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12160 POST THIS CARD NEAR FRONT OF BUILDING . PERMIT NUMBER CITY OF CUPERTINO 12160 INSPECTION DIVISION f yr JOB INSPECTION RECORD . PERMIT EXPIRATION , JOBADDRESS 100$$ Miller Ave UNIT# LOT# I PERMIT EXPIRES IF WORK 'OWNER 'The Kontribeci Group CONTRACTOR Cal—Air IS.NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT I§SU- FOUNDATION - - AN CE OR 180 DAYS FFW M LASTCALLED INSPECTION. LIFER PR EGUNITE ' - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLABI t ' 1 PLUMBING. 1 ; �I�t I C • ELECTRICAL - t� CCD " rs UANCE DATE 1 BLDG. ELECT. PLG. MECK MECHANICAL I❑ ,❑, IrM .7F l 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BLUE. u •BUILDING PF,RMIT WOOD FLOOR (I ' INFORMATION VALUATION S/FT. PLUMBING MECHANICAL. PERMIT TO ELECTRICAL' FRAMING d STORAiSYPE coNsrR. INSULATION` OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • • ROOF , SO.Fi FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE - RES IND CON PO Olney 11 C-1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ _ ASSESSORS PARCEL NO. ROUGH PLUMBING - TRACTNO. PARCEL NO. ' GAS TEST MECHANICAL. - ACC.DATE ACO.FILE NO. ' ELECTRICAL FINALS DATE INSP. ` ,FRAMING - - SAN # u - ZONING ENG.SITE NO. ' INSULATION PLUMBING - GAS • y - - MECHANICAL FIRE SPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEENiSIONEO HEATING �' "� "❑ LATH—INTERIOR - ELECTRICAL PLaaO ZONE aL.u.c. LATH_EXTERIOR FIRE DEPT. r N� v N[3 SHEETROCK GRADE - FEE,SUMMARY SHEAR INTERIOR - BUILDING SHEAR EXTERIOR ' ' TEMPORARY APPROVALS BUILDING FIREWALLS - ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING,INSPECTOR.. MICROFILM LU 'ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. > 'PLUMBING ' o� PLEASE GIVE,JOB ADDRESS WHEN PHONING. Z. MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — . IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL 7 . � OFFICE COPY I. , APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ^� BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 16 ADDRESS �� U L1 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 2 OWNER'SH, PLANCHECKVALIDATION ""xe ^�OTV:, ELECTRIC IPERMIT FEE PHONE Ull CONTRACTOR'S _ VARHITECT pad UTLETS-SWITCHES-RECEP 10.00/1.00 , i �IIL .No. VlJ LIGHTING FIXTURES 10.00/1A0 crDR's �l- L`0PPLIANCES-RESIDENTIAL 4.00 C MPHONE �� PANELS 10.00 DATE OF APPLICATION PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. DR ENGINEER t -LIC.NO. SIGNS TRANS. 3.00 ARCH,OR ENG, 5.00. PERMIT VALID TION' I AD ESS OR SPECIAL CIRCUIT _ 11 ` Ir 'I 11 �N ZIP EMP.METER OR POLE INS. 20.00 I-�� U f [� n AAPPLICADDRESS MOTORS SEE FEE SCH. l ) SERVICE CHANGE 20.00 L } !>]1~,I '02 - LICEN§ED CONTRACTORS DECLARATION ''ll 1 hereby affirm that I am licensed under provisions of Chapter 9 Ll I .Rlist mNLE 0 T,BA OTa NI w <N (commencing with Section 7000)of Division Sof the Business and gppG� fE - M F 7 z Professions Co e,a license is in full fort a s f e rLLJ� V ll I' .II i o License I Con Numbe 9 w p w Dmc Contractor a sa s BUILDINGPERMIT/ 5 at w a OWNER-BUILDER DECLARATION INFORMATION oAO• MISC.- REFER TO ORD X u-0 I hereby affirm that I am exempt from the Contractor's License VALUATION S/FT. Fww J Law for the following reason.(Sec.•7iresa permit to Professions PERMIT ISSUANCE 10.00 r Code:Mycily or county which reyuiresapermil to construct al ter, R ir 40 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NQ ELEC. - G LL requires,the applicant for such permit to file a signed statement ihat TOTAL P MIT TO ' w 8 a he is licensed pursuant to the provisions of the Contractor's License 1- 2 > Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the a Business and Profession$Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE $ the basis for the alleged exemplim,Any violation of Section 7031.5STOR S TYPE CONSTR. d , by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) $.00 of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP •RES.UNITS their Sale 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 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- GAS-EA.SVSTEM-11NC.40UTLETS 6.00 ments are not intended or offered for sale.If,however,the building 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 im- BUILDING USE prove for purpose of salcJm , INDUSTRIAL WASTE INTER - 30.00 RES IND CON Pit Oar O I,as owner of the properly,am exclusively contracting wi .th ❑ ❑ ❑ ❑ ❑ 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 contracts for such projects vi th„a contructor(sj licensed pursuant[n - th0 1 mclor's cru la�lc y1 / SEWER-SANITARY-STORMAEW/VENEA.200f1/16.00 TRACT NO. PARCEL NO. ❑ tum ext w er Se'c-{{f--F`-- - --,B.&P.C.for this WATER HEATER W/VENT 6.00 reason • Owner Date WATER SYSTEM 5.00 ACC DATE ACC.FILE NO. WORT L'R 'COM F-NSATION DECLARATION WATER TREATING EQUIP. 5.00 ' 1 hereby affirm that 1 have a certificate at consent to self-insure, ZONING ENG.SITE N0. or a certificate of Workers'Compensation Insumnro,or a cerci Ued copy thereof(Sec.3800,Lab.C.).) Policy No. Company I 12,P-leIA^�U- (YI 0 ❑ f'i:rli6ed copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z ErCertified copy is filed with the city inspection division. MISC. REFER TO ORD. O Applicant - • Y ❑ N❑ Y ❑ N❑ ~ vaPERMIT ISSUANCE 10.00 TION LU CIiRTIPICCOMPFNSATE OF ATOPN INSURAONCE WORKERSPLG.CONTR. LIC.NO. PLO. FLOODZONE - A.L.U.C. a O (This section need 'not be completed if the permit is for one _ TOTAL Y❑ N❑ Y❑ N❑ 0 Z hundred dollars($100)or less.) 0 O 1 certify that in the performance of the work for which this per. OT Y. 14 MECHANICAL PERMIT'.` FEE FEE SUMMARY LL 1- mit is issued,I shall not employ any'person in any manner so as to , U become subject to the orkers' m ration Lewe of California. 0 i Date AP licanl ALTER OR ADD TO MECH. 5.00 BUILDING } N NOTICE TO A CA T: 1 , r making'his Certilicute of Ex- F ? eruption,you ah u1 beome s bjc t to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provrvons of Ih b r Cod , y must forthwith comply with AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00 FEE U such provisions I S card s all a deemed revoked. C S UCIFION LENDING AGENCY AIR HANDLING UNIT(OVER IO,OMMC.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the ark for ich his permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 6.00 MICROFILM 3097,Civ.CJ. Lender's Name HEATING UNIT(OVER 100,000 B.T.UJ 9.50 Lender's Address ELECTRIC I certify that I h ve e d chi ap icalkm and state that the above VENTILATION FAN (SINGLE) .4.00 information is mr et. agree to comply with all city and county a PLUMBING ordinances and st to laws relating to building construction, and BOILER-CONRI3H,P.Or100,0008.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL 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 0 CONST.TAX _ may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.0DI gr ati go hit�e�rm�it�. - MECH.CONT. LIC.NO. MECH. U� ig� �fb �l7��( ��013� �� rDTal O TOTAL a Sign of Applican/Contractor Dute A OFFICE COPY