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14025 " 1 POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER CITY OF CUPERTINO iU�S ' INSPECTION DIVISION . JOB INSPECTION RECORD PERMIT EXPIRATION JOBADDRESS a�`�G �� "� �IXrDE UNIT# LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR G �G.QGLL.G'�i IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION p� L � ANCE OR,180 DAYS'FROM LASTCALLED INSPECTION. UFER 'yF(Q"<rd- PREGUNITE Mrz �� • • _ PERMIT VALIDATION ase 1. POUR NO CONCRETE UNTIL ABOVE HAS BE SIGN,EO„ Py /'" & { ' UNDERGROUND /SLAB Ai0 F G PLUMBING ELECTRICAL - ANCE DATE MECHANICAL •" L C. ELECT. PLG. MECH, DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUAnoN S/FT. PLUMBING' - ,. /9.. ~J MECHANICAL PERMIT TO ELECTRICAL - FRAMING ! -2 sroRlEs rz CONSTR.r INSULATION F.. OCC.GROUP RES/UNITS LAP b 1 PLACE NO:SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOFD FT,FLOOR AREA TOTAL ACREAGE I. � / ..-f . DIAPHRAGM IBPtl Be - BUILDING USE R6 IN❑D C❑ON P❑B 01❑hrf r ''APPLY NO,ROOFING UNTIL ABOVE HAS BEEN SIGNED ROWGH AssFssOR S PARCEL No. PLUMBING o P,- _ GAS TEST - _ �7 00.+ 9' ocIvewp T, AC' PARCEL NO.. MECHANICAL ACC,DATE ACC,FILE NO. ELECTRICAL „»" FINALS DATE INSP. FRAMING - S N # /S4„Ci ZONING ENG.SITE NO. - INSULATION LllM81NG GAS �- MECHANICAL /�� / FIRE SPRINrc ENERGY T2 V V ` � V ❑ N❑ V ❑ N❑ COVER NO WORK UNTIL AB0,V E N;JUEIY HEATING LATH-INTERIOR � FLOOD ELECTRICAL � " ZONE A.LUC. LATH-EXTERIOR FIRE DEPT. �� ❑ N❑ v N❑ SHEETROCK O Z SGRADE ' �� ''ceu:'wr, FEFTSUMMARY',": SHEAR INTERIOR ��Z BUILDING 30- 1 I - SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC _ �,.�� - PLAN CHECK GAS FEE NO TAPE OR,PLASTER•UNTIL ABOVt AS BEEN SIGNED„ OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. 'MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505,' ELECTRIC H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. ". SEE PERMIT FOR EXPIRATION DATE - MECHANICALS ' CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL > CALLING,FORI.FINAL INSPECTION.' �--- ' OFFICE COPY - • APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY rtlI VING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 140 5 ADDREaaOh1ILLARD LANE, LOT 3 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OwNER's j] .. ,_ PLAN CHECK VALIDATION ""Me 9,, ELECTRIC PERMIT FEE CORP. ( 415 )PHONE 941-414 CONTRACTOR'S NAME ,��'',w,``�y UTLETS-SWITCHES-RECEP 10.00/1.00 _ 5 p`�e" TLIc N'9,d?jn4 3 LIGHTING FIXTURES 10.00/1.00 ADDRESS _M 141 �I7� 1 PPLIANCES-RESIDENTIAL 4.00 ADOREss LOSPHON PANELS 10.00 d DATE OF APPLICATION PLAN CHECK 7 P.C.NO. ARCHITECT PANELS (OVER 200 AMP) 20.00 OR GREG W. BENTON, -n LIC.NO. SIGNS TRANS. 3.00 ARCH OR EN SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ADDRESS X13 MONTEREY AVE. LOS GArlos , - - ZIP 9 TEMP.METER OR POLE INS. 20.00 SCH. 6 - ��' ADDRESS 1 A 1 FIRST ST. - MOTORS SEE FEE SCH. ADDRESS 1 Y LOS ALTOS SERVICE CHANGE 20.00 woo LICENSED CONTRACTORS DECLARATION i7 J l a u ti I hereby affirm that I am licensed tinder provisions of Chapter 9 ISSUANCE DATE' N (commencing with Section 7000)of Division 3 of the Business and Q e. BLDG. ELECT. PLG. MECH. H o- Professions Code,and my license is 5u,.b for diff;cy. rp: z o,�- License Class Lic. r �•TlIZ•'[Sd_ f1I z 0 H w Date ContY a y s 3 BUILDING PERMIT a Ic w u OWNER-BUILDF ARATION - INFORMATION w0 v w I hereby affirm that I am exem t from the Contractor's License MISC.- REFER TO ORD 3 u y' P A ! VALUATION $/FT. to u o A Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 V Code:Any city or county which requires a permit to construct,alter, /(i// Q ea Q Q Improve,demolish,or repair any structure,prior to Its Issuance,also ELEC.CONTR. LIC.NO. G o+ i 0, requires the applicant for such permit to file a signed statement that EL C. TOTAL PERMIT TO F $ he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(commencing with Section 7000)ofDivision3ofthe e(�f�(ua�r ic Business and Professions Code)or that he is exempt therefrom and GTY. PLUMBING PERMIT FEE t-m the basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES TYPE''C/OONS/TTR. n 3 .- by any applicant fora permit subjects the applicant toacivil penalty ALTER-DRAIN III VENT-WATER (EA.) 5.00 s�l/t/'Ca of not more than five hundred dollars(SSOO).): ❑ I,as owner of the 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 R_-3 Code:The Contractors License Law does not apply to an owner of r property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve_ f ments.am not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 8.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or ins- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 REs USED CON Pe Omer ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business 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 3.)-6; contracts for such projects with a conlracton s)licensed pursuant t. fire Contractor's Lice nsc Law. SEWER-SANITARY-STORM EA.200ft/10,00 Q_� TRACT NO, PARCEL NO. ❑ I am exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00 �Q6� reason Owner. Date WATER SYSTEM 5.00 ACC:DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to sell'-insure, ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy thereof(Sec,3800,Lab.C.). - Policy No. Company 0 ❑ Certified copy is hereby furnished. ' FIRE SPRINK ENERGY T-24 Z Z Certified copy is file r the city division. MISC.- REFER TO ORD. G plicant - Y ❑ N❑ Y ❑ N❑ fY to CCR KATE".OF F.XEM ON FROM WORKERS' PERMIT ISSUANCE 10,00 d '� FLOODZONE A.L.U.C. LU > COMP17NSATION INSURANCE. PLG.CONTR. LIC.NO. PLG. Btl v❑ N❑ Y❑ N❑ CL Cl (This section need not be completed if the permit is for one TOTAL Z hundred dollms(S100).,less.) U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY UL F mit is issued,I shall not employ any person in any manner so as to 0 Wbecome subject to the Workers'Com pensmion Laws of California. y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } N NOTICE TO APPLICANT:,If,after making this Certificate of Ex- Fz emplion,youshould become subject to the W.rkers'Compensati.n APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with - FEE CO such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10ACC.F.M.) 6.00 SEISMIC FEE 130.1 I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 J_'- the performance of the work for which this per�if is issued(Sec. MICROFILM 3097,Civ.C.).t�.UF'lSfL'TI1.lt7 1.(AT(_ fti.ty HEATING UNIT(TO 100,000 B.T.U.) 8.00 G Lender's Nag HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Ov y,C Lender's Address /�a *, I certify that l have read this application and State that the above VENTILATION FAN (SINGLE) 4.00 0- d,.0 information is correct. I agree to comply with all city and county PLUMBING /a i ordinances and state laws relating to building construction, and BOILER-COMPO H.P.or100,000B.T.U.) 6.00 Is hereby authorize representatives of this city to enter upon the BOILER-COMP (over 100,000 BTU)SEE FEE SCH. MECHANICAL fw 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 ue against said City in consequence of the granting.f thi r it. MECH.CONT. LIC.NO. MECH, �n TOTAL L/T BO TOTAL a�3 ure of Applicunt/Contractor Data /T3 OFFICE COPY