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8388 POST THIS CARD NEAR FRONT OF BUILDING Pf RMIT NUMBER CITY OF CUPERTINO Q Q INSPECTION DIVISION 8388 JOB INSPECTION RECORD A* �J//w /^/ PERMIT EXPIRATION JOB ADDRESS 0`' '"'� f�D/I LOT# PERMIT EXPIRES IF WORK OWNER CT IS NOT STARTED WITHIN INSP CTION E INSPECTOCTION RVORD 180 DAYS OF PERMIT ISSU. ANC. OR 180 DAYS FROM FOUNDATIO LAST CALLED INSPECTION. UFER PREGUNITE - PERMIT VALIDATION T POUR NOCONCRETEUNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE 8 ELEC PLG. MECH. MECHANICAL - [I E DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING O NFORRMM PERMITATION WOOD FLOOR VALUATION SIFT. PLUMBING ice• MECHANICAL ERMIT TO ELECTRICAL FRAMING $TORI S TYPE CONSTR. , INSULATION OCC,GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT.FLOOR AREA TOTAL ACREAGE • ROOF DIAPHRAGM ouIL usE CON IND CON PB OIM1rr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED EL ASSESSORS PARCEL NO, ROUGH PLUMBING TRACT NO, PARCEL NO: GAS TEST MECHANICAL ACC.OATE ACC.FILE NO. ELECTRICAL -11. y- FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY T,24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING YD NE) YE] N❑ LATH-INTERIOR ELECTRICALp FLOOD ZONE, ?.L.U.C. LATH-EXTERIOR FIRE DEPT, YE:] NE] Y NE] SHEETP,OCK GRADE FEE SUMMARY SHEAR INTERIOR IBUILDING _ - FJ SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING , FIREWALLS ELECTRIC PLAN CHECK FEE ' GAS NO TAPE. OR PLASTER UNTIL ABOVE HAS BEEN SIGNED PANCV SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, 'ELECTRIC F-• F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o 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 BUILDING PROJECT IDENTIFICATION GO�- ERMIT NUMBER yI.,CD,NG APPLICATION & PERMIT ADORES, O/•�(�,. C!wO0 ,1 O p BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 8388 R' OWNES PLAN CHECK VALIDATION ' NAME OTY. ELECTRIC PERMIT FEE • NAME Ac �.• vHONE S- corvrRoes OUTLETS-SWITCHES-RECEP 10.0011.00 r LIC.. LIGHTING FIXTURES 10.00/1.00 CONTRA AD / APPLIANCES-RESIDENTIAL 4.00 / C PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC,No. SIGNS TRANS. 3.00 ADRESS eec. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS 7�/ SERVICE CHANGE 20.00 y/p,'JC� ,-02 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANOSO TE Na w (commencing with Section 7000)of Division 3 of the Business and ,42Q U IJO BLDG. ELELT. v..PL MECH. H o z Professions Code.and my license is in full force and effect. ❑ Z O u, - License Class Lie.Number ! ❑ 9 w t Uak• Contractor City of Cupertino BUILDINGIPERMIT6S a w ,Jai OWNER-BUILDER DECLARATION I FORMATION E: 3 LL I- 1 hereby affirm that I am exempt from the Contactor',License MISC.- REFER TO ORD H u_O v, Law for the following reason.(Sec.7031.5,Business and Professions vALU TD JET. PERMIT ISSUANCE Q fO:QO n erf(no Code:Any city or county which requires permit to construct,alter, /D acto Q 2O innProvC,demolish,or repair any shuclurc,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. / -D o requires the applicant for such permit to file a signed statement that TOTAL Lw QQ PERMIT TO K $ he is licensed pursuant to the provisions of the Contractor's License H z r Law(Chapter 9(comme.emgwith Section 7000)of Divi,mr3o Fthe a Business and Professions Code)or that he isexempt therefrom and CITY. PLUMBING PERMIT FEE ar f O the basis for the alleged exemption.Any violation o(Section 7031.5 STORIES TYPE CONSTR. d3 � by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(S5000.): ❑ 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 offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,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 F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve- ments are not intended or offered for sale If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvemem is sold within one year of completion,the owner- GAS-EASYSTEM-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 ❑ 1,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 dues not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00 contracts for such projects with n contractoRs)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. ❑ l am exempt under Sec ,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner - Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of Consent to self-insure' ZONING ENG.SITE NO. or a Certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab CJ. Policy No. Company 0 ❑ Cerlitiedcopyisherebyl urn ishCd. FIRESPRINK ENERGY T-24 Z Z ❑ Certified copy is fled with the city inspeclion division. MISC.- REFER TO ORD. Y ❑ N❑ v ❑ N[_O Applicant CC CERTIFICATE OI'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y [:] N❑ C. O (This section need not be completed if the permit is for one TOTAL 0 2 hardred dollar-,(4100)or less I U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- 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. / O a BUILDING Datc Applicant ALTER OR ADD TO MECH. , 5.00 } rn NOTICE 'TO APPLICANT: If,after making this Certificate of Ex- Z entption,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=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE S-a 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(See. 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 a � - I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 • information is correct.1 agree to comply with all city and county PLUMBING (3 H.P.or 100,000 B.T.U.) 6.00 ordinances and state laws relating to building construction, and BOILER-OOMP hereby :ethnriac representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. 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 CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 granting of this permit. MECH.CONT. LIC.NO. METH. - �� c� � TOTAL TOTAL i Si nam eo A hunt/Contractor Dd f OFFICE COPY