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09697POST THIS CARD NEAR FRONT OF BUILDING ' CITY -OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS �o5y5 deo ra �� UNIT# LOT# •` y-" OWNER /I NIs CONTRACTOR r e, PFHMIT NUMBER 096Q7 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED' WITHIN 180 DAYS OF PERMIT ISSU. ANCE OR 180 DAYS FROM LASTC,4LLED INSPECTION.' T INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION f iN• /( .yi*— —/ LIFER PREGUNITE - PERMIT VALIDATION _ q�/v��•:.1 _ I(SsuIANC€DATE .. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB' PLUMBING ELECTRICAL, .MECHANICAL BLDG. EEcT.PLG. MECH. a: :o ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT 'INFORMATION . WOOD FLOOR PLUMBING � ., �, VALUATION $/FT.. MECHANICAL ELECTRICAL - PERMIT TO Q !iV FRAMING INSULATION STORIES TYPIC CONSTR. _ OCC GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO IT. FLOOR PR[P TOTAL ACREAG[ DIAPHRAGM' BU.. NG USE ` RES IND .. cON , PB Olne, ❑ ❑ ' ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH 'ASSESS ORSPAIICEL NO. _ PLUMBING -- - - GAS TEST TRACT NO.' PARCEL NO. MECHANICAL ELECTRICAL . FINALS DATE INSP. ^cc, onrE •- ACC, FILE No. FRAMINGSAN # INSULATION PLUMBING ZONING - ENG. SITE NO. GAS MECHANICAL � � � '. FIRE SPRINK Y ❑ .N❑. ENERGY T 24 - v'❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL FLOOD ZONE ° ❑ N❑ A.L.uc. ° ❑ ,N❑ LATH—EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY' SHEAR INTERIOR BUILDING BUILDING - SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC! LECTRIC PLAN CHECK FEE - GAS , NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY• -. SEISMIC FEE, OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED 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 CONST. TAX CONST. IMPORTANTI PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL . ' urrHa GUPY, , APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT lDENT[ FICATION & PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBERAPPLICATION 09697 g°"°'N° ADDRESS Q D� OWNER'S `lOO NAME , r pD ^♦� / I -5.I ,3 jcJ CITY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION CONTRACTORS L' F UC.NO. 42C) UTLETS- SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR ADDRESS �-A ajn�J.�.d FHONE "'3"'mS APPLIANCES -RESIDENTIAL 4.00 PANELS I 10.00 AORRCRITEC ENGINEER . TIC. NO, PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE P.L. NO. SIGNS TRANS. 1 3.00 ADDRESS Ana SPECIAL CIRCUIT 1 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 ZIP /�p�y`,'.�✓ ASS ADDRESS MOTORS I SEE FEE SCH. SERVICE CHANGE, 20.00 / / SEgq LICENSED CONTRACTORS DECLARATION TEMP. POLE 30.00 I hereby affinn that I am licensed under provisions of Chapter 9 Cris gN•C/E(NdQMCJd• (commencing with Section 7000) of Division 3 of flit Business and Lice, SSIOIIi (.'OIIL-, an Illy IICCnSC IS III full force y' 'Ct. License us_ Lin. Number y BLDG. ELECT. PLG. MECH, -( (+ Otgu e ❑ hi[1•`` �L.-[Jf rirr,�Yiiirrr;.Jl^J!{EE(rrr _ Uutc Contractor �dP1 OWNER -BUILDER DECLARATION 1 hereby affirm ing 1 am exempt frons the Contractors License Lew fortire "citylor following reason uiresa permit locord Professions Code: Any City or county which stricture permit m construct, ager, improve, demolish, or repair any stricture, Prior nh its issuance, also requires the applicant for such permit to file a signed statement that he is licensedpeepursuant en the provisions of the Contractor's License Law (Chaptcr9(communcingwith Section 7000)oCUivisiml3 ofthe Business and Professions Code) or that he is exempt therefrom and BUILDING PERMIT INFORMATION MISC.- - REFER TO ORD PERMIT ISSUANCE t 10.00 VALUATION S/Fi. ELEC. CONTE, UC. NO. ELEG ' TOTAL DTV. PLUMBING PERMIT FEE PERMIT O Irzz 4/�2 the basis for the alleged exemption. Any violation of Sect ion 703 1. 5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 15500).): STORIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.) 5.00 ❑ I, as owner of the property, or my crnployec.% with wugesas their sole compensation, will do the work. and tie structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RAs. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code 'The Contractor's License Law does not apply to an owner of FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM -11NC.4 OUTLETS 6.00 property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- memsarenotintended or offered for sale. If, however, the building 50. FL FLOOR AREA TOTAL ACREAGE Or improvement is sold within one year of completion, the owner builder will have the burden of proving that the did not build or int- GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale). O I, as owner of the property. Too exclusively contracting will RES IND CON Pe Other -INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec, 7044, BusinessLAWN and Professions Code T'he Contractor's License Law does not apply to an owner of properly who builds or improves thereon. and who SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPR IN KLERS - OVER 5 (EA.) 1.00 contracts for such projects with a contmctogs) licensed pursuant to the Contractor's License Law. ❑ I and exempt order Sec.-, HAP.C. fo, Hill reason SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner Dan, WATER SYSTEM - 5.00 ACC.OATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 W'ORKERS'COMPEN'SA1 ION DECLARATION 1 hereby alfirm that I have a certificate of consent to sell-insore. ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance. Or a certified copy Ihcrcof(Sec. 3500, Lab.C.l) Policy No. Company_ ❑ Cert il ieJ copy is hereby furnished it Ccrtific�yc.spy in fled sllLInspection division. Applicant-/�Q-w-+-� + L�---- s FIRE SPRINK Y [] N� ENERGY T-24 Y ❑ N� MISC. - REFER TO ORD. C F R' 1' I IT ICA' 1'E OP I'S EM PTI ON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one PERMIT ISSUANCE 10.00 FLOOD ZONE Y N A.L.U.C. V N PLG. CONTE. LIC. NO. TPEG OTAL hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per- mit is issued, 1 shall not employ any person in any manner so as to DTV. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING 4 becomsubject to the Workers' Compensation Laws of California. Dote Applicant ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate Of Ex- APPLIANCE, 5.00 AIR HANDLING UNIT (TO 1Q000CF.M.) 4.00 PLAN CHECK FEE emptiuo, you should become subject to the W'orkeri Compensation provisions of the. Labor Code, you must forthwith comply with such provisions or this permit shall be deensed revoked. AIR HANDLING UNIT (OVER IOJ=C.F.M.) 6.00 SEISMIC FEE aa� CONSTRUCTION LENDING AGENCY I hereby affirm that there it a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the perlunnance of the work lot which this permit is issued (See. 3097, CiYC.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lenders brinAddy Lender's Address HEATING UN IT ER 100,000 B.T.U.)9.50 ELECTRIC I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 inlonnation is correct. I 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 this city to enter upon the hereby authorize representatives ins inspection above-mentioned property for inspection paity to. BOILER -COMP IOW,r 11X1,000 BTU) SEE FEE. SCH. ' MECHANICAL (We) agree to save, indemnify and kcup harmless the City of MISC, - REFER TO ORD. Cupertino against liabilities, judgments, costs and expenses which may in ny way a roc against said City in consequence of the granli f is per it.MECH. a _ 9 /d �s PERMIT ISSUANCE 10.00 CONST. TAX CONT. LIC. NO. MECH. TOTAL TOTAL 'ig a re of ApplicantlC ntractor Date OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICALI PERMIT NUMBER 09697 BUILDING ADDREss )PIP D p OWNER'S `luO _QC _SI 3Z �I OTY, ELECTRIC PERMIT FEE PLAN CHECK VALIDATION NOMTRAciDRs OUTLETS-SWITCHES-RECEP 10.00/1.00 LIC.NO. 4q20 DATE OF APPLICATION LIGHTING FIXTURES 10.00/1.00 ORs CONTRACTORS ADDRESS i-TAJ- .1 -PHONE S APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 ENGINEER ORRCNREC LIc. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE C. NO. SIGNS TRANS. 3.00 ADDRRESS ENc' SPECIAL CIRCUIT 5.00 Vf PERMIT VALIDATION rrEMP. METER OR POLE INS. 20.00 ZIP �y ��`•x, --. APPLICANTS ADDRESSMOTORS ADDRESS SEE FEE SCH. SERVICE CHANGE 20.00 /c y/(0/` LICENSEDCON'1RACTORS DECLARATION TEMP. POLE 30.00 I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, lin ll my he, se Is in frill force and effect, License Class Lia, Number ISSUANCE DATE BLDG. ELECT. PLG. MECH. LD ❑ ❑ O DateContractor BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION I hereby all',,.mm 1 am exempt from Ole Contractor's License Law for the following, reason. (Sec. 7031.5. Businessand Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issum loc, also 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 oflhe Business and Professions Code) or that he is exempt therefrom and MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION I� d� 1 $/FT. ELEC. CONTE. LIC. N0. ELEC. TOTAL PERMIT TO �'/f�� �� �� �� //�a /4 2 OTY. PLUMBING PERMIT FEE the basis for the alleged exemption. Any violation of Section 703 LS STORIES TYPE CONSTR. by any applicant for x permit subjects the applicant OLD civil penalty of not more than five hundred dollurs($500)J, -1 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the st mtnve is not , ALTER -DRAIN IEA.) 5.00 BACK FLOW PROTECT. DEVICE 4,00 OCC. GROUP RES. UNITS -DRAINS -FLOOR, ROOF, AREA,COND. 5.00 intended or offered for sale (Sec. 7044. Business and Professions Cade: The Common,% License Law does not apply to an owner of FIXTURES - PER TRAP 5.00 sa PT. FLOOR AREA TOTAL ACREAGE propertywhohuildsorimprovesthereon, and who does such work himself or through his own employees, provided that such improve- mentsme, not fntcndcd or offered for sale , however, the budding GAS: EA. SYSTEM -11NC. 4 OUTLETS 6.00 or improvement is solJ within one year of[oalpletion. the owner- builder will have the burden ofproving thufhe did not build or im- ,flow, for purpose of sate). KOal;ps owner of the property, ant exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to un owner of properly who builds or improves thareun, unit who GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts 1'or such projects with a contractons) licensed pursuant to the Corumcmi s License Law. SEWER -SAN EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ lore exempt under S,,._, B &P.C. for this mason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATERTREATING EQUIP. 5.00 WORNERS'COMPRNSATION DECLARATION I hereby affirm Dial I have a cenil icate of cunsem to zel Ginnue. Or a Certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof(See 38001 ih.C.). Policy No. Company F'7NOALI 1A o� p ❑ Certified copy is hereby f;',1 s5 d Q Certifiedfopy is tiled with the city inspection division. Applieaat�-�_ t r �r� - FIRE SPR INK y ❑ N ❑ ENERGY T-20 Y ❑ N❑ MISC. - REFER TO ORD, CGR1'I17ICA-1'1:OF EXEMPT ]ON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE ('Phis section need not be completed if the permit is fur one Y E]N❑ Y E]N❑ PLG. CONTR. LIC. NO. PLG. TOTAL hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per- initis issued, 1 shall not employ any person in any Iglu mer so as to OTY. MECHANICAL PERMIT FEET FEE SUMMARY BUILDING 3 p S -U become subject to the R'orkers' Compensation Laws of California. Date Applicant NO'T'ICE TO APPLICANT': II', after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10000C.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 10=C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the perfourance of the work for which this permit is issued (Sec. 3097. Civ.C.). MICROFILM H EATING UN IT (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 VENTILATION FAN (SINGLE) 4.00 I certify that l have read this application and stale that Orn above information is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and PLUMBING BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOI LER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to cnler upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgnants, costs and expenses which may in ny way a me against said City in consequence of the gmanti f is Percy. MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECN. 1d .e5_ TOTAL TOTAL ig a ore o(Applicant/C llractor Dale INSPECTOR COPY :+`