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11700POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO ER 00 FPERMIT INSPECTION DIVISION JOB INSPECTION RECORD )}}11 L� `/ 19 Hu rthrsTon PI ATION JOB ADDR ESS UNIT# LOT# PERMIT EXPIRES IF WORK OWNER ( CONTRACTOR IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM INSPECTION DATE I INSPECTOR INSPECTION RECORD FOUNDATION LIFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALID IATION- POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL aDG. ELECT. PLO. MECH. ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION + PLUMBING � - VALUATION Ste. mb LN 7 $JET. MECHANICAL ELECTRICAL�(l1//��/K PERMIT TO FRAMING _Z /A H7S J INSULATION STORIE TYPE CONSTR, OCC. GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO. FT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE REP IND CON PB Olnrl APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ,DS ❑ ❑ ❑ ❑ , ROUGH - - / ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO, PARCEL NO. MECHANICAL ELECTRICAL FINALS DATE INSP. ncc. DATE ACC. FILE NO. FRAMING Q�f- SAN # INSULATIONPLUMBING ZONING ENG, SITE NO. GAS MECHANICAL FIRE SPRINK Y ❑ IN F] .ENERGY T-24 Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH-INTERIOR ELECTRICAL FLOOD ZONE Y❑ - El A. L.Oc. Y❑ N❑ LATH-EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APP OVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE' OCCUPANCY OF. BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. 1 MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0� PLEASE GIVE JOB ADDRESS WHEN PLUMBING Z PHONING. MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! coNsr. rnx PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY Ij\PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY • BUI LDI NG PROJECT I DENTI FICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 11700(D BUILDING ADDRESS 0 r Z OWNER'S NAME GER + QZr/u PRUNE J 2S9 b DTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION CONTRACTORSUTLETS-SWITCHES-RECEP t.p & 7,C11014 LI C. No. 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S �Q-g2y y� AOUREss / PHONE PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR ENGINEER uc, No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ADDRESS ENG. ZIP SPECIAL CIRCUIT 5,00 PERMIT VALIDATION pp 6= - pp yy ry1 U �+ V ISSUANCE DATE . BLDG_ ELECT. PLGMECH. D E n ❑ ❑ EMP. METER OR POLE INS. 20.00 APPLICANT aDDRESSDRE55 MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CON 'TRACTORS 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. License Class Lie. Number Dale Contractor OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Business and Professions Code: Any city orcounty which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant fur such permit to file a signed statement that he is licensed pursuant to me provisions of 00 Contractor's License of Division 3 of the Law (Chapter 9 ( commencing with Section is exempt Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 703L$ by any fora permit subjects lite applicant macivil penalty of not moreorethan file hundred dollars fS5001.): ❑ 1, 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 sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does 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 - forms are not intended or offered 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 h e did not build or im- prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractorts) licensed pursuant to the Contractor's License Law, reaps Ia .B.&P.C. for this n la BUILDING PERMIT INFORMATION MISC.- REFER TO OR PERMIT ISSUANCEVALUATION 10.00 ��dp $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO. I� ( / DTV. PLUMBING PERMIT FEE STORIE6 TYPE CONSTR. ALTER-DRAIN&VENT-WATER(EA.) 5.00 BACK FLOWPROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND. 5.00 F IXTUR ES - PER TRAP 5.00 GAS - EA. SYSTEM -1 INC. 4 OUTLETS 6.00 SO. FT. FLOOR AREA TOTAL ACREAGE - . - GAS EASYSTEM OVER 4 (EA.) 2.00 BUILDING USE FlEfix IND CON PB Other ASSESSORS PARCEL NO. INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SAN ITARV-STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Ow r Date WATER SYSTEM 5.00 WOR KERS'COMPF,NSATION DECLARATION 1 hereby affirm that I have a LcRificme of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereofISec. 3800, Lab.CJ. Policy No. Company ACC. GATE ACG FILE NO. WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. ❑ Certified ropy is hereby fwith tJ. ❑ Certified Copy is filed with the city inspection division. Applicant FIRE SPRINK v ❑ N 0 ENERGY T44 Y ❑ N� MISC. - REFER TO ORD, CERTIFICATIi OF EXEMPTION PROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) 1 certify that in the performance of the work for which this per. mit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If. after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must 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 ]or lire performance of the work for which this permit is issued ISec. 3097, C.,C.). ' Lender's Name Lender's Address I certify that 1 have read this application andSime that the above information is correct. I agree to comply with all City and county ordinances and stale laws relating to building construction, and hereby authorize representatives of this city t0 enter upon the above-mentioned properly 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 granting O(m PERMIT ISSUANCE 10.00 PLODD ZONE Y [J N A.L.U.C. Y ❑ No PLG.CONTR. LIC. No. PLG TOTAL QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE 7 `7 AIR HANDLING UNIT (TO 1OpCF.M.) 4.00 00 AIR HANDLING UNIT (OVER 10,000C.EM.) 6.00 SEISMIC FEE 3(J, EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM ELECTRIC HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 VENTILATION FAN (SINGLE) 4.00 BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 PLUMBING 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 / qqq �7 Applicant/Contractor Ua e OFFICE COPY