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12738POST THIS CARD NEAR FRONT CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION _ JOB ADDRESS '�L9 %% F%�Wd 0�`T' C/ Z3 CT �/[//�/ /qJ�� OWNER 7/ W 17,/T('S'j C, CONTRACTOR OF BUILIJINQ % RECORD # � LOT# 11p -z C(T'U J`7 RIJIT NUMBER 12738 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 INSPECTOR INSPECTION RECORD FOUNDATION - ' UFER PREGUNITE I PERMIT VALIDATION PAID r ,I p _ •- J I ISSUANCE DATE a� ojl EECT. o PO • m�' "BUILDING PERMIT INFORMATION p POUR n C CRETE UNTIL ABOVE WAS BEEN SIGNED UNDERGROUND/SLAB - PLUMBING. JU ELECTRICAL MECHANICAL ., Ylt 3N DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - + WOOD FLOOR VALUATION SIFT. PLUMBING �p _� _� MECHANICAL 00 ELECTRICAL FRAMING - - - - PERMIT TO '_i . (••^ L INSULATION �0./ - - r , STORIES TYPE CONSTR. OCC, GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM - b`L- IZCRES - BUILDING USE IND CON PB Omer ❑, 0 ❑ ❑ ❑ APPLY NO ROOFING UNliL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PARCEL NO. _ TRACT NO. PARCEL NO. f ''l• PLUMBING 3-/o-ooj_ GAS TEST- - MECHANICAL _ - ELECTRICAL FINALS DATE INSP. ACO DATE ACC. FILE NO � FRAMING SAN* .).[J INSULATION PLUMBING - p_y ZONING ENG. SITE NO. I GAS • MECHANICAL -/0•Pj' FIRE SPRINK vo NCD ENEROV T3A Y E) N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 3_/per LATH -INTERIOR j' 64ELECTRICAL FLOOD ZONE YE] N0 A.L.U.C. Yo N❑' LATH -EXTERIOR .Z -f(S V FIRE DEPT. - SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDINO+ - BUILDING _ SHEAREXTERIOR• TEMPORARY APPROVAL - FIREWALLS ELECTRIC PLAN CHECK FEE CI �' GAS p_ NO TAPE OR PLASTER UNTIL ABOVE HAS BEEWSIGNED IOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR: i MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE'.;' CALLING FOR FINAL INSPECTION. TOTAL OFFICECOPY - O ZZ F O L ao Z Uo LL U UJ } a F � dE APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY - bUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER /moi OEss ADDRESS �a�� PLAN/S ING-MECHANICA BUILDING - ELECTRICAL- PLUMBL 12738 OWnERS PLAN CHECK VALIDATION "AME,/ A/04� PHONE OTY. ELECTRIC PERMIT FEE /� 2S �J ckNTRACTo N E UTLETS-SWITCHES-RECEP 10.00/1.00 eek 1W _ sec. No, 3 LIGHTING FIXTURES 10.00/1.00 � / 13i� DATE OF APPLICATION CON A Tons ADORE MONE3S " PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 OgcwTecT A'� ENGINES .�G/ ( '(i� 'J �i sec, N. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .C. NO. SIGNS TRANS. 3.00 ARC H.OH ENG.'^ //,' " L /Z ARCREss 4/l/^ S. SpyVT.4 LY'✓LlTlyr/ 01,E [�rS C S LA ZIP Nvw SPECIAL CIRCUIT 5.00 r R IT VALIDATION `;i,l �IQBi U Y EMP. METER OR POLE INS. 20.00 APPLICANT, ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I HIO !U� I hereby afOrn that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code d my license is in full fort f t License a Lia Numb<r ISSUANCE OATS BLDG. ELECT_ ❑ PLG. MECH. ❑ ❑ Date/�_Contrador INFORMPERMIT INFORM PERMIT OWNER -BUILDER I kRAI L N 1 hereby affirm that I am exempt from the Contractor s License Law for the following reason. (Sec. uiresa. Buspermitto and Puct, aloes Code: Any mulish county whiny structure p rio it o its issuance, st a r, improve, demolish,or repair any structure, priortod sementalso he is tic the applicant for such permit ns Ole a signed statement that he is licensed pursuant en the provisions of the Cantr.¢loo License baw(Chapler9lcomcuu; Cogwith Section is7000) of Code) or that he is exempt therefrom and bais and exempt MISCREFER TO ORD .- VALUATION �C x-/ S/FT. PERMIT ISSUANCE 1 O.DO ELEC. CONTR. LIC.NQ ELEG TOTAL PERMIT TO - (��f./ QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the he alleged thebasisthe alleged exemption. Any fo by any applicant fora permitsubjects ihe0).): amwacivB penalty subjects pplicnt a civil applicant of not more than five hundred dollars (5500).): � ALTER-DRAIN-WATER(EA.)5.00 ❑ I, as owner of the properly, or my employees with wages as their sok compensation, will do the work, and the structure is not intended or offered for sak (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS-FLODR, ROOF, AREA, COND. 5.00 Code: I'ha Contractor's Licause Law does not apply to an owner of v operty who builds or improves themon, and who docs such work himself or through his own employees, provided that such improve. ments are nolintended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.00 So, FT. FLOOR AREA / TOTAL ACREAGE GAS-EA.SYSTEM-11NC.40UTLETS 6.00 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- prove for purpose of salt.). ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Othw ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 liceriscd contractors to construct the project (See. 7144, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improvn thereon. and who LAWN SPRINKLERS - 1 INC 5 V.B. ' 6.00 LAWN SPRINKLERS -OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a emutractons) licensed pursuant to Contractors License law. SEWER -SAN V -STORM EA. 20011110.00the TRACT NO. PARCEL NO. O lam exempt under Sec. ,B.&P.C. far this reason 7/p7IP- WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO, WATER TREATING EQUIP. 5.00 WORK ERS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers Cc ration InwraR or a artilled ZONING ENG. SITE NO. ropy thereof (Sec. 3800, Lab.C. Policy No. Company ❑ Ccrli c copy is herb fumished� ❑ CerC ted ops is de with the ty inspection division. Applicant FIRESPRINK Y❑ N❑ ENERGY T24 Y❑ N❑ MISC.- REFER TO ORD. CERT OI° F-MPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.O. COMPEN ATION INSURANCE (This section need not be completed if the permit is for one PLG. CONTR. LIC. NO. PLG. TOTAL Y E] N ❑ Y ❑ N❑ h tied red dollars (S 100) or less.) I certify that in the performance of the work for which this per- mil is issued, I shall not employ any person in any manner so as to QTYMECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workcri Compensation Laws of Califumia. Dale Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE emption, you should become subject to the Workers' Compensation provisions of the labor Cody, you must forthwith Comply with such provisions or this permit shall be deemed revoked. AIRHANDLING UNIT(OVER IO=C.F.M.) 6.00 SEISMIC FEE S CONSTRUCTION LENDING AGENCY 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. 3097, Civ.C). s MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Leavitt', Address H EATI NG UN IT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC I certify that l have read this application und'slnle that the above VENTILATION FAN (SINGLE) 4.00 imornalion is correct, 1 agree to comply with all city and Cmmty ordinances and state laws relating to building construction, and PLUMBING BOILER -COAT 13 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP 0., 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize rtpresentativn of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX 7c:� �d (We) agree to save, indemnify and keep harmless the City of Cu tiro agdam, liabilities, judgments, costs and expenses which -a m any way ac < against said City in conwqu ce f the g of this pe AllTOTAL PERMIT ISSUANCE 10.00 MECH, CONT, LIC, N0. MECH. TOTAL Si ore of A li f onlraaor ate ' (� // OFFICE COPY NO RNAL INSPECTION•■OCCUPANCY PLANNING D ':: M PROJECT: ADDRESS: IIJT 3 �� OBTAIN PLANNING DEPARTMENT APPROVAL P IOR TO FINAL INSPECTION OR OCCUPANCY. CONTACT RANDY FOR INFORMATION.