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14024 1 POST THIS CARD NEAR'FRONT OF BUILDING CITY OF CUPERTINO PERMITNUMBER - INSPECTION DIVISION 14024 JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS . �O� 'E UNIT# LOT# PERMIT EXPIRES IF WORK OWNER GE.?Ga;RO •GI,EV CONTRACTOR 6e a-e0 IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER . PERMIT VALIDATION PREGUNITE S:' s a POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED, PAID UNDERGROUND /SLAB PLUMBING' ELECTRICAL MSUIEDATE PLG. MECH. MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR vALunnoN $/FT. PLUMBING MECHANICAL PERMIT TO ELECTRICAL FRAMING STORIES TYPE CONSTR. INSULATION OCC.GROUP RES.UNITS PLACE,NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED- SO,FT.FLOOR AREA. TOTAL ACREAGE ROOF -, y DIAPHRAGM 'S BUILDING USE RES IND CON Pe Ober APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ ❑ ❑ ❑ ROUGH d �� ASSESSORS PARCEL NO. P UM - - 3� 09 TRACT NO, A CEL NO, G TEST - W.CHANICAL '� ELECTRICAL ACC.DATE ACC FILE NO. FINALS'' DATE"", " .INSP,7 FRAMING SAN # /;LyL� •zoNlNc ENG.SITE NO. INSULATION -L��j PLUMBING -2— C� - -��_J/owLt+. 10:,27-SS' GAS — (�,• MECHANICAL FIRE SPRINK ENERGv r.zA �r e Y ❑ . ND Y ❑ N❑ ' COVER NO WORK UNTIL ABOVE HAS BEENSIG'NEDt; 'j HEATING 2-� �/ LATH-INTERIOR - p 17-W ELECTRICAL FLOOD ZONE aL.L.U.C. LATH-EXTERIOR FIRE DEPT. v❑ "❑ Y ❑ "❑ SHEETROCK GRADE FEESUMMARY SHEAR INTERIOR BUILDING /,2�.- �. SHEAR E - -I TEMPORARY APPROVALS BUILDING �' XTERIOR FIREWALLS. ELECTRIC — - ' PLAN CHECK GAS FEE NO TAPE OR PLASTERIUNTIL ABOVE HAS BEEN SIGNED, OCCUPANCY SEISMIC FEE /OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FIN ALISSIGNED BY BUILDING INSPECTOR. MICROFILM 1 ARRANGE FOR JNSPECTION BY PHONING 252-4505, ELECTRIC- /� I 0� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING / '7 1 r' PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT FOR EXPIRATION DATE .- MECHANICAL 47 ;' : 'IMPORTANT! CONST.TAX / PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY • PERMIT NUMBER BU L6ING PROJECT IDENTIFICATION - 'APPLICATION Sl PERMIT I BUILDING - _ + Y ADDRESS Mi: DLLARD LANE LOT Z BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 14024 1!1 OWN R'S PLAN CHECK VALIDATION NAME GERARD DEVELOPMENT DTV. ELECTRIC PERMIT FEE CORP. ( 415 )PHoeE 941-414 _ CONTRACTOR'S NAME ,f �, t� / UTLETS-SWITCHES-RECEP 10.00/1,00 Sd I•AE 2"1404`) LIGHTING FIXTURES 10.00/1.00 ..3 LIC.NO. ADDRESS roR•s 141 r-uze-T PPLIANCES-RESIDENTIAL 4.00 S Jbeuv j P.ca,EC_�41-4141 MPANELS 10.00 DATE OF APPLICATION ORCHrtacr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. -4 ENGINEER W. BENTON, ARGHT-n-iECT LIC.NO. SIGNS TRANS. 3.00 ARCH.OR EN SPECIAL CIRCUIT 6,ff0 PERMIT VALIDATION .. ADDRESS 13 MONTEREY AVE. rTDS, CA ZIP 9 5 TEMP.METER OR POLE INS. 20.00 ADDRESSTs- n MOTORS SEE FEE SCH. /I 141 FLRSt ST. t) L SERVICE CHANGE 20.00 //' o o LICENSED CON'FRACI'ORS DECLARATION J „ r/�" - is u I hereby affirm that I am licensed under provisions of Chapter 9 1 ANCE DATE y< a (commencing with Section 7000)of Division 3 of the Business and BLOC. ELECT. PLG. MECH. F i Professions Code,and my license is in frill force d e e I. �� ,-s--1.• 2 0 Data ee Clal "x�'-VV-Lia Number - _ Cut y r w Data Contractor ¢ m f � BUILDING PERMIT ¢ ¢ ¢ OWNER-BUILDER :CLARATION ¢ w u INFORMATION w ;a I I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD ut VALUATION $/FT. F u 0 J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 Q T Code:Any city or.ounty which requiresu permit to construct,niter, X IS Q 0 Improve,demolish,or repair illy structure,prior t0 Its issuance,also ELEC.CONTR. , LIC.NO. ELEC, Ja LL requires the applicant for etell permit to file a slimed atffiemlal that TOTAL/ iPERM IT TO a. E $ he is licensed pursuant to the provisions of the Contractor's License Law(Chapter9(commencing with Section 7000)of Division Sof the e Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE ¢r$ the basis for the alleged exemption.Any violation of Section 7031.5 • STORIES TYPE CONSTR. a ; by any applicant for a permit subjects the applicant macivilpenalty .fuel more than five hundred dollars(5500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 t2 S� ❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT.DEVICE 4.00 OC GROUP RES.UNITS 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 or property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 D=_ SO.FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- meetsarenalintendedoroffered for sale If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 , 3d']� or improvement is sold within one year of completion,rile 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 PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ El I,as owner of the properly,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 Ihercon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ��6_ SLCL- contracts for such projects with a contractors)licensed pursuant m SEWER-SANITARY-STOflM EA.200ft 10,00 / the Contractors License Law. / TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 �p2 reason Owner Due WATER SYSTEM S.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARA'HON WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a.Citified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Company. O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24 Z Z Certified copy is d with Ih inspection division. p A Ilicant_ MISC.-' REFER TO ORD. Y ❑ N❑ Y E] N❑ Cc H PERMIT ISSUANCE 10.00 d- FLOOD ZONE A.L.U.C. CC TI PICATF.OF EXEMPTION PROM WORKERS' Lu 0 _ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. TOTAL O V❑ N❑ V ❑ ry❑ (This section need not be completed if the permit is for one D Z hundred dollars is 100)or less.) - - L) O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT, FEE FEE SUMMARY IL I- mit is issued,1 shall not employ any person in any mumlct so as to U become subject to the Workers'Compensation Laws of California. i Date Appliculft ALTER OR ADD TO MECH. 5,00 BUILDING } W NOTICE TO APPLICANT: If,after nmking this Certificate of Ex- h ? emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 •PLAN CHECK . provisions of the Labor Code, you most forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1C.EM.) 6.00 SEISMICFEE /3 I hereby affirm-(hal there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 S the performance.of the work for which I)IS permit is issued(See .� MICROFILM 3097,Civ.CJ, I HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Nam(��b �aT l' Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that l have read this application and state that 11above VENTILATION FAN (SINGLE) 4.00 1 information is correct.I agree to Comply with all City and county PLUMBING Q e.� ordinances and state laws relating to building construction, and BOILER-CON?13 H.P.Or 100,000 B.T.U.) 6.00 / hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX ec y y y PERMIT ISSUANCE 10.00 0� ma man way an uta acc�'nst said City in consequence of the City in consequence of(he granting of this of this. MECH,CONT. LIC.NO. MECH. 1�� TOTAL t�L�C7� TOTAL lgnature of Ap a.11Contrector Dateof Ap and/Conlrector Date ' OFFICE COPY . .