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13585 L n POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PERMIT NUMBER 13585 INSPECTION DIVISION I JOB INSPECTION RECORD PERMIT EXPIRATION JOBADDRESS .10055 ,MILLER AVENUE - UNIT# LOT# PERMIT EXPIRES IF WORK OWNER THE. KONTRABECKI GROURNTRACTOR - OWNER/BUILDER IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION REC D 180 DAYS OF PERMIT ISSU- FOUNDATION JV.-�_fr- /J ANCE'OR 180.�DAYS FROM LAST CALLED INSPECTION. LIFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB , g/ PLUMBING v/ ELECTRICAL - Y V� ISUANCE DATE MECHANICAL 1 I �`-E ^ BLOG. ELE CT. PLG. MECH. •' �� 1. E 1 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDp ° I� Q� ri1,t BUILDING PERMIT WOOD FLOOR `1 INFORMATION VALUATION $FT. PLUMBING +� ' MECHANICALL � 'PERMIT TO ELECTRICAL I� i FRAMING �/V��E`C iMPRov�l INSULATION ,STORIES TYPE co"srR. ' OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I ' ROOF SO,FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB OIRel APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - - ❑ ❑ El El ❑ ASSESSORS PARCEL NO, ROUGH PLUMBING _ TggCT NO. PARCEL NO. GAS TEST - - MECHANICAL ACC.GATE PCC.FILE N0. ELECTRICAL U•-4 • FINALS DATE . INSP, FRAMING SAN # ZONING ENG.SITE NO. INSULATION_ PLUMBING. .� • - GAS FIRE SPRINK ENERGY T 24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING E] "❑ ❑ NEI LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.0 c. II�� LATH—EXTERIOR FIRE DEPT., v_ Y❑ N❑ .YU N[] SHEETROCK - - GRADE ,. FEESUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING 7 FIREWALLS ELECTRIC: PLAN CHECK GAS - FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE =, OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE.REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESSWHEN.PHONING. Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! TAX PLEASE READ REVERSE SIDE BEFORE - ; CALLING FOR FINAL INSPECTION. TOTAL ., OFFICE COPY .., - 'APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER BUILDING .. - APPLICATION & PERMIT ADOOaREBS15- p�CLe //L' e) q BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 35 5 OWNER' I" PLAN CHECK VALIDATION NAME G�w, �9{Hq -^ QTY. ELECTRIC PERMIT FEE Alma, .r PHONE /00 NAME AcroRs UTLETS-SWITCHES-RECEP 10.00/1.00 097.C./ c.No. LIGHTING FIXTURES _ 10.00/1.00 CONTRACTOR'S PPLIANCES-RESIDENTIAL 4,00 ADDRESS /J ' iJ, PHONE PANELS 10.00 DATE Of APPLICATION ARCHITECT PLAN CHECK FEE OR �• / . Cga9 PANELS (OVER 200 AMP) 20.0000 �- ENGIN .uc.NO. ° SIGNS TRANS. 3.00 ARM.-OR ES _ - PERMIT VALIDATION ARM.-OR SPECIAL CIRCUIT - 5.00 SPA Aleioacl4 zip 7y/dEMP-METER OR POLE INS. 20.00 APPLICANT'S - MOTORS SEE FEE SCH. ADDRESS l-OLf1A�- ,I -Aw • . . SERVICE CHANGE 20.00 u0+09 LICENSED CONTRACTORS DECLARATION - 93 <U w 1 hereby afOrrn that I am Bcenwd under provisions of Chapter 9 ,'Ip%Vn 1 AANCE DATE 2 (commencing with Section 7000)of Division 3 of the Business and - 11L 'BLDG. ELECT. PLG. MECH. 1- z Professions Code,and my license is in full force and effect: V El ❑ 13 c0 u o License Class Lie.Number - ,A H w Date Contractor. , am f , BUILDING PERMIT m(c sai OWNER-BUILDER DECLARATION wr I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION w w VALUATION $/FT. F LOa Law for the following reason,(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 �y w Code:Any city or county whichrequiresapermittoconstruct,alter, S7- Sz G improve,demolish,or repair any structure,prior to Its issuance,also ELEC.CONTR. LIC.NO. ELEC. K 0 Ie requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO X he is licensed pursuant to the provisions of the Contractor's License HIQ Law(Chapter 9(commencing with Section 700mof Division 3 ofthe Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE M 1-0 the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant loa civil penally ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(8500).): ❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT.DEVICE 4.00 OCC.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,AR EA,CON D. 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 TOTALACREAGE himself or through his own employees,provided that such improve- .cuts are not intended or offered for sale.l I;however,the building GAS-EA.SYSTEM-111NC.4OUTLETS 6.00 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 im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB oma, ❑ 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 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 con(ructs for such projects with acontractur(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ttI10.00 the Contractor's Lice Se Law. TRACT NO. PARCEL NO. ❑ lam exempt drSec.' ,RAP,C.far this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.GATE ACC.FILE N0. ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. '5.00 I hereby affirm that I have a certificate of consent to self-insure, ZONING or u certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy thereof(Sec.3800,Lab C.). Policy No. Company 0 .F1- Certifiedc hereby is elf FIRE SPRINK ENERGY T 24 Z Z In ;ff:ertiftel c Uriler tAl�.W)ILiuspection division. MISO.- REFER TO ORD. O/V Applicant [[ V ❑ ry❑ V❑ N❑ ~ yPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. 2 (CERTIFICATE OF EXEMPTION FROM WORKERS' LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. LG P . CL Q (This section need not be completed if Ile permit is for one TOTAL Y C] N❑ Y❑ NC] =) hundreddollars(S100)Or less.)' U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mil is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. 0lu Datc Applicant BUILDING JO YOU a ALTER OR ADD TO MECH. 5.00 tJ } N NOTiOn.TO APPLICANT: If,after making this n'Co pe of fix- ? em vision you the L become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK pr visions of the Labor Code, you must forthwith comply with FEE " U such provisions or this verist shall be deemed revoked, AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00 CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE 14106 I 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(Sec. MICROFILM 3097,CN.C.). a HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name - HEATING UNIT IO VER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct.1 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction,and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter Lion the BOILER-COMP(Over 100,01X1 8TUl SEE FEE SCH. MECHANICAL above-mentioned property far inspection purposes. (We) agree save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino ag ' t liabilities,judgments, costs anJ expenses which PERMIT ISSUANCE 70.00 CONST.TAX may in a w accrue•ngainsj said City in consequence of the grantin this tl[. CV6,11 � MECH.CONT. LIC.NO. MECH. TOTAL 0� TOTAL / •-. nature o` pplicen[IConUactor - Date OFFICE COPY L _ "•;-(-kPPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY r BUILDING PROJECT IDENTIFICATION PERMIT NUMBER �( BmLDINc APPLICATION & PERMIT ADDRESS Op Jars ,A. BUILDING-ELECTRICAL-PLUMBING -MECHANICAL . 13885 WNER'S - PLAN CHECK VALIDATION . NAME T yA / oa PTV. ELECTRIC PERMIT FEE �` , f C O- PHONE / �/ CONTRACTORS L(� OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME r NAME r PIbIArl � � r LIC.I LIGHTING FIXTURES 10.00/1.00 CONTRACTOR R PDREACroRs SS Zl -OZg PPLIANCES-RESIDENTIAL 4.00 ^ (]CT,� q 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 ARCH OR ENG. 5.00 CIRCUIT S.QQ PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS \ MOTORS SEE FEE SCH. e",-)ADOREss SERVICE CHANGE Aj2000 n11 W o o LICENSED CONTRACTORS DECLARATION 9OF 7 u u I hereby affirm that I am licensed under provisions of Chapter 9 (? 1 _ ISSUANCE DATE T (commencing will,Section 7000)of Division 3 of the Business and R n p. BLDG. ELECT. PLG. MECH. r w Profess'. Code rte ply license is in full for�p c x1Qr' ' 0. - License ass LV Lin.Number_•(_jJL .� e ❑ ❑ ❑ w r °w ate Contractor/L.II x s I` C� BUILDING PERMIT IC.w OWNER-BUILDER DECLARATION - INFORMATION E. M0 REFER TO ORD X g;u.w I hereby affirm that I am exempt from the Contractor's License 0_ VALUATION SIFT. F LL m j Law fertile following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, 'Q al¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. - ELEC. / 9Qd i A a, requires the applicant for such permit to file a signed statement that TOTAL ( �U PERMIT TO w $ he is licensed pursuant to the provisions of the Contractor's License 0> Law(Chapter 9(commencing with Section 7000)of Division 3 oftlie CLGrtZ7 a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERM I FEE a 1-0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. uby any applicant for a permit subjects the applicant loo civil penalty ALTER-DRAIN&VENT-WATER .) 5.00 of not more than five hundred dollars($500).): ❑ 1,as owner Of the property,or'my employees with wages as BACK F LO PROTECT.DEVICk. 4,00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-F ,ROOF,ARE D. 5,00 Code:The Contractors License Law does not apply to an ownef of property who builds of improves thereon,and who docs such work FIXTURE -PE TRAP 5,00 - SO,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve mends are not intended.,offered forsale.If,however,the building GAS=EA.SVM-11NC.4 TS 6.00 .r improvement is sold within One year of completion,the owner- GAS-EA.SVS -OVER 4 A.) 2.00 BUILDING USE builder will have the burden of proving flint Ile did not build or lin. - - RES IND CON PB Omer prove for purpose of sale.)., INDUSTRIAL WA EINTE 30.00 ❑ I,as owner of the property,am exclusively contracting with licensed comractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INV45r.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVE (EA.) 1:00 contracts for such projects with a conductors)licensed pursuant to gEWER•SANITAR V-STORM EA.200f[ 10.00 the Contractor's License Law. / TRACT NO. PARCEL NO. ❑ I am exempt under Sea ,B.&P.C.for this WATER HEATER W/VEN 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQU 5.00 Thereby affirm that I have a certifcalc of consent to salf-insure' ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.).G Policy No. Company _ Q CBlllhe op share fume. ed _ FIRE$PRINK ENERGY TQ4 Z O nrti d c y is f will t division. MISC.- - . REFER TO ORD. Y[3 NC] Y ❑ N❑ ~ rn PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. cc CERTIFICATE OF EXEMPTION FROM W KIiRS' W COMPENSATION INSURANC' PLG.CONTR. LIC.No. PLG. v N Y N❑ 0- Z (Thiss-section need not be completed if the permit is for one TOTAL hundred dollars(S 100)or less.) U O 1 certify that in the performance of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I. mil is issued,I shall not employ any person in any Intoner so as to U become subject to the Worker'Compensation Laws of California. UJ OL Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } V) NOTICE TO APPLICANT: If,after making(his Certificate.f Ex- � Z emptier,you should become subject to fhe,Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply will' FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.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 for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 7 Lender's Address - ELECTRIC /aLJ cry I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agreeto comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representutivcs of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE BCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cuperti adjust liabilities,judgments, costs and expenses which PERMIT ISSUANCE - 10.00 CONST.TAX may a way u ,I I most said by in conseq encs of the gr ting this er it. MECH.CONT. LIC.N0. MECH. TOTAL' TOTAL Sign lure of Applicant/Contractor 1 to OFFICE COPY