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13664 POST THIS CARD NEAR FRONT OF BUILDING � CITY OF CUPERTINO 136PERMIT NUMBER ER INSPECTION DIVISION 64 JOB INSPECTION RECORD 1184 ELMSFORD DRIVE PERMIT EXPIRATION JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK OWNER WAKINS CONTRACTOR ACE IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION f LIFER LASTCALLED INSPECTION. PERMIT VALIDATION PREGUNITE . POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ✓ PLUMBING ELECTRICAL ISSUANCE'UATE MECHANICAL BLDG, ELECT. PLG, MECH, DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION t - VALUATION $SFT. PLUMBING MECHANICAL ELECTRICAL PERMIT TO FRAMING INSULATION STORIES TYPE CONSTR. OCG GROUP RES.UNITS M� PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT,FLOOR AREA TOTAL.ACHEAGE ROOF DIAPHRAGM BUILDING USE HES IND CON PB Olnei APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL NO, MECHANICAL ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING ISAN # INSULATION PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ NF] LATH-INTERIOR ELECTRICAL FLOODZONE A.L.U.C. LATH-EXTERIOR FIRE DEPT. -Y 1:1 -El Y ❑ N 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 ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM I ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ! PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL 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 PROJECT I DENTIFICATI ON PERMIT NUMBER WILDING APPLICATION & PERMIT ADDRESS BU L G - ELECTRICAL-PLUMBING-MECHANICAL 13664 OWNEq'S� v PLAN CHECK VALIDATION NAME /j) TV ELECTRIC PERMIT FEE 1 PHON ✓ NAMECONTR UTLETS-SWITCHES-RECEP 10.00/1.00 NOME y��\\ GI .IN p'�� LIGHTING FIXTURES 10.00/1.00 fo'ADNrggcro 's /+ ;. pp NCES-RESIDENTIAL 4.00 CON ES l ( P OrvE NE IO.00 DATE OF APPLICATION ARCHH CT f ANE S (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No. SIGNS TRANS. 3.00 ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION zIvrrEMP.METER OR POLE INS. 20.00 AMOTORS SEE FEE SCH. ADDRESS oREss SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION Q u I hereby affirm that 1 am licensed under,provisions of Chapter 9 ISSUANCE DATE v,Q w (commencing w' Se n 000)of Divisio of the on ess and BLDG. ELECT. PLG. MECH. r w z Professions Co e, li ens•rs in full fore• d e ❑ ❑ ` ❑ Z,o,_., - Licen - 'c.Number fG�VI�- oz o Date ntractor4CCE - BUILDING PERMIT ¢ ¢ O >R-B .D:A DECLAo a " MISC.- REFER TO ORDINFORMATION w S LL T- I hereb affirm that 1 am exempt from so ¢ o¢ Law for the following reason.(Sec.7031.5,Businessand Professions pERMIT ISSUANCE 10.00 VALUATION $/FT. Code:Any city or county which requires a permit toconstruct,alter, ¢ Qimprove,demolish,or repair any structure,prior W its issuance,also ELEC.CO . LIC.NO.NTEELEC. o M requires the applicant for such permit to file a signed statement that TOTAL ¢ u- ta m m lie is licensed pursuant to the provisions of the Contractor's License PERMIT TO Fz > Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe - ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE s¢ o ¢ �$ the nyapor the a for exempubjetstheaplica of Section 703L5 STORIES TYPE BTR. d ; _ by any applicant fim a permit subjects The applicant toacivil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00 of not more than five hundred dollars(5500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS 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 thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AgEA TOTAL ACREAGE himself or through his own employees,provided that such improve. mems 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 IEA.1 2.00 builder will have the burden of proving that he did not build or int. BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 3000 RES IND CON Pe Omer . ❑ I,as owner of the property,am exclusively contracting with El Q 0 0 El licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCEL 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 contracto0s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft 1 the Contractor's License Law. / 0.00 TRACT NO. PARCEL NO. ❑ ]aro exempt under See,-,B.&P.C,for this WATER HEATER W/VENT 6.00 reason OwnerDale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION 'WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self-insure, or fica c of orkerp nsatio _su a ce, rp a certified ZONING ENG.SITE NO. co T e '111YtIC t7`\'(C_J-^C'`` O Po N pal 'I¢ L itch f FIRESPRINK ENERGY T 24 Z Z ❑ Certifie c 's e w he city inspection division. MISC.- REFER TO ORD. O Applicant [] N[ Y ❑ NEI _a PERMIT ISSUANCE 10.00 � CISRTIFlCA f: EXIiM ON PROM WORKERS' LORD ZONE A.L.U.C. W 7 COMP NSATION INSURANCE. PLG.CONTE. LIC.NO. PLG. . I I CL O (This section nee0 n I be completed if the permit is for one TOTA N� V NE] Z) Z hu nfivd dollars(S 106� less.) U O 1 certify that in th erformance of the work for which this per. QTY MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued, 1 shall not employ any person in any manner so as to 0w become subject to the Workers'Compensation Laws of California. y nate Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE TO APPLICANT: If,after making this Certificate of Ex- F. 2 eniption,you should become subject In the Workers'Compensation APPLIANCE 5.00 PLAN CHECK U provisions of sor this the Labor Code, you must forthwith comply with FEE p permit shall be devoted revoked. AIR HANDLING UNIT(TO 1Op00QF.M) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10.000GEM.) 6.00 SEISMIC FEE 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.). ) HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender's Address ELECTRIC I certify that I have read this application and state that The above VENTILATION FAN (SINGLE) 4.00 information is correct.I agree to comply with all city and County PLUMBING e ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. g01 LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indenmify and keep harmless the City of MISC.- REFER TO ORD. CupertinoJagaimabilities,judgments, costs and expenses which pERMIT ISSUANCE 10.00CONST.TAX 'y in accrue against said City in conseyuence of[heting on' luMECH.CONT. LIC.NO. TOTALot TOTALSig t re ant/Contractor OFFICE COPY