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13843POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS (// o S y / �' et(Ti¢Tc�$�� UNIT# LOT# p OWNER O BG�,�, C CONTRACTOR PERMIT NUMBER 13843 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION DATE I INSPECTOR INSPECTION RECORD FOUNDATION UFER PREGUNITE PERMIT VALIDATION ` ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL' MECHANICAL BLDG. ELECT. v,Lp. ME❑CH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING • VALUATION ��' $/FT. MECHANICAL ELECTRICAL FRAMING INSULATION STORIES TYPE CONSTR. OCC. GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO, FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RLS IND CON PB OInPI ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL - ACC.DATE 'ACC. FILE NO. FRAMING INSULATION .a5�� jDAETEINSP. M-S ZONING ENG. SITE NO. FIRE SPRINK Y ❑ N❑ ENERGY T.T4 Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED LATH -INTERIOR ELECTRICAL 2-2v-� FLOOD ZONE Y ❑ N❑ A. L.U, C. Y ❑ N❑ LATH -EXTERIOR FIRE DEPT. SHEETROCK E FEE SUMMARY SHEAR INTERIOR UILDING �La-�'�- BUI DING �. SHEAR EXTERIOR TEMPORARY APPROVAL FIREWALLS ELECTRI P N CHECK EE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE o2G- OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ELECTRIC 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 - PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL e c7� OFFICE COPY O Z_ Z F jr-y LU LO- 0 Z) Z 00 LL I- 0 w � a f- ? `l, APP'1_ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ' BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 13843 BUILDING ADDRESS !{ T OWNER'a Q _ NAME /p�``y� / S 7 � -P �ON14-R T DTV, ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICAT ON CONTRACTORS NAME LIGNO. UTLETS- SWITCHES -RECEP 10.00/1.00 Q ^ / 2 -'LIGHTING FIXTURES 10.00/1.00 CONTRAC ADDRE ADDREBB PHONE PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR J��.y %AN`"i C///1/ ENGINEER l/� uc. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK F�F-E ..C. NO. /? SIGNS TRANS. 3.00 2/(� ADDRESSRC" .00 y ADDRESS ENG, /O// 7t r�/r�N/i Si- Si�/f�'V 21P/ice/U l� SPECIAL CIRCUIT 5,00 PEflM T VAL GA Ory d' ISSUANCE DATE EMP. METER OR POLE INS. 20.00��_J APPLICANT '$ ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect Class oNumber Date Cnntsctor BLDG. ELECT. � PLG. MECH. 1:1License OWNER -BUILDER DECLARATION I hereby collo that 1 son exempt 131.5, Be Contractor's License Law for the followingreason(See.luresa,itocndtruct, mons sun pair any structur e permit riot o construct, also Code: e, dem y demolish, requires, demolish, or repair any sticture, prior m its issuance, that for such permit to filo a signed statement else requires the licensed pursuant of the Contractor'svis3 License he is (Chapter pursuant to the ng withprovisionsSection Lawasiness dProfosion,Code) For Section is 00) exempt Business and Professions Code) or that he is exempt therefrom and Any violation tto ofSection 703L5 the basis for the alleged exemption. subjects by any applicant fora permit subjects SSOO).licanttoacivil penally of not more than five hundred Dollars (5500)J: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for salt (Sec. 7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsare not intended oroffered for sale. If, however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im- prQye for pu{{�gg.¢f sole.). of the property, he exclusively contracting with 1711, as contractors anIsed contractors to construct Om project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who ha co tr improves thereon. and who contracts for such project with a ConUaclDAs) licensed pursuant to the Contractor's License Law. reason am exempunder Sec. ,B.&P.C. for this" BUILDING PERMIT INFORMATION MISC-- REFER TO ORD PERMIT ISSUANCE 10ter,.00 Q VALUATION g 61 d $/FT. ELEC.CONTR. LIC. N0. 9 ^ TELEC.OTAL TOTAL ..7d c� �1 �s PERMIT TO /TUvi%fig/ 4. /V%Q DTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER-DRAIN-WATER(EA.)5.88 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 SG. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE ElRES IND CON Pa ower � Q � ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS -OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date ?J. .�'�+Ty WORKERS'COMPENSATION DECLARATION f� 1 hereby affirm that I have a ai,tlticate of COnrent to sclfwimorv, or a certificate of Workers' Connpensation Insurance, or a certified copy thereof (See, 3800, Lab.CJ. Policy No. Company WATER SYSTEM 5.00 ACC.DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 I ZONING ENG. SITE NO. ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city inspection division. Applicant MISC. - REFER TO ORD. FIRE SPRINK y ❑ N ENERGY T24 Y [-] IN CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (S 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 no become subject to the Workers' Compensation Laws of California. Dec Applicdnt NOTICE TO APPLICANT: 11, after making this Certificate of lis- emption, you should become subject to the Workers Compensation Provisions of the labor Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). Lender's Name PERMIT ISSUANCE 10.00 FLOOD ZONE V E]N A. L.U.C. V 0 N0 PLG.CONTR. UC. NO. PLG 'lam. TOTAL - v v QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING /! ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=12-F.M.) , 4.00 PLAN CHECK FEE AIR HANDLING UNIT (OVER 10MC.F.M.) 6.00 SEISMIC FEE �(O EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Address I information that I have read this application With state that d caboveounty county informations estate.I agree tocomply with construction, ordinances and state lows relining to building const r tion, and hereby authorize representatives ec this City es enter upon flit about-tnentianed property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the grant in Jhi per. rt �j/ 2�/� HEATING UN IT (OVER 100,000 B.T.U.)9.50 ELECTRIC did 3� VENTILATION FAN (SINGLE) 4,00 PLUMBING U � BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00 BOI LER-COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL TOTAL �2 Slgnam of Apphcam/Contractor Date UFFICE COPY