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8367 POST THIS CARD NEAR FRONT OF BUILDING PERM1III NUMBER 1 CITY OF CUPERTINO Q *% INSPECTION DIVISION 83 JOB INSPECTION RECORD PERMIT EXPIRATION SOB ADDRESS IOCy�_y � ' yl�l7� T`#/� LOT rPERMIT EXPIRES IF WORK OWNER CONTRACTOR .✓ IS NOT STARTED WITHIN INSPECTION DATE INSPEATOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- �f 6`{� fay N" J�YdrLy,�ol. •'-ANCE OR 180 DAYS FROM FOUNDATION i - LASTCALLED INSPECTION. UFER PREGUNITE �i3�r � »••' PERMIT VALIDATION POUR NO CONCRETEUNTIL ABOVE HAS BEEN SIGNED T `�J UNDEDERGROUND /SLAB PLUMBING ELECTRICAL a_ - ISSUA CE OAr MECHANICAL OG. EL EC . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Bull DI Nc ERMIT WOOD FLOOR /cam', .Lm INFORM TION VALUATION SIFT. PLUMBING MECHANICAL I ' ' I) PE HIM TQ ELECTRICAL ,[r i I • O FRAMING INSULATION _ay.�' STORIES TYPE CONST . i OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' SO.FI.FLOOR AREA TOTAL ACREAGE ROOF J DIAPHRAGM B W LDI USE RES IND GON ON PB Olnw APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑, El El El ❑. ' ASSESSORS.PARCEL NO, ROUGH PLUMBING 0 8 5A T iHACI NO. PARCEL NO. GAS TEST MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING eV,r, 6(w I-'Z SAN # ZONING ENG.SITE No. INSULATION f�L-o'!7-gs PLUMBING GAS FIRE SPRINK ENERGY T-]A MECHANICAL Y ❑ No Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - FLOOD]ONE A.L.U.C. LATH-INTERIOR ELECTRICAL LATH-EXTERIOR FIRE DEPT. v[:] RE] v ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING .BUILDING SHEAR EXTERIOR ( TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM J ELECTRIC Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING j 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - � IMPORTANT! CONST.TAX 'r \ PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. !C ' \ OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY QUI LD1 NG PROJECT I DENTI FICATI ON PERMIT NUMBER mu ZING APPLICATION & PERMIT .ADPRIvs��o J ,J�� J I BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 8367 VvNER'i (W�•� (,I PLAN CHECK VALIDATION nV//� TY. ELECTRIC PERMIT FEE • k„� I V / PHONE . PAM CONT CTORs UTLETS-SWITCHES-RECEP 10.00/1.00 / NAME• _$Y ,16 - No, Q26? LIGHTING FIXTURES 10.00/1.00 Y X11 G 1985 ANTRACTOR'S -Z PPLIANCES-RESIDENTIAL 4.00 ADDRESS �{�r1 PHONE PANELS 10.00 It Of {NRQICATION ARCHITECT ////{{��//'�1//��/,�/,4� �/nf/✓�]/✓�y/Y'�� 2 PANELS (OVER 200 AMP) 2Q.QQ O-, PLAN CHECK FEE P.C.NO. DR �"V ,C 1 J I J -_ ENGINEER LIC,No SIGNSTRANS. 3.00 ARCH.OR END. �/ ��p� ��11 ( �/ SPECIAL CIRCUIT 5.QQ PERMIT VALIDATION 2.54 2 IMOJO IP %68 TEMP.METER OR POLE INS. 20.00 APPLICANTS OYI690 MOTORS SEE FEE SCH. /Or ADDRESS ✓�`/� [ / SERVICE CHANGE 20.00 w o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 a it. I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE h G w (commencing with Section 7000)of Division 3 of the Business and R DG ELECT.A P G. MECH F H z Professions Code,and my license is in full fGr G I Jivel. z o - License Class Lic.Numlier O w Datc Conion,wr a Y BUIL ING RMI IT x w¢ OWNER-BUILDER DECLARATION INFORMATION D REFER TO ORD X 3 n N I hereby afllrm that I am exempt from the Comrado License MISC.- VALUATION S/FT. ..o¢ Law for the following reason. 703 L5,Business and Pr nfsions PERMIT ISSUANCE 10.00 �OI ✓VO f" ✓�J Code Any city or county which requires permit to cunMruc,alter, ¢ ODtt <FO improve,demolish,ur repair any structure,prior to its issue also ELEC.CONTR. LIC.NO. ELEC. Sz a LL requires the applicant for such permit to tile a signed stalcmentslhat TOTAI/ • PERMIT TO u w m he is licensed pursuant In the provisions of the Contrmto,',Lil,6. /�� I .�7 .-1 La z r Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �1'1/ 1 ,V ¢ Business and Prossions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE fe ¢ r$ the basis for the alleged exemption.Any violation of Section 7031.51 1r STORIES TYPE CONSTR. a F by any applicant for permit subjects tire applicant on civil penal 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 RES.UNITS their sole compensation,will do the work,and the structure is not intended or oll'ered for sale (Sec. 7044, Business and Professors DRAINS-FLOOR,ROOF,AREA,GOND. 5.00 Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who does such work F IXTUR ES-PEI!TRAP 5.0 SG.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- • . ' enu are not intended or offered for sale.If.however,the building GAS-EA.SYSTEM-11 6.00 m I or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE / builder will have tire burden of proving that he did not build or im- IND CON PB Otherprove for purpos4 of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,all,exclusively contracting with ❑ ❑ Cl ❑ 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 Conlraclor's License Law does not apply to as o Per of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.1 1.00 c tr is for such projects with a contractods)licensed pursuant to SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO. It ontraclor's License Law. I.Hr emptunder Se c. .BAP.C.for this WATER HEATER W/VENT 6.00 XOwner Date ' WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COM SAT'ION D17CLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofconsent to sell-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C. Policy No. Company ❑ Certified copy is hereby furnished FIRE SPANK ENERGY T-24 Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. Y ❑ N❑ Y E] N❑ O Applicant y CERT'IPICATF--OP EXEMP9'ION PROM WORKERS' V[D N PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c. COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. ,P/ (This section need not be completed if the permit is for one TOTA ❑ Y [3 NE] hundred dollars IS 100)or less.) FEE SUMMARY O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT F E P mit is issued.I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. BUILDING W Dale Applicant ALTER OR ADD TO MECH. 5.00 '} W NOTICF:'TO APPLICANT: It,cher making Dlis Ccrlil icutc of lix- F 2 Sorption,you should become Subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK / provisions of the Labor Code, you must forthwith comply with FEE C,I such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10MC.F.NL) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affmn that there is a construction lending agency for E HAUST HOOD(WITH DUCT) 5.00 -JA / the performance of the work for which this permit is issued ISce, 3097,Civ.C.p HEATING UNIT(TO 100,000 B.T.U.) 8.00 ICROFILM e/ Leader's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 LECTRIC Lenders Address I 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 anJ rounty I PLUMBING 3 ' /• ordinances and slate laws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00 T hereby authoriLe representatives of this city to enter upon the 801 LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL / above-purtumed properly 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 CONST.TAX / may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 gr ting fthiS crit. MECH.CONT. LIC.NO. MECH. /✓/"��`''',�,/�'��'r TOTA)/ TOTAL /) f Signature of Applic Conlructor Dale / ✓ V�� \ - OFFICE COPY - -- G