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14030 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER - CITY OF CUPERTINO ' 94030 INSPECTION DIVISION JOB INSPECTIONRECORD . PERMIT EXPIRATION JOB ADDRESS �a5 ' .b ��F UNIT# LOT# B �) PERMIT EXPIRES IF WORK OWNER GER ehtCONTRACTOR GE q.Qp IS NOT -STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ,. FOUNDATION y - ANCE OR 180 DAYSIFROM LASTCALLED INSPECTION. UFER PR EGUNITE .PERMIT VALIDATION J _ PAI POUR NO CONCRETEUNDERGROUND /SLAB ,BEEN SIGNED PLUMBING QWe8�1R - / �-� ELECTRICAL Of D C1� ISSUANCE GATE BLDG. ELECT. PLG. MECH. MECHANICAL r rl DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $IPT. PLUMBING -Air 140 MECHANICAL' S-�� a +' PERMIT TO ELECTRICAL FRAMING 4-1 7�v y�t STORIES TYPE CONSTR. INSULATION 5'11 —$ij J - -OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - SO.FT.FLOOR AREA TOTAL ACREAGE• DIAPHRAGM "Y / 1 BUILDING USE ' RES IND CON PB Olner APPLY NO ROOFING UNTIL,ABOVE HAS BE-M SIGNED © '❑' El ❑ El A55ESSOHS PARCEL NO. ROUGH 3�6 -c��Li 4/—e7 PLUMBING GAS TEST A TRACT NO. PARCEL NO. '�l a�2?/' F _.E :!, MECHANICAL '�'F ACC.DATE ACC FILE N0. ELECTRICAL ;fit FINALS , "?!IC!ATE'.> � INSP. FRAMING 77 SAN * ♦ e - ZONING,. ENG.SITE No, INSULATION PLUMBING E GAS FIRE SPRINK ENERGY T]E MECHANICAL RCOVER`NO'WORK'UNTIL';gBOYE�H_ASIBE_ENSIGNED _ 'HEATING ❑ N[-] ❑ N[:] LATH—INTERIOR ELECTRICAL FLOOD zorvE A.L.0 c. LATH-EXTERIOR FIRE DEPT, Y❑ N❑ Y ❑ No SHEETROCK GRADE - FEE SUMMARY ' SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK GAS FEE ,NO;TAPEOR PLASTERflNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY . SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC •- IW- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z�, PLEASE GIVE JOB ADDRESS WHEN PHONING. = SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY z ..j APPLICANT TO FILL IN INFORMATION WITHIN RED LINESOPtJSE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI F16ATION PERMIT NUMBER ADAPPLICATION & PERMIT 4 0 3 0 ADDRESS ODRtArMILLARD LANE LOT 8 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL Ow ER's +b;„'' L.': PLAN CHECK VALIDATION NAME GERARD DEVELOPMENT on. ELECTRIC PERMIT Fee CORP. ( 415 b.DNE 941-4141- 1Z CONTRACTORS ftV UTLETS-SWITCHES-RECEP 10.00/1.00 NAME S r S-1 wOA `�'Mv LIC.NoO'I Y LIGHTING FIXTURES 10.00/1.00 CONTRACTORS 141 F9 ILSs 2 APPLIANCES-RESIDENTIAL 4.00 ADDRESS S ` PMO PANELS 10.00 a DATE OF APPLICATION ARRCHITECT ry- .• - �NTON, PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. O ENGINEER ARCHITECT LIC,No. C13629 SIGNS TRANS. 3.00 ARCH.OR EN'513 MONTEREY AVE. ISPECIAL CIRCUIT 5.00 PERMIT VALIDATION 1 . LOS GATOS, CA. ZIP 95030 TEMP.METER OR POLE INS. 20.00 n APPLICANT'S MOTORS SEE FEE SCH. P 1�G74/ -� ADDRESSDDRESS ', T1.4�1 F�����IT.��RTI1(ST��T SLT�a.� [�n�t�i SERVICE CHANGE 20.00 f� X Lib..".D&TJ%Ql 0RSG&I.AR6'"22 < u U 1 hereby affirm that 1 am licensed under provisions of Chapter 9 v ISSUANUIE DATE y< i (commencing with Section 7000)of Division 3 of the Business suit BLppp��e PLG. MECH. r w i Professions Code,and my license is in full forme an e 41 I z o rA - License Class m Lic.Nuber. `i m r Date-_1_�q/�-��,p�Contruclor ' BUILDING PERMIT ¢ a w u OWNER-BUILDER DECLARATION INFORMATION A o a X ; 1 hereby affirm that I am exempt from the Contractor's Licence MISC.- REFER TO ORD t- uolir VALUATION $/FT. ¢ Law for the following Demme.ch(Sec. requires 5.aermit to construct, PERMIT ISSUANCE 10.00 Code:Any city or county which require,a permit[o construct,otter, /?/'�.�.1 R ¢¢G improve,demolish,or repair any structure,prior to its issuance,alio ELEC.CONTE. LIC.NO. ELEC. /� 0 o¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO u w$ he is licensed pursuant to the provisions of the Contractor's License > '�/ FILaw 9(commenciagwidl Section 7000)of Division 3 ofthe " f ,(� •Y .F z ¢o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE Ihebasls for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR. by any applicant fora permit subjectsS500)licantloacivilpenalty SNr'f/7 of not mon than five hundred dollars tha applicant ALTER-DRAIN& VENT-WATER (EA.) 5.00 (� ): ❑ 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 --3 Code:The Contractor's License Law does not apply to an owner of pmperty who build,or Improves thereon,and who does such work FIXTURES-PER TRAP 5.Q6 0= SO.FT.FLOORAREA TOTALACREAGE mentsfor not hrough ownemployees,for sale. If,ed ever,hat the improve. GAS-EA.SYSTEM-11NC.40UTLETS 8.00 meats arc not intended or thin one year sales If,however,the building 3 V�/ or improvement is sold within one year of completion, the owner GAS,EA.SYSTEM•OVER 4(EA.) 2.00 BUILDING USE builder will have Ilse burden of proving that he did not build or im IND CON PB Omer prove for 1.as owner of the.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ d as owner of the property,he exclusively contracting with licensed contractors to construct the project(Sec.7044,Business LAWN SPR INKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The who Contractor's License Law does not apply p to tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS'-OVER 5(EA.) 1.00 3�.6 contracts for such projects with a nnurnclorfa)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 Q oTRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&1.C.I' 5.0 or this WATER HEATER W/VENT 0 -- p(J(p p2 reason Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.• WORK ERS'COMPENSA'1'ION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to selFinsum, or a certificate of Workers'Compensation Insurance,or u certified LFIAE ENG.SITE N0, copy thereoftSec.3800,Lab.C.L Policy No. Company 0 ❑ Certified copy is hereby furnished. ENERGY T-24 Z Z J� Certified copy Is d wnh t Iy inspection division. MISC.- REFER TO ORD.APPlicant21 ❑ v❑ -N❑a PERMIT ISSUANCE 10.00 UA.L.0C. M CERTIFICATE,OF EXEMPTION FROM WORKERS'LU COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. �CL (This section need not be completed if [hc permit ix for one TOTAL / ❑ Y ❑ N❑ Z hundred dollars IS 100)or less.) V O 1 certify that in the performance of the work for which this per- QTY. " MECHANICAL PERMIT FEE FEE SUMMARY U. 1 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. / i BUILDING Date Applicant - ALTER OR ADD TO MECH. 5.00 (O�O s� } N NOTICE TO APPLICANT: if,after making this Certificate of 14x- 2 emption,you should become subject to the Worken'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE C..1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE �3 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 ISec. MICROFILM 3097,Civ.C.). T I / HEATING UNIT(TO 700,000 B.T.U.) 8.00 Lender's Namr�A'JPFtift4b Na?L g�Q H EA I I NG UN IT IOV ER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC 7 -1 I certify that 1 have read this application and state that the above unty VENTILATION FAN (SINGLE) 4.00 information n correct. I agree to comply with all city and courtlyPLUMBING Q ordinances and state laws relating to building construction, and BAILER-COMP I3 H.P.or 100,0008.T.U.) 6.00'- 99 hereby authorize representatives of this city to enter upon the BOILER-COMP (Ovar 100,000 BTU)SEE FEE SCH. MECHANICAL e7p 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 PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the granting of this per MECH.CONT. LIC.NO. MECH. ��_ I_?^d2 TOTAL 39l TOTAL dod71 Sig�of Applicait/Contractor Date UTJ OFFICE COPY