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12727 POST THIS CARD NEAR FRONT OF BUILDINGPERMIT NUMBER CITY OF CUPERTINO 12727 INSPECTION DIVISION • JOB INSPECTION RECORD PERMMEXPI RATION JOB ADDR S �� # T# .PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STAjiTED WITHIN I SPECTION DATE I INSPECTOR I SPE T NRECORD 180.DAYSOFPERMITISSU- TOUNDATION v ANCE OR 180 DAYS FROM I UFER LASTCALLEDINSPECTION. PREGUNITE, PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ✓ UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE� MECHANICAL _ OL G. ELECT. PLG. MECH. El ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR , INFORMATION VALUATION $/FT. PLUMBING MECHANICAL ELECTRICAL - - PERM1 ODJJ�/[v FRAMING INSULATION STORIES, TYPE CONS 41 OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO,FT,FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB Ober ❑ APPLY NO ROOFI G UNTIL ABOVE HAS SIGNED El 1:1 F-1 ❑ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST TRACT NO, PARCEL N0. MECHANICAL - ELECTRICAL - ` 1 . --,FINALS:' r. .. DATE INSP. ACC.DATE. ACC.FILE No. FRAMING P t-b.;&, 'tt[C. SAN # ZONING ENG,SITE NO. INSULATION - - PLUMBING ,. GAS FIRE SPRINK ENERGY T 24 MECHANICAL Y ❑ N❑ Y''❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN S GNEO HEATING FLOOD ZONE A,L.0 L. LATH—INTERIOR - --�2'-S ELECTRICAL. -`G/- LATH—EXTERIOR - - FIRE DEPT. Y❑ "❑ Y❑ N❑ SHEETROCK - GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR. TEMPORAR.YAPPROVALS FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE O,R PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE / OCCUPANCYOF BUILDING IS NOT.PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM' a ARRANGE FOR INSPECTION BY P=PHONING. ELECTRIC ; IQ�', ONE WORKING DAY BEFORE REQPLUMBING IZ PLEASE GIVE JOB ADDRESS WHE- SEE PERMIT FOR EXPIRAMECHANICAL -IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY P.G &E, CITY OF CUPERTINO COPY GAS SERVICE NOTICE , 19� To You are hereby authorized to connect the GAS service for I Owner or Tenant At /n f� /"I'G G 9/1� New Service - No. of Meters Reconnect x No. of Add. Meters Move Service May eter PLUMBING INSPECT O ELECTRIC SERVICE NOTICE P.G.b E.COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO 19 / To You are hereby authorized to Connect electrical service or Owner or Tenant 1W j At /oU-o I No.of Wires Size of Wires Size of Switch Motor Load Voltage Phase ' Herring Load K.W Voltage Li9hr 110-New Service Reconnect 11 No.of Meters Heor IPO-Three Wire More Service.._ No.of Add,Meters Power Three Phcse Move Meter Q• ELECTRICAL INSPECTOR L APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER \' BUILDING - APPLICATION & PERMIT 12727 �r ADDRESS ' / � BUILDING- ELECTRICAL-PLUMBING-MECHANICAL OWNER'S - PLAN CHECK VALIDATION "AME ;•OT�Y. ELECTRIC PERMIT FEE 4NOPHONE NAME c OR OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME uC.No, LIGHTING FIXTURES 10.00/1.00 ADDRESS 9%0r- roll's APPLIANCES-RESIDENTIAL 4.00 DREss I NE PANELS ' 10.00 DATE OF APPLICATION ORCHlrscrPANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc.No. ISIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS: 20.00 APPLICANTS - MOTORS SEE FEE SCH. n ADDRESS `� SERVICE CHANGE 20.00 //q, p•�// u0+o o LICENSED CONTRACTORS DECLARATION ry/a / a u 1 hereby affirm That f am license)under provisions of Chapter 9 ISSUANCE DATE Z w (Commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. G 'a" Professions Co any m license is in full for s�Jf I. ❑ ❑ Z o N- License Cl in y Lie.Number _�1 �- 4 m = w Dale 1-'J_„!c7- Cnntruclor , ¢ x s '' BUILDING PERMIT ¢ a ¢ OWNER-BUILDER DECLARATION I F TION doa" MISC.- REFER TO ORD x ;u y I hereby affirm that I am exempt from the Contracmr's License V U I $/FT. p1o. 0¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 y w Code:Any city or county which requires permit to construct,aller, -R o-Q--O - ¢ < improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. i' ELEC. is 0 u requires the applicant for such permit to file a signed statement that TOTAL 0 whe is licensed pursuant to the provisions of the Contractor's License 's > Law(Chapter 9(commencing with Section 7000)of Division 3 often, i ¢ Business and Profession.Cade)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE / /RZE ¢ 0 the basis for the alleged exemption.Any violation of$eclion 7031.5 1 STORIES TYPE CONSTR. n3$ by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN&VENT-WATER (EA.) 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 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 Profeanons 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- mentsamnolintendedorofferedforsalc.IL however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 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 PS other CII,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 docs not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 con tracts for such projects with a mntractor0l licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. Cl I am exempt under Sec. ,W&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm (hat I have a certificate ofconsenl to sell-insure, _r or a certificate of Workers'Compensation InsuraNce,or a cerlifiLd ZONING ENG.SITE N0. ,�1 copy thereeoQf IS c.3�800,L.b.C.1 Policy No.lL`ACN.CI�ompanY-u-5_F-f_� O ❑ Ce tifiedcopy Icreb rnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Cer -c ys�. ith t cililh t cit- ins cel ion'tlivision. O APPIICa111 MISC.- REFER TO ORD. Y❑ . N❑ v ❑ N❑ ~ vaPERMIT ISSUANCE 10.00 � - CERTIFICATIi OP IiXF:MPTION FROM WORKERS' FLOOD ZONE A.L.D,C. UJ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG, CL 0 (This section need not he completed if the permit is for one TOTAL Y E) N❑ Y❑ N❑ Z hundred dollars IS 100)Gr less) U 0 1 certify that in the pcomonance of the work for which this per, CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,1 shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. m Date ApplicantBUILDING �•- SD NOTICE.TO APPLICANT:'H,u1'ter making this CLHilicatc of Ex- ALTER OR ADD TO MECH. 5.00 Z emptlon,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith Comply with FEE C..) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10ACC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE. I hereby affirm that them 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,CmC). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lenders Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with allcity and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP IOVBl 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 exMnses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the ofThis permit MECH.CONT. LIC.NO. MECH. r _ T TOTAL TOTAL x Sign mof pplimnt/Con cror Date OFFICE COPY - I