ProcommcnC de)with Season is exempt Dtherefoof the 1 i O Business and 1'rokssions Codd or that he is exempt nherclrom and QTY. PLUMBING PERMIT FEE ¢ r S the basis for the alleged exemption.Any violation of Section 7031.5 STO IE TYPE CONSTR. a � by any applicant for a permit subjects the applicant loucivilpenally ALTER-DRAIN IEA.) 5.00 of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees m with Wages as BACK FLOW PROTECT. DEVICE 4.00 Oce.GROUP RES.UNITS IbmF sole CoPvnsation,will do the work,and the xtmcture is not intended or of'f'ered for sale (Sec. 7044, Business and Professions ' DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The CommClor's License Law docs not apply to an owner of property Who builds of improves thereon,and who does such Work FIXTURES-PER TRAP 5.00 6Q FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenotintendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 r improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose ofsale.). IND INDUSTRIAL WASTE INTER. 30.00 ❑N PB Other� Cl d as..our of the property,and exclusively contracting with11 licensed contractors to construct the projen(Sec 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's o improv Law does not apply to tr owner of property who builds tr improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a eontruemrfs)license,pursuant to the Commc . License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. I am exesempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 ' atio Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPIiNSA1fON Di", Rn'['ION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Comm penlion Insurance,or a certified ZONING ENG,SITE N0. copy thereof(Sec 3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished' FIRE SPRINK ENERGY T-24 Z Z O Certified copy is filed with the city inspection division. F O Applicant MISC.- REFER TO ORD. Y IN v ❑ NC] CC m CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.II.C. LU > COMPENSATION INSURANCE: PLG.CONTR, LIC.NO. PLG CIL O 1This section need not be completed if the pe nm it is for one TOTAL Y❑ IN[:j I v Cj IN[j ::) Z If un doll dollar,IS 100)o r less.) U O I certify that in the performance of the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY l.L H mit is issued.I shall not employ any person in any mmnner s+a w U become Rhj,ut to the Wofkers'Compensation Laws of Califormu. } a Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING /3d w NOTICIi'1'0 APPLICANT: If,after making this Certificate of Ex- z emption.You should become subject to Bm Workers'Compensation APPLIANCE 5.00 PLAN CHECK U provisions of the Labor Code, you most forthwith comply with FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE / 33 I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) . 5.00 the performance of the work Do 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 HEATI NG UN IT(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 n correct. I agree to comply with all City and county BOILER-COMP l3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to comply with construction,, and hereby authorize representatives of this city to enter upon the 1301 LER-COMP Over 100,000 BTU)SEE FEE SCH. above-mentioned Property for inspection purposes. MECHANICAL (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 may in any way accrue against said City in consequence of the grout g of this pemlit. MECH.CONT. LIC.NO. MECH. y5- TOTAL TOTAL /7 r f- SIg alureo Applicant/Contractor x Date OFFICE COPY