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14120\„POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS 10605 MERRIMAN UNIT# LOT 4k OWNER PISANO CONTRACTOR 4 -STAR MECH PF'RNil T NUMBER 14120 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION LIFER PREG NITE U PERMIT VALIDATION � ! ISSUANCE LATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL BLDG, El ELECT. 0 PLG. MECH. 13 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR W VALUATION SIFT. PLUMBING / D MECHANICAL ELECTRICAL I / / To• /I FRAMING INSULATION STORIES TYPE CONSTR. OCC. GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF � SO. FT. GLOOR AREA TOTAL ACREAGE DIAPHRAGM tlIIILU USE RES IND CONVB ONer El cl 11 CD F-1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED S E SSOR 5 PA R C E L NO ROUGH WN1 ON PLUMBING GAS TEST TRACTNU, PARCEL NO. MECHANICAL ACC. DATE ACC. FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG. SITE NO. INSULATION PLUMBING GAS FIRE SPRINK Y Ej NEJ ENERGY T 24 v [:] N❑ MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE Y0 NE) A. L.U. C. Y 0 N❑ LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. FEE SUMMARY SHEETROCK GRADE SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC 1FLEN CHECK GAS SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. I MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, LU WORKING DAY BEFORE REQUIRED INSPECTION. O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY k Z F, O i - LU CL O D Z UQ LL U O W6 F- A N F 2 A APPLICANT'70.F-iLL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION FICATION APPLICATION & PERMIT BUILDING PERMIT NUMBER 14120 1412 0 BUILDING ADDRESS , O 5 y 1 OWNER'S NAME ))�� PHONE�25 DTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTORS NA E�j OUTLETS -SWITCHES -RECEP 10.00/1.00 FIXTURES 10.00/1.00 M r,14 LIC.NO.W2_otif113HTING DATE OF APPLICATION C,ONTRACTOR'S AB DRESoS p y/�y.�/{ I � Ekali �"l PHONFL✓��i4 PPLIANCES.RESIDENTIAL 4.00 PANELS 10.00 ARCHITECy1� ASA �!-�+� OR ✓/'IOU" /t/'T Jr/O ENGINErR uO NO PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENG. ADDRESS SOO SPECIAL CIRCUIT . PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 ZIP t✓� APPLICANT'S ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 1 hereby afDnn that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions C �.�ml my license is in full fu e/y f ol� Licen lass _W Lic. Number_ 7 V NUANCE DATE BLDG. ❑ ELECT. ❑ PLG. MECH. ❑ Date Contractor BUILDING PERMIT OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of5ection 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500).): INFORMATION MISC. - REFER TO ORD VALUATION 5/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO q� CITY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.) 5.00 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS 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- mentsarenotintendedorofferedforsale. IL however, the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00. or hnprovement is Sold within one year of completion, the owner- builder will have the burden of proving that he did not build or int- prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING USE RES IND CON PS Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 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 - OVER 5 (EA.) 1.00 contracts for such projects with a contraelorts) licensed pursuant to the Contractor's for License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 ❑ lam exempt under Sec. ,B.&P.C. for this reason Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation ace, or a certified ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab.C.).,I Policy No. Copany Y1/ m ❑ Certified copy is hereb rrI d. ❑ Certi co is ed r the cantry i_spetlion division. ApplicCe, FIRE SPq INK Y❑ N❑ ENERGY T"24 Y ❑ N❑ MISC.- REFER TO ORD. PERMIT ISSUANCE 10.00 FLOODZONE Y❑ N❑ A.L.U.C. Y❑ N❑ C TIFICA 6OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one PLG CONTR. LIC. NO. PLG. TOTAL CIT MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California. Date Applicant BUILDING ALTER OR ADD TO MECH. .' 5.00 NOTICE TO APPLICANT': If, after making this Certificate of Ex- cmption, you should become subject to the Workers' Compensation provisions of Ore Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. APPLIANCE , I `' r 5.00 PLAN CHECK FEE M AIR HANDLING UNIT (TO 1OSMCF..)_,4( 00 i AIR HANDLING UNIT (OVER 10X0C'F.M:)'6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM I hereby afOno that there is a construction lending agency for the performance of the work for which this permit is issued (See. 3097, Civ.C.)m. HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Nae Lender's Address VENTILATION FAN (SINGLE) 4.00 I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. PLUMBING gOILFA-COMP(3 H.P. Or 100,000 B.T.U.) 6.00 BOILER -COMP f0ver 100,000 BTU) SEE FEE SCH. MECHANICAL 3 Q MISC. - REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against Said City in consequence of the PERMIT ISSUANCE 10.00 D MECH. CONT. LIG NO. MECH. TOTAL I_30-- TOTAL of thi cnniL -ZSR 9 /Con racr Date na areplica m OFFICE COPY