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09978 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY -OF CUPERTINO 099NINSPECTION DIVISION JOB INSPECTION RECORD h , PERMIT EXPIRATION JOB ADDRESS _ I WIT LOT PERMIT. EXPIRES IF WORK OWNER / CONTRgCTOR - IS NOT STARTED WITHIN INSPECTION ATE INSPECTOR INSPECTION RECORD -180 DAYS OF PERMIT ISSU- FOUNDATIONANCE OR 180 DAYS FROM UFER I-"__ ST CALLED INSPECTION.,• s0 w • PREGUNITEPERMITVnuDAnoN - ro v . of ' I P' e POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED . UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLD ELECT. PLG. MECR) DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - INFORMATION PLUMBING' VALUATION SIFT. ' � t� MECHANICAL • ELECTRICAL + PE MIT To FRAMING _ - • ' INSULATION STORIES TYPE CONSTR, OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF .. - n $O,4T,FLOOR AREA TOTAL ACREAGE DIAPHRAGM / • UI LOC NUSE REQS INDPB cvnu, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑' El ROUGH ASSESSORSPAR EEL NO. PLUMBING - GAS TEST TRACT NO, PARCEL NO.', MECHANICAL - - y z O� ' ELECTRICAL, ACC.DATE ACC.FILE NO. FINALS DATE INSP. FRAMING SAN # " INSULATION ZONING ENG.SITE No. PLUMBING - • GAS I - MECHANICAL FIRE SPRINN • ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y❑ N❑ -° ❑ N❑ LATH—INTERIOR - ELECTRICAL - FLooG ZONE ' . alL�.u.c. I• Y❑ N : - Yo N❑ LATH—EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR." TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK, -FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ' OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDINGINSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, -ELECTRIC H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE.JOB ADDRESS WHEN PHONING. ' Z a. — SEE PERMIT FOR EXPIRATION DATE MECHANICAL IMPORTANTI• coNsT:rnx PLEASE READ REVERSE SIDE BEFORE 'CALLING FOR FINAL INSPECTION. 'TOTAL -•� OFFICECOPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMITNUMBER BUILDp9E55I G. APPLICATION & PERMIT 09978 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL NWNER'a PLAN CHECK VALIDATION N E S• CITY. ELECTRIC PERMIT FEE PHO �r NME AcroR UTLETS-SWITCHES-RECEP 10.00/1.00 / uc.No. LIGHTING FIXTURES 10.00/1.00 ADDRESS Sf C41S-1 -APPLIANCES-RESIDENTIAL 4.00 E . HONE PANELS 10.00 DATE OF APPLICATION ARCHITEC PLAN CHECK FEE P.C.NO. OR .+ PANELS (OVER 200 AMPI 20.00 ENGIN • NO. SIGNS TRANS. 3.00 P ARCH,OR ENG. PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 q zI EMP.METER OR POLE INS. 20.00 .00T 3 O APPLICANTS - eP AOOREs)* MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 City, Of Cupertino D ¢i F 00 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 ¢ w < v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE N< (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. r 0 Professions Co and my license is in full forU and effect ❑ ❑ ❑ ❑ oo License Class Lic.Number�•:+r4Q )_ _ Dale r • Contractor Q -,i J ¢ ¢ ¢ a OWNER-BUILDER DECLARATION BUILDING PERMIT w°'D MISC.- REFER TO ORD INFORMATION g w 1 hereby affirm that I am exempt from he Contractor's License O_o j Law for(he followingreason.(Sec.7031.5,Businemmul Professions VALUATION S/FT. - PERMIT ISSUANCE 10.00 Code:Any city or county which requires n permit to construct,alteq ' ¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIQ NO. ELEC. 0 u requires the applicant for such permit to file a signed statement that TOTAL a w m he is lice sed pursuant to the provisions of the Contractor's License PEHMI T f 2 a Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe f 4 0 Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE ¢ H $ the basis for the alleged exemption.Any violation of Section 7031.$ IES YPE CONSTR. a3 � by any applicant fora permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(my em): ❑ Las 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,AR EA,COND. 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 SO.FT,FLOOR AREA TOTALACREAGE himself re through his own employees,provided ho that such improve- men(sarc through oroffered for employees. e.molded that such building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- builder will have the burden ofproving(hal he did not build or im. GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 I❑ ❑N ❑ Other ❑ 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. 6.00ASSESSORS PARCEL NO. and Professions Coda: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 contrac(ods)licensed pursuant to I the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec..,BAP.C.for his WATER HEATER W/VENT 6.00 6e.Grt/ reason " Owner Dme WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. &5CF.RTIFICATEOF f(Sec.3800,Lab.C.. j� Ocopy is .rugby furlshed. FIRE gPRINK ENERGY T-24 Z fie copy is filed w�m thye city inspection divisi - F MISC.- REFER TO ORD. Y N❑ Y ❑ NO Ir EMPTION FROM WORKERS' PERMIT ISSUANCE. 10.00ION CL (This section need not beTcomplleted Rif heEpermit is for one PLG.CONTR. LIC.NO. TO1,AL CL CI 0 Z hundred dollars(S100)or less.) U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of California. a Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING } N NOTICE TO APPLICANT: If,after making this Certificate of Ex. ? caption,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 revoked. - AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PMC.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 tSec. MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read this applicalion 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 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned properly forinspectionof purposes. (We) agree to save, indemnify and keep It the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in anyway accrue against said City in consequence of the gra ling of this permit MECH.CONT. LIC.N0. MECH. sis �. �,. -W TDTAL TOTAL ignature p 'cant Contractor Date OFFICE COPY