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14029POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO. PFRMIT NUMBE(1 14029 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS a/y4c'� O /1/f //G2iL LG l /i Ig UNIT# LOT# 7 6E,e ��V• PERMIT EXPIRES IF WORK OWNER 410 CONTRACTOR (j [_b IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION DATE INSP CTOR INSPECTION RECORD FOUNDATION UFER. _ PREGUNITE , PERMIT VALIDATION pip ., �/D�1 �JANI, i(00 . - ISSUANCE DATE POURAO CONCRETE UNTIL ABO E HAS B, SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL BLO.D. MFCH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $OT. PLUMBING MECHANICAL S- ELECTRICAL PERMIT TO FRAMINGINSULATION STORIES TYPE CONST.._� y�OCC. GROUP RES. UNITS f IL ABOVE HAS BEEN'SIGROOF •- SO, FT. FLOOR AREA- TOTAL ACREAGE 7DIAPHRAGMBUILDING USE HES IND CON PB Omer 0 ❑ El ❑ ,APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PARCEL NO 3aZ 6 -env / / - Y/7 PLUMBING TRACT N0. PARCEL NO. GAS TEST 23- T 95- MECHANICAL ELECTRICAL FINALS --.'DASiE INSP. ACC. GATE ACC. FILE NO, FRAMING - Q� SAN * i444_/ INSULATION PLUMBING Z.ONING ENO, SITE NO. W e'`! GAS - MECHANICAL FIRE SPR INK r ❑ N� ENERGY T29 v N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED :', HEATING LATH-INTERIOR - ELECTRICAL - FLOOD ZONE v ❑ N[D . A.L.0C. Yo NEI LATH-EXTERIOR v FIRE DEPT. SHEETROC mirl ADE FEE SUMMARY SHEAR INTERIOR -(�-�IFJC BUILDING BUILDING ./. el SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC - PLAN CHECK FEE GAS ,NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE /? ' OCCUPANCY OF BUILDING IS NOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o�ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMetN� PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL Z — SEE PERMIT FOR EXPIRATION DATE — CONST. TAX IMPORTANT! TOTAL ' PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY ole i roc AsGZ. Q J GZra 1- w w0 U va FU0 Q¢o0 2 a S O Z_Z P N W _ ad, 7Z U_0 LL E Ow } ti u •AUPLICANT TO FILL IN INFORMATION WITHIN,RED LINES - USF Bj,LL POINT PEN ONLY, BUILDING PROJECT 1 DENTI FICATIONt APPLICATION rVOERWT BUILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER A A O ^ I (� G BUILDING ADORE s / . ow ER's GERARD DEVELOPMENT NAME - QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CORP. 415 HONE 941-414 DATE OF APPLICATION CONTRACTOR'S NAMELIC. NO�s/L p� 4jA„Vx/1� 2 1•'T�QrV . 2 UTLETS- SWITCHES -'R ECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S 141 . >=-tic-��r- ApORLeSS s I T\. C, b ON g41-4141 APPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 �- ARCHITECT • r - - OR ENGINEER ARCHITECT C13629 IC. PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS." 3.00 OREry ARCH...... ADDRESS `LOS GATOS, CA. 9503 zIP SPECIAL CIRCUIT 5.00 - �gplpgPMIT VALIDATION - ntADDRESS EMP. METER OR POLE INS. 20.00 ADDRESrvT's 141 FIRST $T. MOTORS SEE FEE SCH. MOTORS SERVICE CHANGE 20.00 LOS ALTOS C 1`f p F LICENSED CONTRACTORS DECLARATION' Qf VUj`r 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is N full To a d ff c License CWss lLieicense Number21 ISSUANCE DATE BLDG. ELECT. ZL PLG. MECH. Date d--�/ _��Conlractor . BUILDING PERMIT - _ �OWNER-BUILDER DECLARATION a 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 o 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 INFORMATION MISC.REFER TO ORD PERM IT ISSUANCE 10.00 Q_:: VALUATION $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO QTY. PLUMBING PERMIT FEE Law (Cha ter 9(commencin with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and �l STORIES TYPE CONSTR. V the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ALTER -DRAIN -WATER (EA.) 5.00r ❑ 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 Oce. GROUP R -3 RES. UNITS / DRAINS -FLOOR, ROOF, AREA,COND. 5.00 Code: The Contractor's License Law does not apply m an owner of property who builds or improves thereon, and who does such work himself or through his Own employees, provided that such improve- meals are nor intended or offered for sale. If, however, rhe building F IXTUR ES - PER TRAP 5.00 SO. FT, FLOOR AREA �, 0 7 '7 TOTAL ACREAGE GAS -EA. SYSTEM -1 INC40UTLETS 6.00 or improvement is sold within one yeat,of completion, the owner. builder will have the burden of proving that he did not build or im. prove for purpose of Sale.). ❑ 1, as owner of rhe property, am exclusively contracting willi GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CDN PB Omer •� ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business 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 - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. g contracts for such projects with a conlructons) licensed pursuant 10 the Contractor's License Law. �. SEWER-SANITARY-STORMEA.200ft/10.00 Q TRACT NO. PARCEL NO. ❑ I um exempt under Sec.-, BAP.C. for tilts reason ACC. DATE ACC. F ILE NO. WATER HEATER W/VENT 6.00 Owner' Data WATER SYSTEM- 5.00 WATER TREATING EQUIP. 5.00 WORK ERS'COMPENSATION DECLARATION I hereby affirm that I have a certn'k;ale ofcoment to self -insure, Compention Insurance, or a certified or a certificate of Workeri sa ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab.C.L Policy No. Company FIRE SPANK v ❑ N❑ ENERGY T-24 Y ❑ N❑ /QJ Certified copy is hereby furnished. CntApplicant died copy ed with inspection division. MISC.- REFER TO ORD. ^" CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00/0 FLOOD ZONE A.L.U.C. PLG, CONTR. LIC. NO. TPLG OTAL /67 COMPENSATION INSURANC17 (This section need not be completed if the permit is for one Y N ❑ ❑ V ❑ N❑ , 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 NOTICE TO APPLICANT: If, after making this Certificate of Ex. O TY. •MECHANICAL PERMIT FEE n FEE SUMMARY BUILDING /D 60 u ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE ' emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10=CF.M.) 4.00 AIR HANDLING UNIT(OVER I0,000C.F.M.)6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued fSec. 30nder's . am i„•��-.1 � �aT � Lender's Nam Lender's Address EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATI NO UN IT (OV E R 100,000 B.T.U.) 9.50 ELECTRIC PLUMBING /,% /07 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 totaling to building construction, and VENTILATION FAN (SINGLE) 4.0 BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00,{�s BOILER -COMP (Over 100,0000TU) SEE FEE SCH. MECHANICAL u _ hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 0 ^� CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses whicls may in any way accrue against said City in consequence of the granting of this I �] J *_rI,� SQA 4fU0utcUT% MECH.CONT. LIC. NO. MECH. TOTAL � 7, / TOTAL or" Signatureof Applieant/Contractor-r OFFICE COPY