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14233 POST THIS CARD NEAR FRONT OF BUILDING NO CITY OF CUPERTINO PERMIT 14233 INSPECTION DIVISION JOB INSPECTION RECORD pl� ,t PERMIT EXPIRATION JOB ADDRESS �?.Jr„3• /L� �0.2 .G, %4-4NIT#k' LOT# -- �J �/A-C-I'< V_ C�O//C7,/ PERMIT EXPIRESIIF WORK OWNER ��/Q. "'�"�� CONTRACTOR GJ L.O r2-$ IS NOT STARTED WITHIN INSPECTION DATE INSPECTORp INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ��l r v eC. ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. UFER PREGUNITE PERMIT vauoanoN) POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB fl r PLUMBINGpi ELECTRICAL •14SSUANCE DATE MECHANICAL D ELECT. PLG. MECH. FEB DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED RNLUUDING PERMIT INFORMATION WOOD FLOOR ALUATION 1OFT. PLUMBING MECHANICAL ELECTRICAL0 . FRAMING INSULATION - STORIES TYPE CONSTR. 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 OM1, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 1-1 1:1 0 ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO, PARCEL NO, MECHANICAL , ELECTRICAL FINALS DATE INSP. ACCDATE ACG FILE NO. FRAMING SAN # INSULATION PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v C] NE Y ❑ "o FLOOD ZONE A.L.U,C. LATH-INTERIOR , ELECTRICAL LATH-EXTERIORFIRE DEPT. d3 ev.v,r Y❑ No Y ❑ NE]SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING i ' SHEAR EXTERIOR TEMPORARY PP OVA BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY,BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL w - CALLING FOR FINAL INSPECTION. OFFICE COPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LD1 NG PROJECT I DENTI FICATION PERMIT NUMBER DING APPLICATION & PERMIT A°OREaa 14233 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ` O rveR's PLAN CHECK VALIDATION "A CITY. ELECTRIC PERMIT FEE (/i/ ✓� � PHONE � �/�� JC N�ONTR CTORS �1.,, OUTLETS-SWITCHES-RECEP 10.0011.00 �7/ 9J- �' jkk MI6 t.t01'I-E-tJ BAQ'S LIGHTING FIXTURES 10.00/1.00 LIC.NO. CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00 .' �aqDRESS�p�_ lS2t� I V^EN11 PHONE 1�•0 PANELS 10:00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. . oR PANELS (OVER 200 AMP) 20.00 ENGINEE (c.No. SIGNS TRANS. 3.00 aRpo�Ry.cO�R EN n (y� PERMIT VALIDATION A IV_ /r�'If/�/4 SPECIAL CIRCUIT 5.00 �.1 zlv EMP.METER OR POLE INS. 20.00 APPLICANT'S �ys MOTORS SEE FEE SCH. PO ADDRESS MOTORS SERVICE CHANGE 20.00 qty woo LICENSED CONTRACTORS DECLARATION nn . Y < L,v I hereby affirm that I am licensed under provisions of Chapter 9 D ISSUANCE DATE < N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. G. MECH. z o3 Professions Code,a my license is in full torefp'� d ( rU{b n}s-.S ❑ License Ch ss Lic.Number y. u O 2 F Dale�r?f/ Contractor ¢y s d BUILDING PERMIT ¢ ¢ w u OWNER-BUILDER DECLARATION INFORMATION X ;e H 1 hereby affrm that 1 am exempt from the Contractors License MISC.- REFER TO ORD LLOQ Law for the following reason.(Sec.7031.5,Booressand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. � - Code:Anycity orcounty which requiresa permit to construct,alter, 3<71 Q'� ELEC.CONTR. LIC.NO. `) is p Q Q improve,deIIlOI15I1,Of re Palr any atr11C1111C,prior ID It415sllanCl`,aI50 ELEC. wm¢ requires the licensed Pursues for the revisit to file i signed actor's i that TOTAL A pcwui_T�� he Is Chaptpursuanten the provisions of the Contractor's s License �V7C� r z a Law(Chapter 9(commencing with Section 7000)uf Division3of this 4 D Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE ¢ H the basis forthealleged exemption.Any violation of Suction7031.5 STORIES TYPE CONSTR. a ; � by any applicant l'or a permit subjects the applicant ton Civil penally ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollar.,($500t): ❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their Sole cola pensalion,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business Died Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does inch work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE himselfor through his own eneployces,provided that Such improve GAS-EA.SVSTEM-11NC.40UTLETS 6.00 Dents arc not intended or offered for sale.11',however,the building or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or im .. BUILDING USE prove for purpose of sale.). INDUSTRIAL.WASTE INTER. 30.00 RES IND CON PB Other ❑ I,as owner of the property.Din exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 6 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:'Fhe Contractor 8 License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractoos)licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have ace ti er ofeemse t to self-insure, ZONING ENG.SITE N0. or a certificate of W rl��Lerjj'Cpp n Insurance,or a certified colic titer f$e�$�P�/.JB.'CV/1v„�� T PolicyNo e" Company _I-�SXfP O ❑ Cerll dCopy ishemb flu Tatted. FIRESPRINK ENERGYT-24 Z 2 wCerti a opy a wl h the city inspection division. MISC.- REFER TO ORD. �J APPlicam I Y❑ N❑ Y❑ "❑ ~ sea PERMIT ISSUANCE 10.00 LU - CERTIFICATE ENI EXEMPTION FROM WORKERS' FLOOD ZONE A.L.u.C. W > COMPIiNSATION INSURANCE PLG.cuNTR. sec.NO. PLG. IL 0 Z (This section need not he completed if the permit is for one TOTAL Y[:] NE] Y[:] ❑ N hundred dollars IS 100)or less.) U O 1 certify that in the performance Of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL {- mit is issued,I shall not employ any person in any manner So as to U become subject to the Workers'Compensation Laws of Calilmmia. U i Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING ��`� } W NOTICE TO APPLICANT: If,after making this Certificate of mix Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCTION LI?NDING AGENCY AIR HANDLING UNIT(OVER I0AOOC.EM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the 3097 performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name H EATI N G U N IT(0 V ER 100,000 B.T.U.)9.50 Lenders Address ELECTRIC I certify that I have read this o application and state that the above VENTILATION FAN (SINGLE) 4.00 information n correct. f agree t°comply with all oily ucti courtly PLUMBING ordinances and state laws relating to building constnrelion, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to roar upon the BID LFR (DVB1100,000 BTU)BEE FEE SCH. MECHANICAL above-mentioned properly for inspection ParPOSCS. (We) agree to save, indemnify and keep harmless the City Of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs :uul expenses which PERMIT ISSUANCE 10.00 CONST.TAX 6ignature any way accrue against Said City in cons'cqucnce of the Of( per MECH.CONT. LIC.NO. MECH. U/�. a TOTAL TOTAL of Arrlicant/Contruclor D:IIL OFFICE COPY