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13367 POST THIS CARD NEAR FRONT OF BUILDING ` PERMIT NUMBER CITY OF CUPERTINO 13367 r INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 10501 PINEVILLE - UNIT'#' ' _LOT# PERMIT EXPIRES IF WORK OWNER ESTER CAPULLI CONTRACTOR ANTIQUE TERMITE IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. AWE OR 180 DAYS FROM FOUNDATION LASTCALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB' PLUMBING ELECTRICAL ISSUANCE DATE t BLDG. ELECT. PLG. MECH. MECHANICAL' © ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $&T. PLUMBING MECHANICAL ' PERMIT TO ELECTRICAL I FRAMING7 �� ~ INSULATION STORIES TYPE CONSTR, OCC,GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED / ROOF SO.FT.FLOOR AREA TOTAL ACREAGE 6 DIAPHRAGM BUILDING USE RCS IND CON PB OUrer APPLY NO ROOFING UNTIL ABOVE HAS 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 # .INSULATION PLUMBING ZONING ENG.SITE NO. Qq� GAS FIRE SPRINK ENERGY L MECHANICAL. N COVER NO WORK UNTIL ABOYE HAS BEEN SIGNED HEATING v " 1 v � LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C. LATH-EXTERIOR ' FIRE DEPT. Y❑ N❑ Y ❑ No SHEETROCK GR�AD E �l FEE SUMMARY SHEAR INTERIOR BUILDING ' TEMPORARY APPROVALS BUILDING SHEAR EXTERIOR - FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE'FOR INSPECTION BY PHONING 252.4505, ELECTRIC FW- ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. ` OFFICE.COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER o LOING ADDRESS APPLICATION & PERMIT 13367 /0-.5-01 -P BUILDING -ELECTRICAL-PLUMBING-MECHANICAL I QWNER'SPLAN CHECK VALIDATION NAME tJI/./l OTY. ELECTRIC PERMIT FEE PHUUUNE CONTRACTORS /y��r a,/♦� UTLETS-SWITCHES-RECEP 10.00/1.00 .l. NAME r '�� • �n VIJ 1•-' 1 71�yrylt•II ervn V It..NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR' APPLIANCES-RESIDENTIAL 4.00 ADDRESS (0 V ,5, p{fd a�E• �I PHONE CflS' 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' SPECIAL CIRCUIT SOO PERMIT VALIDATION ADDRESS . Zap EMP.METER OR POLE INS. 20.00 APPLICANTS - MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 Foo LICENSED CONTRACTORS DECLARATION u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE aZw (commencing with Section]000)of Division 3 of the Business and L ELECT. PLG. MECH. 0.z Professions Code,and my license is in full open effec ❑ ❑ ❑ 2 0= License Cl Con Number a o m i w Data - ' y ced -1s tt BUILDINGPERMIT a a w u OWNER-BUILDER DECLARATION 4 INFORMATION ATION wo MISC.- REFER TO ORD ;e N I hereby affirm that am exempt from the Contractor's License VALE JA p $/FT. I- a_ o J Law for the following reason.(Sec.7031.5,Ifusinessand Professions -PERMIT ISSUANCE 10.00 Pt Ij - Code:Any city or county which requires a permit to construct,alter, / p'Q Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.N0. ELEC. i 0 M requires the applicant far such permit to file a signed statement that TOTAL PERMIT T E m he is licensed pursuant to the provisions of Bae Contractor's License r Hi> Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe Vj�weliI[ QY/� a 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. n 3 .. 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(5500).): ❑ 1,as owner of the property,or my employees with wag"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 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his awn employees,provided that Such improve- mentsare not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM-1 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 int- RES IND CON PB Olner prove for purpose of sale.). INDUSTR IAL WASTE INTER. 30.00 ❑ I,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 properly who builds or improves t)ereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law: SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACO.FILE NO, WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a canificate.fcoment lose]f-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING , ENG.SITE NO. copyther f ea 3 p})_Lab.C.lj�- ,t Policy No. I pantfu---T1 II3 O ❑ Certified copy is herebyrnisbed. FIRE SPRINK ENERGY T24 ❑ Certifi��''�cP��N� f+lei�,wit],t��h�eivt��ins�Paction division. MISC.- REFER TO ORD. Z Z Applicant_1;�&ih LU3_T_L�.}f,3 "j ❑ ❑ ❑ ❑ V N V N CC ti CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG. CL Cl (This section Decd not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N ::) Z hundred dollars f$100)or less.) L) O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F- mit is Issued,I shall not employ any person in any manner so as to U become subject to the Workeri Compensation Laws of California. 0. Date Applicant BUILDING �� a ALTER OR ADD TO MECH. 5.00 .3oZ } W NOTICE TO APPLICANT: If,after making this Certificate sa lix- F Z_ emptiu n you should become subject to the Workers'Ccomply with APPLIANCE 5.00 PLAN CHECK provisions io ilia Labor Code, you must forthwith comply with FEE' V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,0000F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=0C.FM.) 6.00 SEISMIC FEE SZO 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. MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100.000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC I certify that I 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 upon the above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCN. MECHANICAL (WC) 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 anyway accrue-against sa�1 City in consequence of the granting o This permit. /) MECH.CONT. .LIC.N0. MECH. -� 3 TOTAL TOTAL 33 , Signature p licant Contractor DatL OFFICE COPY