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12438POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORDepnhL J� ,�� ,�• 1 / / JOB ADDRESS �G�'��"'°" LvOT# OWNER CONTRACTOR 7fl5T PERMIT NUMBER 1243$ PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION E I INSPECTOR 1 S ECT ON RECORD FOUNDATION - LIFER PREGUNITE PERMIT VALIDATION ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL I .e*UI ELEc . PLA, ME R ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED y DING PERMI INFORMATION WOOD FLOOR VALUATION , SIFT. PLUMBING � MECHANICAL ELECTRICAL PERM O TY 'ON ' O IES E ONSTR. FRAMING INSULATION OCC, GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF $O FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM 9ulLO USE HIS IMO CON PR omr, 1:1 0 1:1 I]. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH _ ASSESSORS PARCEL NO. PLUMBING GASTEST TRACT NO, PARCEL NO. MECHANICAL ELECTRICAL FINALS DATE INSP. ACC. DATE ACC. FILE NO, FRAMING SAN # INSULATION PLUMBING ZONING ENG. SITE NO. GAS FIRE SPRINK Y ❑ NF] ENERGYT24 Y [3 No MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE Y❑. NQ A.L. U.C. YC] N❑ LATH—INTERIOR ELECTRICAL LATH -EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR - BUILDING i BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN'CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILMLU - ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLEASE GIVE JOB ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL /0�"' OFFICE COPY _ / APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY V BUILDING PROJECT IDENTIFICATION APPLICATION &PERMIT UILDING- ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 12438 BUILDING A�RESa OWNER'S NAME K �QlY P ONE QTY. ELECTRIC PERMIT FEECONT PLAN CHECK VALIDATION /(J�/�/J�qU\ Vf 'L I , NAME croRs NAME ` OUTLETS -SWITCHES -RECEP 10.00/1.00 hionz �iVPC. NO. D LIGHTING FIXTURES 10.00/1.00 C)� DATE OF APPLICATION CONTRACTORS ADDRESS Z.(�: ljj PHOxE /t37J APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 6 ARC CT(1� OR (' is ANELS (OVER 200 AMP) 20.00 - PLAN CHECK FEE PP.C.NO. SIGNS TRANS. '3.00 ENGINES f.NV LIC. NO. AARCH DDH OR ENG. �•^^ SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 ZIP 7 ADDRESiTs MOTORS SCH. SERVICE CHANGE v� ' LICENSED CONTRACTORS DECLARATION city (A I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and ( Professions Cnde• y license is in full for I rap BLD CT. P MECH. License Clay Number Con Contractor _ Date nom. DING PERMIT BUILORMATION INFORMATION J� OWNER -BUILDER DECLAR ION I hereby affirm that I am exempt from the Contractor's License Law far the following reason. (Sec. 7031.5, Business and Professions Code: Any city or county which requiresa permit to construct, alter,/lw_a 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 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and MISC. - REFER TO ORD C+�" $/FT. PERMIT ISSUANCE 10.0060VALUATION EL C. CONTR. U NO. ELEC. , / ti TOTAL T /•(/"TER y PERPER MIT TO /H ('10 (. gr OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. Ilse basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of nol mom than five hundred dollars (5500).): ALTER -WATER (EA.) 5.00 ❑ I, as owner of the property, or my employees with wages as sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4,00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.0 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner al' property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenetintendedoroffered for sale. If, however, the building F IXTUR ES - PER TRAP "o SO, FT. FLOOR AREA TOTAL ACREAGE GAS-EA.SYSTEM-11NC.40UTLET 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 int. prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA. 2.00 BUILDING USE HES IND CON PB Omar ❑ ❑ ❑ ❑ ❑ I NDUSTR IAL WASTE I NTER. 30.00 LAWN SPRINKLERS - 1 IN V.B. 6.00 LAWN SPRINKLERS • 0 R 5 (EA.) 1.00 ASSESSORS PARCEL NO. licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. SEWERSANITARY•S RM EA. 200ft 10.00 / TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec.., B.&P.C. for this reason WATER HEATER PfVENT 6.00 Owner Date WATER SYSTE 5.00 ACC. DATE ACC. FILE NO. WATER TR TING EQUIP. 5.00 WORKF.RS'COMPENSATION DECLARATION 1 hereby aff, that I have a certificate ofconsent to self -insure, Insurance, or a Certified copy thereof ISec. 3800, Lab.CPolicy or a certificate of Workers' Co4.11:1uscity ZONING ENG. SITE N0. No. Cdied FIRE SPRINK Y❑ N❑ ENERGY T 24 Y❑ N❑ copy ahereb Certified hts ection division. pplicant M C.- REFER TO ORD. CERTI FICA'f: EXEMPTION FROM WORKERS' ERMIT ISSUANCE 10.00 FLOOD ZONE A. L. u.C. PL .CONTR. LIC. No. PLc. TOTAL CO ',NSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ N ❑ Y ❑ N ❑ QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars(SI00) orlessJ 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 BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, atter making this Certificate of Ex ALTER OR ADD TO MECH. 5.00 -�' APPLIANCE 5.00 PLAN CHECK 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. AIR HANDLING UNIT (TO 10=C.F.M.) 4 FEE AIRHANDLINGUNIT (OVER 101000C. SEISMIC FEE aD`� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of if,. work for which this permit is issued (Set. 3097, Civ.C.). MICROFILM HEATING UNIT (TO 100,000 B.T. HEATING UNIT (OVER 100,000 .)9.50 \n ELECTRIC OD Lender's Name Lender's Address 1 certify that I have. read this application and slate 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) PLUMBING BOILER- COMP I3 H.P. or 100,000 B.T. 6.00 BOILER -COMP (Ove100 000 BTU) BEE FEE SCH r ,. MECHANICAL •-�7 AS hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. Ni REFER TO ORD. (We) agree to Save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in an way accrue against mid City in copse uence of the grat (h' mils(, i CONST. TAX •- MIT ISSUANCE 10.00 C. LIC N0. MOETAL �.] F�fP TOTAL 00 -.- Signatu a iftApplicant/Contractor ate OFFICECOPY