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14144 POST THIS CARD NEAR FRONT OF BUILDING + - - „ ,,,PERMI F NUMBED CITY OF' •CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD,'.' 1 m PERMIT EXPIRATION JOB ADDRESS' - 10481. JOHNSON AVE - UNIT#' LOT, - GARDNER A&H ,HTGPERMIT EXPIRES IF WORK - OWNER CONTRACTOR . ^•IS NOT STARTED WITHIN -'; INSPECTION DATE INSPECTOR I INSPECTION RECORD 180DAYS OFPERMIT ISSU- FOUNDATION , ANCE OR''180 DAYS FROM LIFER - !. - Q LASTCALLEDINSPECTION. ' PREGUNITE e - - I PERMITNALIOATION 1POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB r•'T '. , �- ; 111 PLUMBING -. 1 1 .. 1 � ' :;I '•'L��.3:U:3 ; ELECTRICAL ` ' , ISSUANCE DATE � MECHANICAL BLDG. ELECT. PLG,- .NECK. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOODfLOOR - vawnnoN $/Ra. PLUMBING' .. b - MECHANICAL ELECTRICAL, - - PERMIT'To FRAMING STORIES TYPE CONSTR. INSULATION - - 1,. • . . ' :+% - OCC..GROUP RES.UNITS it - PP,LTA'CE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FL FLOOR AREA TOTALACREAGE DIAPHRAGM ' - BUILDING USE HLS IND•, CONPH GO— IWAPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ - ❑ ❑ ❑ _ ASSESSORS PARCEL NO. ROUGH PLUMBING - _ TRACT NO: PARCELNO. GAS TEST MECHANICAL • ' ELECTRICAL - FINALS DATE INSP. Acc.DATE ACC FILE NO. FRAMING - - SAN # • - PLUMBING ZONING ENG,SITE NO. INSULATION - GAS MECHANICAL _ FIRE SPRINK ENERGY T-74 -COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED - .1 HEATING " ❑ N❑, Y ❑. N❑ LATH—INTERIOR ELECTRICAL FLOODZONE A.LU.C. LATH—EXTERIOR FIRE DEPT.- - - - Y❑ N ' " Y ❑ NE] SHEETROCK .. ' GRADE FEE SUMMARY IF SHEAR INTERIOR ' ' BUILDING• SHEAR EXTERIOR' TEMPORARY APPROVALS BUILDING ' FIREWALLS ELECTRIC PLAN CHECK GAS .'L, . - FEE JNO TAPE,,OR PLASTER UNTIL ABOVE HAS BEEN SIGNED_ OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM r " ' ( - ELECTRIC w ARRANGE FOR INSPECTION BY PHONING252-4505, F, ONE WORKING DAY'BEFORE REQUIRED;INSPECTION. PLUMBING oy . PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION,DATE - �r '• U(J IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. j '? OFFICE COPV APPLICANT TO FILL IN INFORMATION WITHIN'RED LINES -r USE BALL POINT PEN ONLY PERMIT NUMBER BUILDING PROJECT IDENTIFICATION .APPLICATION & PERMIT ' ADOREss BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 14144 0 ( , OWNER'S PLAN CHECK VALIDATION - "AME OTY. ELECTRIC PERMIT FEE ` 6AR.btiI PHONE Z CONTRACTOR'S OUTLETS-SWITCHES-RECEP, 10.00/1.00 NA [ ("II(O �LIC.NO.3 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ' - APPLIANCES-RESIDENTIAL 4.00 ADDRESS ,r,/ , '{ (Q U7,/, PHONE2_ O7� PANELS _ - - 10.00 DATE OF APPLICATION ' ARCHITECT PLAN CHECK'FEE P.C.NO. on PANELS (OVER 200 AMP) 20.00 - . ENGINEER LIC.NO � SIGNS TRANS.. 3.00 + ARCH,OR ENG. SPECIAL CIRCUIT S.00 PERMIT VALIDATION ADDRESS r ZIP TEMP.METER OR POLE INS.. 20.00 1 non eA TS - - MOTORS , - SEE FEE SCH. +s" SERVICE CHANGE 20.00 wo o LICENSED CONTRACTORS DECLARATION a ai I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE Hz "' (commencing with Section 7000)of Division 3 of the Business and ¢ u BLDG. ELECT, PLG. MECH. H o z Professions Code and my license is in fall for nnec(. ❑ o 0= D License Class N Lic. wnber i ❑ F m H Date j j Contractor ¢ y f BUILDING PERMIT ¢ ¢ OWNER-BUILDER DECLARATION ¢ou O - INFORMATION ° a - MISC.- REFER.TO ORD. w g y I hereby affirm that 1 am exempt from the Contractor's License ¢ LLD¢ Law fo nycitllowingrtywhi(Sec.]Ores a permit to Professions PERMIT ISSUANCE' - VALUATION $/FT. - � _ 10.00 Code:Any city or county which structure; a permit to is issuance, alter, a IC <o improve,demolish,Or repair any strucmrc;prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. d - 0¢ requires the applicant for such permit to rile a signed statement that TOTAL PERMIT TO K $ he is licensed pursuant to the provisions of Ilse Contractor's License tz i Law(Chapter 9(commencingwitli Section 7000)ofDivision 3 ofthe f - E o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ s-$ the basis for the alleged exemption.Any violation ol'Section 7031.5 _ STORIES TYPE CONSTR. n ;_ by any applicant for a permit subjects the applicant too Civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than live hundred dollars($500).): ❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 r Code:The Contractor's License Law does not apply to an owner of Property whu builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 Sa FT.FLOOR AREA TOTAL ACREAGE, himself or through his Own employees,provided that such improve- .Cats are not intended or offered for sal,If,however;the building or improvement is sold within one year of completion,the owner. - GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE huilder will have the burden of moving that he did not build or im- prove for purpose of sale,). INDUSTRIAL WASTE INTER.- 30.00 ❑ 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 property who builds or improves thereon,and who. LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractural,licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ l am exempt under Sec. ,B.&P.C.forthis WATER HEATER W/VENT - 6.00 reason - Cavan,Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. -. WORKERS'COMPENSATION DECLARATION WATER TREATING,EQUIP. 5.00 , I hereby affirm (hat I have a certificate of consent to self-insure, or a Certificate of Workers Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.).�� " Policy No. Company luUVTEttL�L21_NIt ❑ Certilled ' y hereby t)nish4d. ,FIRESPRINK ENERGY T-24 Z Z. IIK Certified p 11 ith the city inspection division. MISC.- REFER TO ORD. O Applicant v❑ N❑ Y ❑ N❑ w - PERMIT ISSUANCE 10.00 � - CERTIFICATE 0I7 IiXEMPTION A OR CERS' FLOOD ZONE A.L.U.C. W 1 COMPENSATION INSURANCE PLG.CONTR. LIC.NO. I PLG. d O -(Phis section need not he CUmpleted if Ilse permit iS for-fine TOTAL Y❑ N❑ Y ❑ N❑ =) Z hundred dollars($100)or less.) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY UL F mit is issued,1 Shull not employ any person in any manner c,as to O L) become subject to the Worker Compensation Laws of California. Date Applicant BUILDING a ALTER OR ADD TO MECH. 5.00 } to NOTICE 1'0 APPLICANT: If,after making this Certificate of Ex. - F Z enmtion,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 shut[be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency 1'ar EXHAUST HOOD(WITH DUCT) 5.00 - (he performance of the work for which this Permit is issued(Sec. MICROFILM 3097,Civ C.). a HEATING UNIT(TO 100,000 B.T.U.) 8.00 Leader's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify Ibal I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 ' information is correct. I•agme to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER•ODMP(3 H.P.Or 100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000BTU)SEE FEESCH. MECHANICAL above-mentioned property for inspection purposes. _ (We) agree to 'save,indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,jul"ents, costs and expenses which pERM1T'ISSUAN CE 10.00 CONST.TAX May i ry my accrue gal .t salQ City in consequence of the granti g f MECH,CONT. LIC,NO.' MECH. /1.3•R / TO�� TOTAL �' Signature of Apphcanl/Conte for Date W OFFICE COPY ' 1