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12870 POST THIS CARD NEAR FRONT OF BUILDING. PERMI T CITY OF CUPERTINO INSPECTION DIVISION , . JOB INSPECTION RECORD JOB ADDR ESS 712'1 ,AN M- E14- UNIT# LOT# PERMIT EXPIRES1I F.f000RK OWNER © CONTRACTOR > IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMFT ISSu- FOUNDATION - ANCE_OR 180 DAYS FROM LAST CALLED INSPECTION. UFER • PERMIT VALIDATION ' PREGUNITE L• POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - 89 j•I�wl 1D, 1 UNDERGROUND /SLAB- •� Y�•1t En. PLUMBING ELECTRICAL ISSUANCE DATE - BLDG. ELECT. .,PLG. MECN. MECHANICAL 0. El 41: . 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/RT. PLUMBING MECHANICAL PERMIT TO ELECTRICAL MEC FRAMING / ' 11 � STORIES TYPE CONSTR. INSULATION - - - - OCG GROUP RES,UNITS IF PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SQ FT FLOOR NREA TOTAL ACREAGE ROOF DIAPHRAGM aw LolNc USE ItRES IND CON PB OIBer El 11 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED SE EL G `//✓/i OK � ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT NO. PARCEL NO. GAS TEST MECHANICAL ' ACC.DATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO. INSULATION_ PLUMBING — GAS . SPIRE SPRINK y ENERGY T 24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� IN[:1 LATH—INTERIOR ELECTRICAL -FLOOD ZONE A.L.U.C. LATH—EXTERIOR - - FIRE DEPT. Y C] IN Y �] "� SHEETROCK - GRADE FEESUMMARY SHEAR INTERIOR • BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS - ELECTRIC PLAN CHECK GAS FEET 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, ELECTRIC ONE WORKING DAY BEFORE REQUIRED.INSPECTION. 0'1,7 PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING Z ' SEE PERMIT FOR EXPIRATION DATE MECHANICAL = CONST.TAX IMPORTANT! I. PLEASE READ REVERSE SIDE BEFORE C CALLING FOR FINAL INSPECTION. TOTALr1 OFFICE COPY AP_P61CANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY f BUILDING PROJECT IDENTIFICATION PERMIT NUMBER APPLICATION & PERMIT ADDRESS 128 0 ADoness ' BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 7 OWNERS f PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE • L C PROM NAME CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 NAME ll In A'O ' LIC.ND.v Y6341 LIGHTING FIXTURES 10.00/1.00 ADDRESS roll's PPLIANCES-RESIDENTIAL 4.00 � PHONE - PANELS 10.00 _ DATE OF APPLICATION AR Rrtscr OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER ' LIC.NO. SIGNS TRANS. 3.00 ARCH.OR ENG, 5.00 PERMIT VALIDATION ADDRESS ISPECIAL CIRCUIT ZIP EMP.METER OR POLE INS. 20.00 1 • �,1�A1�� ADDRESS s MOTORS SEE FEE'SCH. U 1`f 'Y ADDRESS SERVICE CHANGE 20.00 woo LICENSED CONTRACTORS DECLARATION 1 -u I, 1 hereby affirm that 1 am licensed under provisions of Chapter 9 - ISSUANCE DATE hQ w (Commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H O i Professions Code,and m license is in full for a and effect. Z O vn License C ss Lie.Number P: wi A. ❑ ❑ LAID g o Date Contractor r Vl VY a xs BUILDING PERMIT BeBe Be a OWNER-BUILDER DECLARATION INFORMATION o " MISC- REFER TO ORD K Y.n w I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. FU04 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 yN Code:Any city orcounty which requires a permit to construct,alter, - acR, improve, or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. a - LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w$ he is licensed pursuant to the provisions of the Contractor's License Fii Law(Chapter 9(commencing with Section 7000)orDivision 3 of the a Business end Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN Be VENT-WATER (EAS 5.00 of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 OCC.GHOUP 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 SG.FT.FLUOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.40UTLETS'6.00 or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- proveforpurpowofsale.). INDUSTRIALWASTE INTER. 30.00 RE5 Irv0 CONPBomar ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to Construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200@/10.00 TRACT N0. PARCEL NO. the Contractor's License Law. ❑ I am exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy there f( ec.3800,Lab.W PolicyNo. Com an P O ❑ Cerifmd copy is herebyed SN� ✓es-4 FIRE SPRINK ENERGY T-24 Z Z QQ Certifiedd 4opy /-s Blethe city inspection division. MISC.- REFER TO ORD. y❑ N❑ y ❑ N❑ 0 Aflplicant RAI6 l' dCe L4PERMIT ISSUANCE 10.00 FLooD zoNE A.L.u.c. LU ; CERTIFICATE E EXN FROM WORKERS' ll.l COMPENSASURANCE PLG.CONTR. LIC.NO. PLG. y❑ 'N❑ Y ❑ N❑ 1 0 (This section need not beted If the permit is for one TOTAL Z hundred dollars IS 100)or les U 0 1 certify that in the perforf the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not empperson in any manner so as to O GO become subject to Ilse Workeensation Laws of California. Dale ApplicanALTER OR ADD TO MECH. 5.00 BUILDING } N NOTICE TO APPLICANT: If,after making this Certificate of Z Ex- emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with F U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4:98 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 e� TCROFILM 3097,Civ.C.). I Lender's Name HEATINGUNIT(OV ER100,000B.T.U.)9.50 ELECTRIC Leader's Address 1 certify that I have read this application and slate(bat the above VENTILATION FAN,(SINGLE) 4.00 information is correct.I agree to comply with all City and countyPLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.) 6.00 hereby authorize representatives of Ibis city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL a above-mentioned property for inspection purposes. (We) agree (o save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Caper' Inst Babilities,judgments, costs and expenses which PERMIT ISSUANCE DCONST.TAX m any w accrue ago' d City in consequence of the ting of this ermlt. MECH.CONT, LIC.NO. MECH. Q T AL a75 TOTAL sg of Applic nt /Cor tar Date+ 217 OFFICE COPY 65141- -