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135120 POST THIS CARD NEAR FRONT OF BUILDING CITY OF "CUPERTINO F ' INSPECTION DIVISION JOB INSPECTION RECORD `9 JOB ADDRESS D r�SQ'GA 4//"tT# LOT# OWNER !% CONTRACTOR INSP TION DATE INSPECTOR INSPECTION RECOR FOUNDATION 17-$ T cmvnaNW UNDE PLUMBING ELECTRICAL MECHANICAL MECHANICAL INSULATION PLACE NO SUBFLOOR UNTIL ABI ROOF DIAPHRAGM JZM APPLY NO ROOFING UNTIL ABC ROUGH MECHANICAL ELECTRICAL FRAMING INSULATION LATH - VjF .IT1T r -1�., l__ COY Vit.•.. �3 �i01 HAS BEEN SIGNED BEEN SIGNED SHEAR EXTERIOR TEMPORARY APPROVAL FIREWALLS ELECTRIC GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING I uJ ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! PLEASE READ REVERSERSESIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY PFRMI F NUM9ER 13512- PERMIT 3512PERMIT EXPIWA ION 'PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. igpirla 1 11 1 BUILDING PERMIT INFORMATION VALUATION PFji Mll TO1 STORIES TYPECONSTR, OCC GROUv RES. UNITS V \ "t SO. FT. FLOOR AREA TOTAL ACREAGE .RUIIOING USE RES IND CON PB 00M1x, ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. I - / I ' J J Q ZONING FINALS DATE FIRE SPRINK Y ❑ N ❑ SAN # /d, FLOOD$ONE Y N❑ PLUMBING FEE SUMMARY GAS MECHANICAL I WORK UNTIL ABOVE HAS BEEN SIGNED j HEATING ,IOR ELECTRICAL RIOR FIRE DEPT. GRADE 310R BUILDING SHEAR EXTERIOR TEMPORARY APPROVAL FIREWALLS ELECTRIC GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING I uJ ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! PLEASE READ REVERSERSESIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY PFRMI F NUM9ER 13512- PERMIT 3512PERMIT EXPIWA ION 'PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. igpirla 1 11 1 BUILDING PERMIT INFORMATION VALUATION PFji Mll TO1 STORIES TYPECONSTR, OCC GROUv RES. UNITS V \ "t SO. FT. FLOOR AREA TOTAL ACREAGE .RUIIOING USE RES IND CON PB 00M1x, ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. I - / I ' J J Q ZONING I ENG. SITE NO. FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N FLOOD$ONE Y N❑ A.L,U.C. Y N❑ FEE SUMMARY BUILDING PLAN CHECK FEE SEISMIC FEE MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TA U TOTAL APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY . BUI LDI'NG PROJECT 1 DENTI FICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 13512 BUILDING AOORESS/0070 � �� Av-� OWNER'S .AME b�t►�nD 171. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION 31S-- �4 so lOr� `0 j GATE OF APPLICATION NAMEJs„ CONTRACTORS E ' SSK uc. oZ455LIGHTING N.�O OUTLETS-SWITCHES-RECEP 10.0011.00 FIXTURES 10.00/1.00 CONTRACTORaPPLIANCES-RESIDENTIAL 1eDDRESS l Gc tj I 5 low L�{`vHOry 255 !, /FIJI 4.00 PANELS 10.0D ARCHITECT E;RyA,1 IT OR IV�'`T'1W 1 ENGINEER uc. NO, PANELS IOV ER 200 AMP) 2000 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENCU i /t � os YJkw ADDRESS '/mow/ lMiYi) p S r K 7 21P SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ppq 1 PAA, C 3 pS7 a o EMP. METER OR POLE INS. 20.00 APPLICANT ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSCU CONTRACTORS DECLARATION I Imreby affirm that I am licensed of Chapter 9 ISS E DATE (commenting with Section 7000) of the Business and PLG. MECH. royf undervisions Professions Cod d my license is in lilf' lr rLicennyy{{��1.q1sau`7 JDam�J1 Contra11OWNGR-BUILDER BUILDING PERMIT UIION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Businessland Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also INFORMATION MISC.- REFER TO ORD VALUATION / fy/ 0 7 Q ffGG $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions ol'the Contractor's License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Gloat more than five hundred dollars (5500).): TOTAL '`r PERMIT TO O�� zf __r ?LZ /-�4) QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. y ALTER -DRAIN & VENT -WATER (EA.) 5.00 ❑ 1, as owner of the property, or my employees with wages as their Sale compensation, will do the work, and the structure is not intended or offered ]or sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00--FCCGROOP RES. UNITS 9 _- 3 P 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 himself or through his own employees, provided that such improve.6na.+ are not intended or offered for sale. I L however, the building 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- pry for purpose of sale J. L as owner of the property, am exclusively contracting with lived contractors to construct the project (Sec. 7044, Business F IXTUR ES - PER TRAP 5.00 SD.FT . FLOOR AREA TOTAL ACREAGE /47 -mems GAS-EA.SYSTEM-11NC.40UTLETS 6,00 GAS- EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING UB 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 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 3 rq ry / -1 / ^-0?3 contracts for such projects with a contracto s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200f1/10.00 TRACT NO. PARCEL No. WATER HEATER W/VENT 6.00 ❑ I am exempt under Sec.-, B &P.C. for this m1son Owner Dale WATER SYSTEM 5.00 ACC, DATE ACC. FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate ofconscut to w1pirxue, or a cerifmate of Workers' Compensation Insurance, or a certified copy thereof(See. 3800, Lab.C.�� , Policy No. CompumY-1h $�4� LMBg).`t Wi_ ❑ Certified copy is hereby furnished. ! Ceti o is file wi the insp Hon division, ZONING ENG. SITE NO. FIRE SPRINK Y ElN ❑ ENERGY T-24 Y F)N[] MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. CATE OF EXEMPTION FROM WORKERS' PLG. CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANC17 Phis section need or be completed it the permit is for one Y El N ❑ Y ❑ NE]( MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or less) 1 certify that in the performance of the work for which this per -QTY. mit is issued, I shall not employ any person in any manner so as m become subject to the Workcm' Compensation Laws of California Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY BUILDING -� ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT(OVER l(LOWC.F.M.) 6.00 SEISMIC FEE 36A EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, CN.CJ. HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Name Lender's Address I certify that I 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 VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER - COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this City to curer upon Ire above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which y in aI accrue against said City in co eequ nce of the DIs Z �SgZatu MISC. - REFER TO ORD. CONST. TA E( ZZ J X�(O PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL ofA r t/ otractor Date OFFICE COPY