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12465 +► P,OSTTH IS CARD NEAR FRONT OF BU I LD ING PERMIT NUMBER CITY OF CUPERTINO 12465 INSPECTION DIVISION OB INSPECTION RECORD PERMIT EXPIRATION JOB ADDESS I I — U # ' 60T# PERMIT EXPIRES IF WORK . OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTIO DATE INSPECTOR INSPE TION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION I / POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING / ELECTRICAL - Iss CE DATE MECHANICAL BLDG, T. L.G. mecH. - ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING VALUATION $/Fi MECHANICAL ELECTRICAL PERMITTO FRAMING ler/rte INSULATION - - STORIES TYPE\O7, OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - SU,FT.FLOOR AREA TOTAL ACREAGE ROOF DIAPHRAGM 9ulLDI USE • HES IND CONON PB OIM1er APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDya �❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. - ROUGH PLUMBING GAS TEST TRACTNO, PARCEL NO. MECHANICAL- ' ACC.DATE ACC.FILE NO, ELECTRICAL FINALS DATE INSP. FRAMING .2 87 SAN # zorvlNG ENG,SITE No. INSULATION PLUMBING GAS MECHANICAL - FIRE$PRINK ENERGY h10 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑' ❑ "❑ LATH—INTERIOR _2, ELECTRICAL FLOOOZONE A.L.u.C. LATH—EXTERIOR FIRE DEPT. Y❑ N❑ Y❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR - - BUILDING _. 7 all SHEAR EXTERIOR TEMPORARYAPPROVALS V BUILDING ✓a a FIREWALLS ELECTRIC PLAN CHECK GA5 FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE - OCCUPANCYOFBUILDINGISNOTPERMITTEDUNTILBUILDINGFINALISSIGNEDBYBUILDINGINSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC � F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING . z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE . TOTAL _ �.- CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 12465 AODRE9as9 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL s .L/nro sw e.I OWNERS PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE COIa./TA /rll Ate/ PHONE CONTRAC OR5 NAME ACo .TT'"NOUTLETS-SWITCHES-RECEP 10.00/1.00 Cti/'r I T6 G0IJ'TM I, UC.NO S'?-S.3LIGHTI NG F IXTURES 10.00/1.00 CONTRACTOR'S pNAPPLIANCES-RESIDENTIAL 4.00 ADDRESS / f49 q'i , 4 �T�, G 4 PHONf3')O:7 tl 7 PANELS 10.00 DATE OF APPLICATION RCNrtECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.G.NO. O OR ENGINEER LOC.No. SIGNS TRANS. 3.00 nooRREss ENG' SPECIAL CIRCUIT 5.0Q PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 /J ANT'S u To RO, MOTORS SEE FEE SCH. s�(� ( r/"°s'�. ADDRESDDRESS SR 0.ArM g.ra ISERVICE CHANGE 20.00 / w o o` LICENSED CONTRACTORS DECLARATION D 4b! � 7 <u u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE e, (commencing with Section 7000)of Division 3 Df the Business and O6 ECT. PLG. MECH. F N i Professi e,and m license is in full fore d I. ❑ ❑ ❑ z o m- Lice a SOV-ic.Number ��q! 9 ° Da1�F'i 3-g7 Contractor �CQ tls_l1L_ rw st My s TQ' TrYR C.r+n` f Up ING PERMIT M Ic w OWNER-BUILDER DECLARATION INFORMATION Ko A I- I Inanely affirm that l am exempt from the Crmtmelor's License MISC.- REFER TO ORD w a-w y p VALUATION FT. u oLLaw for the following reason.(See. uires Business to Professions -PERMIT ISSUANCE 10.00 L- - -a Code:Any city or county which structure permit to consuance,her, 2 ¢¢FO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. V `A O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO A w m he is licensed pursuant to the provisions of the Contractor's License rzr Law(Chapter 9(commencing with Section 7000)ofDoision 3 ofthe /7&-- QyL a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Be F the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant HIS civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).1: ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP REB.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,GOND. 5.00 Code:The Contractor's License Law does not apply to an owner of . property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsare not intended oroffered for sale.If,however,the building GAS-EA.SVSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS'-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will hove the burden of proving that he did not build or im- REB IND CON PB Omar prove for purpose ofsaluJ. INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sue. 7044,Business ILAWN 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 contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.AP.C.tor this WATER HEATER W/VENT 6.00 reason .owner Dale WATER SYSTEM 5.00 ACC.DATE ACL.FILE NO. WORK ERS'COMPENSATION D17CLARATION 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 thercof(Sec.3800,Lab.C.)��'�N� Policy No. Company- / 0 ❑ Certified copy i5 hereby furnished FIRE SPRINK ENERGY T 24 Z Z � Certified c led hity s lion division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ Q A P iCllnl-- V N V N P: LD G/ PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.u.c. CC CERTIFICATE OF EXEMPTION FROM WORKERS' L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL o (This section need not be completed if the permit is for one TOTAL Y❑ NCD Y ❑ N❑ 0 Z hundred d.ion,($100)or IcssJ U O 1 certify that in the performance of the work for which this Per- OTY MECHANICAL PERMIT FEE FEE SUMMARY LL F mil is issued,I shall not employ any person in any manner so as to U become subject to(lie Workers'Componsat ion Laws of California. W Date Applicant ALTER OR ADD TO MECH' 5.00 BUILDING 3a } N NOTICE TO shout become : IL after making this ri'Coupeate of Ex- FZ empisionyou Shouldbecomesubject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you muss forthwith comply with FEE U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10p00 C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm thal there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of Be work for which this permit is issued(Sec. MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Leader's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC • 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 ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.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,judgments, costs and expenses which PERMIT ISSUANCE 10.00 -CONST.TAX may in any way accrue,against said Cit n consequence of the grantingo is permi MECH.CONT. LIC.NO. MECH. 3.q 3,Y7 TOTAL TOTAL 33 0-0 u o Applicanf7midractor Data OFFICE COPY � l