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09588 ' POST THIS CARD NEAR FRONT OF BUILDING 1'F RM IT NUMBER CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS / a ° �(R4Y�fiJ�U uL^� UNIT# L T# _ �/� PERMIT EXPIRES IF WORK OWNER"/ - CONTRACTO ,/� IS NOT STARTED 4WITHIN INSPECTION - DATE INSPECTOR NSPECT ON RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION - ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER PERMIT VALIDATION PREGUNITE PAID POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' UNDERGROUND /SLAB AUG 2 G 1985 PLUMBING ELECTRICAL - ril BE G. ELE PLG. MECH. MECHANICAL _ I. y ❑ ❑+ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL PERMIT TO ELECTRICAL FRAMING STORIES TYPE CONSTR. INSULATION OCC.GROUP RES.UNITS PLACE NO SU BFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT.FLOOR AREA TOTAL ACREAGE • ROOF DIAPHRAGM. + BUILDING USE R E}I IEl El ND CON PB O11 lmv APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. ROUGH PLUMBING _ TRACT N0. PARCEL NO, GAS TEST ty MECHANICAL ACC.OATE ACC.FILE.NO. ELECTRICAL FINALS DATE INSP. , FRAMING / SAN # ZONING ENG SITE NO. INSULATION PLUMBING , GAS FIRE SPRINK ENERGY T 24 MECHANICAL Y ❑ N❑ Y ❑ No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD zorvE A.L.u,c. LATH-INTERIOR ELECTRICAL BJ _ LATH-EXTERIOR 'FIRE DEPT. Y❑ Np Yo Np SHEETROCK - GRADE - FEE SUMMARY SHEAR INTERIOR - BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED 10CCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z� PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL, CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL 'CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT IDENTIFICATION ! PERMIT NUMBER BUDOREESILDING A �� btu+ APPLICATION & PERMIT 09588 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE . _ L PHONE7" tf Q CONT ACTOR NAME UTLETS-SWITCHES-RECEP 10.00/1.00 LIC.NO. LIGHTING FIXTURES 10.00/1.00 CONTR ADDRESS ACTORS APPLIANCES-RESIDENTIAL 4.00 a DDRE PHONE PANELS 10,00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER p�D OR LIC.No. SIGNS TRANS. 3.00 ARCH. nENG. SPECIAL CIRCUIT S,QQ PERMIT ALIDATION ADDRESS ZIP EMP. METER OR POLE INS. 20.00 G 2 6198 APPLICANT'$ MOTORS SEE FEE SCH. .j ADDRESS of Cupertino SERVICE CHANGE 20.00 Ci y woo' LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 a u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE y<uWAi (commencing with Section ]000)of Division 3 of the Business and BL G. ELE PLG. MECH. F w z Professions Code,and my license is in full force and effect. ❑ ❑ zo v, L'. - License Class Lic.Number. Q z I- w Date Contrae m `a s BUILDING PERMIT ¢ ¢w< OWNHR-BUILDER DECLARATION A o A " MISC.- REFER TO ORD INFORMATION w ;LL I- I hereby affirm that I am exempt from the Contractor's License u o¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 OD VALUATION � - w Code:Any city or county which requires a permit to construct,alter, Q ¢ Q Q improve,demolish,or repair any structure prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. / G LL requires the applicant for such permit to GIC a signed statement that TOTAL PERMIT TO n w$ he is licensed pursuant to the provisions of the Contractor's License /, rzi Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the K a� a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE 111 (((,,, C`7 i o w. H $ the basis for the ally a exemption.Any applicant of Section W3 LS STORIES TYPE CONSTR. n ; _ by any applicant fora permit dollars (5000.licam toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(5500).): I ❑ I,as owner of OM property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 Their sole compensation,will do the work,and the structure Is not OCC.GROUP RES.UNITS 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 FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve- merits are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I1NC.4OUTLETS 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 have the burden of proving that he did not build or am- RF IND CON PB Oma, prove for Purpose ol ofse.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ I,as owner of the properly,am exclusively contracting with licensed contractors to construct One project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.8. 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 LAWN SPRINKLERS-OV ER 5(EA.) 1.00 contracts for such projects with a contmetons)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sce. ,BAP.C.for this WATER HEATER W/VENT 6.00 Mason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPRNSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a cenifiene ofconsent to self-insure, ZONING ENG.SITE N0. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(See.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 z Z U Certific opy is filedill, t • C inspection division. MISC.- REFER TO ORD. O Applicant_ Y❑ N❑ Y ❑ No y CF.RT'1 FICA'I'Ii OP li%F,MPTION FROM WORKIiRS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. UJ >_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. D. o (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ D Z hundred dollars($100)or less.) U O I 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 w Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING D } ED NOTICE TO APPLICANT: If,after making this Certificate of Ex- H Z 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 CONSTRUCT ION LENDING AGENCY AIR HANDLING UNITIOVER 1000GEM.) 6.00 SEISMIC FEE D 1 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,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's AddrHEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC ess I certify that I have road 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 lows relating to building construction, an BOILER-COMP (3 H.P.or 100,000 B.T.U.) 6.00 hereby aallureo, rcpmxcaIntives 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. MECH. Kn ..�.�.. `�l�,,s.,- TOTAL TOTAL 30 SI>?j� p 1 t Umtraulor Uetu OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING ADDRESS �PtA APPLICATION & PERMIT ����� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME CITY, ELECTRIC PERMIT FEE PHONE NAMERAc ops OUTLETS-SWITCHES-RECEP 10.00/1.00 LIc.No. t LIGHTING FIXTURES 10.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 ¢j A P PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECTOR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER uc.NO SIGNS TRANS. 3.00 ARCH.OR ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIv TEMP.METER OR POLE INS. 20.00 APPLIEASS DDRMOTORS SEE FEE SCH. A SERVICE CHANGE 20.00 PAID ¢ TEMP.POLE 30.00 Foo LICENSED CONTRACTORS DECLARA'r10N � rt u v 1 hereby affirm that I am licensed under provisions of Chapter 9 - A U 5 E N c w (commencing with Section ]000)of Division 3 of the Business and BL G. EAE MECH. F o z Professions Code,and my license is in full force and effect. E]o 0 v,W License Class Lic.Number .t UBIe Contractor , mh BUI ING PERMIT X ¢ w OWNER-BUILDER D17CLARATION INFORMATION X 3 a- y 1 hereby affirm that I an,exempt from the Contractor's License MISC.- REFER TO ORD F LL o a Law for the following reason.(Sec.7031.5.Buslnessand Professions PERMIT ISSUANCE 10.00 VALUATION g/FT. m � Code:Any city or county which requires a permit to construct,alter, 2 to ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0, ELEC. I O LL requires the applicant for such perinit to file a signed statement that TOTAL n at he is licensed pursuant to the provisions o ' f the Contractors License PERMIT TO H z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe o Business and Professions Code)or that the is exempt therefrom and QTV. PLUMBING PERMIT FEE M H m the basis for the alleged exemption.Any violation of Section]031.5 STORIES TYPE CONSTR. dam _ by any applicant for it Permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).): O I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 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 Conlruetor's License Law docs not ephly 10 an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 'i 5.00 Sa FT.FLOOR AREA TOTAL ACREAGE . himself or through his own employees.provided that such imprmc- memoffend sale.If.however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4(EA) 2.00 builder will have the burden of proving that h - . - . e did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER: 30.00 RE IND CON PB Dire, ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construct the project(See 7044, Business LAWN SPRINKLERS- 1 INC 5 V.B. 600 ASSESSORS PARCEL NO. and Professions Cod,"Che 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 contractots)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I um exempt under Sec.-,B&P.C.for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. , WORKE RS'COMPENSATION DECLARA'r1ON 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. copy turcof(Seo.3800,Lab.C.). Policy No. Company O ❑ Cerlifed copy is hereby furnished. FIRE SPRINK ENERGY T 2 Z Z ❑ Certified copy is fled h the city inspection division. H O Applicant MISC.- REFER TO ORD. v ❑ N❑ v ❑ NE] cc: y CERTIFICAIT:OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W > C0MPF.NSA'6ON INSURANCE. PLG.CONTR, LIC.NO. PLO. d O This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑ 0 Z hundred dollars IS 100)or less.) L) Q 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY L.L H mit is issued, 1 shall not employ any person in any mmnnerso as to O L) become subject to the Workers'Compensation Laws of California. y Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING U } ED NOTICE 'f0 APPLICANT: If,after making this Certificate of Ex- F ? enhption,you should became 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)000QF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PWC.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.Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 e information is correct.I agree to comply with all city and county PLUMBING ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 ! D hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU(SEE FEE SCH. MECHANICAL (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 City in consequence of the granting of this permit. MECH.CONT. LIC.NO. MECH. 1211 TOTAL TOTAL SnFr�r tu�D(❑ p 0.��o(ntr� � Date 0 E - �� D INSPECTOR COPY