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12535 I _ POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 12535 INSPECTION DIVISION JOB INSPECTION RECORD •{ � �D•(7 / � Y I/1�� }/'I,1,,/// PERMIT EXPIRATION JOB ADDRESS 0/WTI ' Y l rl Vim, UNIT# _LOT# !/� PERMIT EXPIRES IF WORK OWNER L CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSP TION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM I LAST CALLED INSPECTION. UFER . PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE BLDG. ELECT. PLG. MECH. MECHANICAL :.1. ❑. 0 LJ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $SFT. PLUMBING D MECHANICAL PERMIT TO ELECTRICAL FRAMING STORIES —TYPE CONSTR, INSULATION OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SQ IT,FLOOR AREA TOTAL ACREAGE ROOF DIAPHRAGM BUILDING USE HCS IND CON Po GO,, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT NO. YARCEL NO. GAS TEST MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL L////-fr FINALS DATE INSP. FRAMING a� Lo 2G ��g SAN # ZONING ENG.SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY T-94 MECHANICAL v ❑ No V ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L.U.C. LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. v❑ NV ❑ NEI SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING S- BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK , F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC • "' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING " PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL r CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY r BUILDING PROJECT IDENTIFICATION PERMIT NUMBER �• aDILDIND APPLICATION & PERMIT 12535 ADDRESS �1 //77 /086/!/IM le I-: AVr-. U -�7-i NO BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'$ PLAN CHECK VALIDATION NA"^� OTY. ELECTRIC PERMIT FEE VA V K PHONE$O S-I CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 6 NAME LIC.No, LIGHTING FIXTURES 10.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE PANELS 10,00 DATE OF APPLICATION ARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc.NO. SIGNS TRANS. 3.00 ARCH.OR ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS J ZIP TEMP.METER OR POLE INS. 20.00 AvvucANrs MOTORS SEE FEE SCH. � P ADDRESS �,f�Q/ SERVICE CHANGE � 20.00 wo a LICENSED CONTRACTORS DECLARATION O <u 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSU va a N (commencing with Section 7000)of Division 3 of the Business and BLDG. IEl PLG. MECH, F y z Professions Code,and my license is in full force and effect. n rn �11�/1 ❑ z O w- License Class Lia Number yM VIZ-} 7�� Date.Contractor. BUILDING PERMIT Ix I[w OWNER-BUILDER DECLARATION INFORMATION K 3 LL y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD uOa Law for ilia following reason,(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION 8/FT. r - Code:Any city or county which requiresa permit to construct,alter, Q ��O Qw<2O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ^ W O R requires the applicant for such permit to file a signed statement that TOTAL�� PERMIT TO d w m u. he is licensed pursuant to the provisions of the Contractor's License F i i Low(Chapter 9(commencing with Section 7000)of Division 3 oflhe -< Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE f i O STORIES TYPE CONSTR. H the basis for the alleged exemption.Any violation of Section 7031.5 reg _ by any applicant for a permit subjects the applicant to a civil penally' ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(S500).): ❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 GCC.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 FIXTURES-PER TRAP 5.00 SQ IT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00 menta are not intended or offered for sale.If,however,the building 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 PS Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ 0 ❑ IicenseJ contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V . 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to un owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts fur such projects with a contractor(s)licensed pursuant to SEWER-SAN ITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Contractor's License Law. ❑ Iunr exempt under Sec. ,B.&P.C.lin this WATER HEATER W/VENT 6.00 reason .Owner al WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSAT10N DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent Io self-insure. ZONING ENG,SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,LaDC L Policy No. Company O ❑ Certified Copy is hereby fumished. FIREBPRINK ENERGYTY4 Z Z Cl Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. y N� y IN[_J M OApplicant CERTIFICA'ITS OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. UJ > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 11TOTAL y❑ N❑ Y� N 0 � (This section need not be completed if the permit is for ono 0 Z hundred dollars IS 100)or less.) U O 1 Certify that in Ora performance of the work far which this per OTV. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,1 shall not employ any person in any manner so as to O W hucnnm subject m the Workers'Coumensation Laws of Cali omia. Dura Applicant ALTER OR ADD TO MECH. 5.00 BUILDING /7 L) } rdia NOTICE: '1'0 APPLICANT: If,after making this Certificate of lix- FZ co ion,you should become subject to the Workers'Compensation gPPLIANCE 5.00 PLAN CHECK �7 provisions of ilia Labor Code, you must foflhwith comply with FEE �� U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 100MC.F.M.) 4.00 CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000QF.M.) 6.00 SEISMIC FEE < O 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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 021-L- Lender's Address I Certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct.I agree to comply with all city and county BOILER-DOMED(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ^.- ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (WC) agree to save, indemnify and keep harmless ilia City of I 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 granlingof this permit. MECH.CONT. LIC.NO. MECH. =7 TOTAL TOTAL 3 7 ^1lI t Sig 7iatura of Apph o tractor I ata OFFICE COPY