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11521 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY. OF CUPERTINO11521 INSPECTION DIVISION 1152 1` JOB INSPECTION RECORD t 11 1 oVe PERMIT EXPIRATION 935 fi JOB ADDRESS UNIT# LOT# • PERMIT EXPIRES IF WORK - OWNER '&tjjeSbatK CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION LAST CALLED INSPECTION. UFER PREGUNITE - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _,,,. UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE - - BLDG. ELECC PLG. AECH. MECHANICAL ❑ ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL ��j ELECTRICAL '•SP - PnER^MITTO T FRAMING STORIES TYPE CONSTR. INSULATION OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED " $O.FT,F:OOH FHEA TOTAL ACREAGE ROOF DIAPHRAGM BUILDING USE - • RES INO CON PB Olne, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ 0 ❑ ❑ ASSESSORS PARCELNO, ROUGH PLUMBING - GAS TEST TRACT NO. PARCEL NO. MECHANICAL ' ACC,DATE ACG FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN M _ ZONING ENG.SITE NO. INSULATION" PLUMBING GAS MECHANICAL FIRE SPRINK ENERGY L]C COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING, v "El v NE] FLOOD 20NE A.LU.C. - LATH-INTERIOR ELECTRICAL LATH-EXTERIOR - FIRE DEPT. - v,� N❑ v �] 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 IS NOT PERMITTED UNTIL BUILDING-FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC i ' 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. 1 OFFICECOPY ' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY •' , BUILDING PROJECT IDENTIFICATION PERMITNUMBER 1 BUILDING APPLICATION & PERMIT /� t ADDRESS '1 1 5 9�5� h' �4 wl C 2a ,•/L ,�fZ BUILDING-ELECTRICAL-PLUMBING -MECHANICAL 21 I I J L OWNER'a PIAN CH ECK VALIDATION -"� "AME I QTY. ELECTRIC PERMIT FEE -'s, '• CONTRACTORS ✓FyJ IJ/`r� I PNONE 2 S7�Q� UTLETS-SWITCHES-RECEP 10.00/1.00 0 NAAMEIVE LIC.No. LIGHTING FIXTURES 10.00/1.00 CCONTRACTOR ADDRESS PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS - 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .c.N OR ENGINEER UC.No. SIGNS TRANS. 3.00 AARC DDRESS ENG SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 ADDRESNr's AADDRESS - MOTORS SEE FEE SCH. /I ) ll,pts/P•-/�� SERVICE CHANGE 20.00 w o o LICENSED CONTRACTORS DECLARATION r a U U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE m a vh (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH. r y Professions Code,and my Ii"HAN is in full force and effect. ❑ ❑ ❑ ❑ z O - License Class Li,Number 9 so F O Date Contractor x s BUILDING PERMIT ce a, w OWNER-BUILDER DECLARATION INFORMATION wo a E. I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD 3 VALUATION S/FT. F LL 0 4 Law for the following Him,(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 0 - Code:Any city or courtly mo ,aims which uims a permit to construct,alter, /�� lE improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.. D LL requires the applicant for such permit to file a signed statement that TOTAL C90 PERMIT TO R he is licensed pursuant to the provisions of the Contractor's License Z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the - < Business and Professions Code)or that he is exempt thacfmm it QTY. PLUMBING PERMIT FEE M = the basis for the alleged exemption.Any violation of S,,ti.n 7031.5 STORIES TYPE CONSTR. a ; by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER (EA.) 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 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not 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 AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- `, 'ments are not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM-111NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE budder will have the burden of proving that he did not build or im- prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30,00 RES IND CON PB Other ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors 10 construct the project(Sec. 7144•Business LAWN SPRINKLERS-1 INC 5 V.B. 6.DO ASSESSORS PARCEL NO. and Professions Cod,:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to the Contmemr's License Law. - SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ plunder .B.&P.C.for this WATER HEATER W/VENT 6.00 Rn ma, ---IDate - WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS•COMPI:NSA1'ION D' LARATION WATER TREATING EQUIP, 5.00 1 hereby afti.n that I have a ccHifkate of consent to self-insure. or a certificate of Workers'Compensalion Insurance,or a certified ZONING ENG.SITE NO. copy thereoff5cc.3900,Lah.C.). Policy No. Company O - ❑ Certilled copy is hereby furnished FIRE SPRINK ENERGY T 24 Z Z ❑ Certified copy i Bled with the city inspection division. MISC.- . 0 Applicant REFER TO ORDY❑ N❑ Y ❑ N❑ rn CERTIFICA'fEOFEXIiMPT10NI:ROMWORKF-RS' PERMIT ISSUANCE 10.00 FLOOD ZONE AL.U.C. LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y E] N❑ Y[:] N❑ CL Z (This section need not be completed if the permit is for one TOTAL hundred dollars(S 100)or less) - U O I certify that in the perfommnce of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL'U THE is issued,I shall not employ any person in any mann,,so as to O W beEmi,subject to the Workers Compensation Laws of California. BUILDING ��/W Iv time Applicant ALTER OR ADD TO MECH. 5.D0 } W NOTICE TO APPLICANT: If,after making this Certific tC of Ex- F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed invoked. AIR HANDLING UNIT(TO 10)000QF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000QF.M.) 6.00 SEISMIC FEE I 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,Clv.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC O (N 1 certify that 1 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 C ordinances and state laws relating m building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize rcprL Hwti,,A of this city to enter upon the BOILER-COMP Over 10(A00 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inslwctiun purposes. (We) agree to save, indemnify and keep hmmless the City of MISC.- REFER TO ORD. W' "Nrleate ' liabilities,judgments, costs and expenses which PERMIT ISSUANCE 1Q,QQ CONST.TAX a st said City i ons,quence of[hc MECH.CONT. LIC.NO. MECH.7.22 -8( TOTAL TOTALicz o actor Dale OFFICE COPY