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11634 POST THIS CARD NEAR FRONT OF BUILDING ' PERMIT NUMBER CITY OF CUPERTINO 11634 INSPECTION DIVISION JOB INSPECTION RECORD y/^ / /j/e,�+ /�J PERMIT EXPIRATION JOB ADDRESS._((,�!� o �E�C,µ v� UNIT# LOT It PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER ' PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED I� UNDERGROUND /SLAB ' rte PLUMBING U ! ELECTRICAL IS SO DATE MECHANICAL ')BLDG. ELECT. PLG.' MEOW X. z 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR - AV/ALUATION $/FT. PLUMBING MECHANICAL r� PkRMIT TO [ ELECTRICAL 1/L' o E/eO FRAMING STORIES TYPE CONSTR. INSULATION OCG GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT FLOUR AREA TOTAL ACREAGE ROOF DIAPHRAGM BUILDING,USE NES IND CON PB OJnn APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING C' TNACI NO. PARCEL NO. GAS TEST MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL 11 eZJr86 FINALS DATE INSP. FRAMING s �. L SAN # N� ZONING ENG.SITE NO. INSULATION PLUMBING 70 GAS FIRE SPRINK ENERGY RPE MECHANICAL Y ❑ No Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH-INTERIOR ELECTRICAL �j'1j FLooD ZONE A.L,uc. LATH-EXTERIOR FIRE DEPT. v❑ N❑ r ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPRIOVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE " OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM 5 ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — CONST.TAX . IMPORTANT! 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 BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER aUROING M APPLICATION & PERMIT �. ADDRESS •O,f/� II S //� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 11634 I NAMEOWNER S 6 V1Q��f,3 1r ,3 PLAN CHECK VALIDATION .� f/ CITY. ELECTRIC PERMIT FEE CL N PHDNE` - CONTRACTO 'S OUTLETS-SWITCHES-RECEP 10.00/1.00 Q .- NAME LIC,No. LIGHTING FIXTURES 10.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO, OR ENGINEER uc.NO ISIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS ZIP EMP.METER OR POLE INS. 20.00 ASMOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE F1 20.00 ^ U w 0 o LICENSED CON'FRACfORS DECLARATION �'�s^/ 1u.T <u v I hereby affirm that I am licensed under provisions of Chapter 9 AUG �: s� SUAN E DATE m a n (commencing with Section 7000)of Division 3 of the Business and BLDG. EAr. U MECH. H w z Professions Code,and my license is in full force and effect. �7 Ip ❑ z o m- License Class Lie.Number. D= D Data Contract., City of Cupertino BUILDING PERMIT ¢ w a OWNER-BUILDER DECLARATION INFORMATION E 3 LL y 1 hereby affirm that I am exempt from[he Contractor's License MISC.- REFER TO ORD u o a, Law for the following reason.(Sec.7031.5,Businessand Professions pERMIT ISSUANCE 10.00 _ VALUATION 3/FT. Ly I Code:Anycityorcountywhich requires apermit toconstruct.alter, _d -/,-,&L" QQ ¢Q Improve,demolish.or repair any sturaure,prior to Its ISsuanCC,also ELEC.CONTR. LIC.N0. ELEC. Q it -O¢ requires the applicant for such permit to file a signed statement that TOTAL l��V _� pERMIT TO d w m" he is licensed pursuant to the provisions of the Contractor's License H z i Law(Chapter 9(commencingwlth Section 7000)of Division 3 of the �N7C�.z p'R � c-"QJ(.¢ a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE sip ¢H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a Permit subjects the applicant too civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(8500).): O 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 1 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractors 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 TOTAL ACREAGE himself or through his own employees,provided that such improve- meats are not intended or offered mprove- meatsarenotintendedoroffered for sale.If,however,the budding GAS-EA.SYSTEM-11NC.40UTLETS 6.00 1) or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 IN 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 ILAWN SPRINKLERS-OV .) 1.00 contracts for such projects with a contmctORS)licensed puramnt to the Contractor's License Law. SEWER-SANITARY-S M 0 tt/l U.00 TRACT NO. PARCEL NO. l am exempt under Sec. .B.&V.C.for this WATER HEATERW/ .00 on Owner Date WATER SYSTEM Pf 00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING E .00 1 hereby affirm that I have a certificate of consent to self-imume. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Lah.CJ. Policy No.-Comp any O ❑ Certified copy is hereby l'umished, FIRE SPRINK ENERGY T 24 Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.MO- Y ❑ N❑ Y ❑ N❑ F 0 Applicant CCN CERTIFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00FLOODZONE A.L.U.C. Lu _ COMPENSATION INSURANCE PLG.CONTR. LIC NO. PLG. 10 TOTAL Y❑ N❑ Y ❑ N❑ ITre section need not be completed if the permit is for one L) Z hundred that (5100)pe less.) U O I certify that h the performance of the work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY 11. H mil is issued,I shall not employ any person in any manner so asto (] W become subject to the Workers'Compensation Laws ofCalifornia.. BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 F_ t6/1 NOTICEtion,TO shouldbecome APPLICANT: If,after making this Certificate of Ex- F_ Z envision you should become subject to the Workers'Ccomply'wit] APPLIANCE 5.00 PLAN CHECK a-dy Q 2- provisions provisions io the Labor Cit$h you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 GF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE , I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Cie.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address 1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county� PLUMBING ordinances and state laws relating to building constriction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 Hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property far inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against Babilities,judgments, costs and expenses which CONST.TAX may in any way accrue agai st said City in con$►quence o the PERMIT ISSUANCE 10.00 graNing [his per 't. � IIs_ A 'f MECH.CONT. LIG NO. TOTALS y'a \ JJl )Jr1,06 TOTAL Signature of Applicant/Contractor OFFICE COPY