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12174 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMB"I CITY OF, CUPERTINO ' 2174 INSPECTION DIVISION JOB INSPECTION RECORD .• ,SUITE# PERMIT EXPIRATION JOB ADDRESS 10055 ' MILLER AVE. , JTK - UNIT# LOT.# PERMIT EXPIRES IF WORK OWNER KONTRABECKI.•GROUP - CONTRACTOR CAL-AIR, INC. IS 'NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION _ ANCE OR 180 DAYS FROM UFERLAST CALLED INSPECTION. r PREGUNITE. '+ I - - - 1,PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB r' PLUMBING ELECTRICAL - is UANCE DATE / MECHANICAL L 9LOG. •ELECT. PLG. MECH. -/S -7 Q ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIG ED leaf (� / BUILDING PERMIT /L�.! INFORMATION WOOD FLOOR i �'i VALUATION $/FT. PLUMBING .. " MECHANICAL PERMIT TO ELECTRICAL FRAMING + INSULATION - ST RI S.N' TYPE CONSTfI � � � - � , PLAID OCC,GROUP RES.UNITS ,PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED % "• "!L0 ' � FL FLOOR AREA TOTAL ACREAGE ROOF DIAPHRAGM Qf CgQettt euaalNc USE I C3RES IND CON P8 OIRCI 0PPLYAGA0OFING UNTIL ABOVEHAS BEEN SIGNED ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST ,. TRACT NO. •PARCEL NO. MECHANICAL ACC.DATE - ACC.FILE NO. ELECTRICAL "'FINALS DATE INSP. FRAMING + SAN,* ' ZONING ENO.SITE NO. INSULATION- PLUMBING - - GAS FIRE SPRINK ENERGY T-24 MECHANICAL ' COVER-NO WORK;UNTILABO.VE'HAS,BEEN�SIGNEO=:'? HEATING YE] N� Y NC] FLOOD ZONE A.L.U.C.. LATH—INTERIOR- ELECTRICAL LATH—EXTERIOR OGAS PT. pY❑ N� Y ❑ NE] SHEETROCK FEE SUMMARY j SHEAR INTERIOR GSHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS C PLAN CHECK FEE NO.TAPE',OR PLASTER UNTIL ABOVE HAVBEEN SIGNED". OCCUPANCY I "SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED U NTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM AkRANGE FOR_INSPECTION BY PHONING 252-4505, ELECTRIC H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z W 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 nT 41A 5R8IF� IINAPPLICANT TOILN a, APPLICANT WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT �� ^10055 Miller Av., = Suite BUILDING - ELECTRICAL-PLUMBING-MECHANICAL DINNER'S PLAN CHECK VALIDATION {.v t,�,., /�.. QT„Vi '. ELECTRIC PERMIT - FEE _ ." Kontrabecki .Grou PRONE CONTRACTORS NAME UTLETS-SWITCHES-RECEP 10.00/1.00 Cal-Air, Inc. LID.NG137195 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 ADDRESS 1775 S. lst St. S.JVNE .947-0155 PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.NO. SIGNS TRANS. 3.00 AARCH.OR DDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20,00 APPLICANTS i - MOTORS SEE FEE SCH. /,- ADDRESS 1775 S. lst St. San Jose SERVICE CHANGE 20,00 wo O LICENSED CONTRACTORS DECLARATION <u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE s-Gy (commencing with Section 7000)of Division 3 of the Busine55 and BLDG. ELECT. PLG. MECH. N i Professions Co y license is in full fur a 4i z 0. License Cl�qqq Lic.Number, .7 ❑ ❑ ❑ 2 Date�ll�_ 'Contractor - r a Y E o - - BUILDING PERMIT ¢ ¢ ¢ OWNER-BUILDER DECLARATION INFORMATION a0 MISC-- REFER TO ORD . X , ; m 1 hereby affirm that 1 am exempt from the Contractor's Liceme u, in Law for the following reason.(Sec,703 1.5,Busmessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. WM Code:Any city or county which requires a permit to construct,alter, _ a ¢<Q improve;demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. u E D u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w$w he is licensed pursuant to the provisions of the Contractor's License rz > Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe 4 c Business and Professions Code)or that he is exempt therefrom and CITY. 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 to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($500).): ❑ 1,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 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 6.00 SO.FT,FLOOR AREA I, TOTAL ACREAGE himself or through his own employees,provided that such inhprove. Bents are not intended or offered for sale.If,however,the building GAS-EA.ISYSTEM-I INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the 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- prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CDN PB Done, ❑ 1,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 ASSESSORSPARCEL NO. and Professions Cade:The Contractor's License Law docs 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 with a contractors)licensed pursuant to - t e COntmclor's License Le w. SEWER-SANITAR-SANITARY-STORM EA.200ftI10.00 TRACT NO. PARCEL NO. I am exempt under St..-,BAP.C.for this WATER HEATER W/VENT 6.00 Tea no _ Ow er / 11 Data WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO, WORK ERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have.,a certificate ofconsent to self-insure, ora certificate of Workers'Censation Insurance,or u certified ZONING ENG,SITE NO. cop thereof IJIec.3800,Lab.CT j'1P,Y,f T �'..l - v PolicNo.-C-mpany y__ML.tual ' - O crtilicd copy i-hereby ished. FIRE SPRINK ENERGY T24 Z 2• ZLI Certified with lite 'ity inspection division. O Apph a�nt . -]Jf� R MISC.- REFER TO ORD. y ❑ N v ❑ N❑ 2 W f�CERTIFA-1CATh OF F:XEMPTIOII' OM WORKIiRS' PERMIT ISSUANCE 10.00 ,FLOOD ZONE A.L.U.C. LU COMPENSATION IN ^NCE PLG,CONTH. LIC.N0. G. CL O (This section need not be completed if the permit is for one TAL Y❑ N❑ V ❑ N❑ :D Z hundred dollars($100)or less.) U O I certify that in the performance ol'the work for which this per- 6TY. MECHANICAL PERMIT 19x3 ' FEE FEE SUMMARY U. F mit is issued,1 shall not employ any person in any manner So as to 1 U become subject to the Workers'Compensation Laws of California. y Dam Applicant ALTER OR ADD TO M 0 5� BUILDING } W NOTICE TO APPLICANT: If,after making this Certificate of E 11 F" emption,you should become subject to the Workers'Compensation APPLIANCE Cjy PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1 C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000 C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work;or which this permit is issued(Sec. HEATING UNIT(TO 100,000'B.T.U.) g 3097, .00 - MICROFILM 's Na . LenderrName Lender's Address- HEATING UNIT(OVER 100,000 B.T.U.)B.50 ELECTRIC - 1 certify that 1 have read this application and state that the above.. VENTILATION FAN (SINGLE) 4.00 ...i information is correct. I agree to comply with all city and countyPLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or 100,000 B.T.U.) 6.00 'a.. 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 PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the gmntin�g�of this permit. MECH.CONT. LIC.NO. MOTAL q Signature of Applicant/Contracto O e Cal-Air 137195 �/ TOTAL OFFICE COPY