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13304II n POST THIS CARD NEARFRONT OFBUILDING•.'� CITY OF CUPERTINO INSPECTION.DIVISION " JOB INSPECTION RECORD -, - JOB ADDRESS •.9 S'S7 ORANGE BLOSSOSI Dk. - UNIT# _ LOT#•V • - OWNER .Norman Wild CONTRACTOR Northland Environment •. PFRMI{'NUMBER - - 13304 •' PERMIT EXPIRATION PERMIT EXPIRES,IF WORK 1S NOT STARTED WITHIN 18O DAYS OF PERMIT ISSU-' ANCE,OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION'RECORD • ! FOUNDATION' UFER PREGUNITE - - - PERMIT VALIDATION ?�_ J. ��/ ISSUANCE DAT POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' UNDERGROUND/SLAB PLUMBING _ ELECTRICAL - MECHANICAL. BLDG. ELECT. 'PLG. I MECH. El 00 NOT POUR FLOOR UNTIL ABOVE HASBEEN SIGNED , . ' - - 'BUILDING PERMIT INFORMATION ' WOOD FLOOR- - -' VALUATION - S/ET. ,PLUMBING - - MECHANICAL •'PERmiT ro ELECTRICAL ,r FRAMING STORIONSTRI INSULATIONOCC. GRNR$ T,�REATCTAL PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNEDROOF$O, Fi. [LOCREAGE DIAPHRAGM 9UI LDING USE RES IND CON PB •00 - 1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. ROUGH. PLUMBING,'' - _ TRACT NO, PAHC[L NO, GAS TEST - .. MECHANICAL .. ACCGATE . ACF FILE NO. ELECTRICAL .FINALS•^', �• DATE �' `�JNSP.-, FRAMING SAN # ZONING ENG. SITE NO. INSULATION PLUMBING b _ GAS FIRE SPRINK ' v.� 'N E] ENERGY T.24 v,�''NO ' - MECHANICAL 'COVER NO. WORK UNTIL ABOVE HAS BEEN',SIGNED: ;-HEATING FLOOOZONE v ❑ •' N .Q A.L U.C. 'v C1 N❑ LATH -INTERIOR ELECTRICAL LATH -EXTERIOR FIRE DEPT.. FEE SUMMARY ;� + SHEETROCK'- GRADE SHEAR INTERIOR. - BUILDING /J BUILDING SHEAR ExTERIORT MPORARY APPROVALS PLAN CHECK FEE _ FIREWALLS ELECTRIC, • GAS SEISMIC FEE `. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCOPANCY, �jkjj Ti - OCCUPANCY OF BUILDINGIS NOT PERMITTED UNTIL' BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ELECTRIC. ARRANGE FOR INSPECTION BY PHONING 252=4505, IJ 'ONE WORKING DAY BEFORE REQUIRED INSP�EOTn I 0- PLEASE GIVE JOB ADDRESS WHEN PHONINOI. �''(!Q}c7 IRO. Z - SEE PERMIT FOR EXPIRATION DATE - PLU'MB'ING MECHANICAL CONST. TAX - 'IMPORTANT! PLEASE,READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION: TOTAL ' % OFFICECOPY All APPLICANT TO FILL 'IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY •BUILDING PROJECT IDENTIFICATION . M APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 13304 BUILDING ADDRESS J , f p� OWNER'S v1 NAME yJ �04/ ND/C /'r AAl WIZ, PHONE - QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION PLAN CHECK FEE P.C. NO. CONTRACTORs NAME n Q d� W,6 P�R1f*1�{/ IC. No. 7� UTLETS -SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR ADDRESS 749 //749 �f-cq 1y0. PHONE - ARCHITECT OR ENGINEER uc.rvO. PPLIANCES-RESIDENTIAL 4.00 PANELS 10.00 PANELS IOVER 200 AMP) 20.00 ,` ISIGNS TRANS. 3.00 ARCH OR ENG. ADDRESS SPECIALCIRCUIT 5.00 PERMIT VALIDATION - EMP. METER OR POLE INS. 20.00 ZIP / 1/\ .. rG�✓ ADDS ESS ra ADDS ESS 21 Z Z63- 54AITD 67AV dje6 ui MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONIRACI'ORS DECLARATION I I hereby affirm that I am licensed Under provisions Of Chapter 9 ISSUANCE DATE (cunhmencing with Section 7000) of Division 3 of the Business and Professions Cod��paany�Ll, ,y license is in full force' feet. License Class �+9 C'.SG Lic. Number Datcry�_u/_Contractor u r / p exie BLDG. ❑ ELECT. ❑ PLG, MECH. ❑ ❑ BUILDING PERMIT OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law forthe following reason. (Sec. 7031.5, Business and Professions INFORMATION MISC: - REFER TO ORD VALUATION $/FT. PERMIT ISSUANCE 10.00 Code: Any city orcourty which requires a permit to construct alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencingwith Section 7000)of Division 3 ofte Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of5ection 703 LS by any applicant fora permit subjects the applicant bar civil penalty of not more than five hundred dollars ($500).): ELEC. CONTR. UC. NO. ELEC. TOTAL PERMIT TO OTY. PLUMBING PERMIT FEE STORIES TYPE CONST . ALTER -DRAIN -WATER IEA.)'S.00 BACK F LOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS ❑ I, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the'structme 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- ments SEC Rot intended oroffered for sale. If, ),owever, the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im- prove for pmpoC ofsWeJ. I ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Other ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00❑ LAWN SPRINKLERS- 1 INC 5,V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code: The Contmclor's License Law does not apply ro 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 contructorls) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER'W/VENT 6.00 C]I am exempt under Sec. ,BAP.C. for this reason Owner Dale - - WATER SYSTEM .5.00 �;,� ACC. DATE ACC. FILE N0, IO WORKERS'COMPENSATN' DECLA RATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of coracrLto self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof [Sec. 3800, Lab.CJ,�A DIF VAL- P licy'No. Company Certified copy is hereby furnished. a Certified copy Is fle It I ' city inspection division. Applicant - CERT'1FICATI:01' INEMPTION FROM WORKERS' FIRE SPRINK v ❑ N ❑ ENERGY T-24 v F] No MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG.CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE This section need not be completed if the permit is for one Y❑. N❑ Y❑ NEII QTY MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or less.) 1 certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of F.x- emplion, you should become subject to the Workers' Compensation Provisions of the labor Code, you most forthwith Comply with such provisions or this permit shall be deemed revoked. DING ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 - N CHECK AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT(OVER 10,000 C. F.M.) 6.00 MIC FEE FFE CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) - 5.00 I hereby affirm that there is a construction lending agency Ior the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). HEATING IT` Tp 100,000 B.T.U.) 8.00ROFILM LL:.YLender's HEATING UNIT (OVER 100,000 B.T.U.)9.50 CTRIC Nanhe Lender's Address I'certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and VENJILATI6N.F AN NG LE) 4.00 PLUMBING ' BOILER-COMP(3 H.P.rb 100,000 B.T.U.) 6.00 BOILEF�-C151JP�„ ). .GOO BTU) SEE FEE SCE. MECHANICAL hereby authorize representatives of this city to enter upon ther above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX (We): agree to save, indemnify and keep harmless the City,. Cupertinoagainst liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the PERMIT ISSUANCE - 10.00 MECH.CONT. LIC. NO. MECH. orAL ' TOTAL ,"oGD grantingoftli t. TA;,- - " Z7� Signature at Appplicant/Contractor '• Date OFFICE COPY