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124310 POSTTHARD NEAR FRONT OF BUILDING • CIl OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDR U # LOT# (� OWNER I O /� CONTRACTOR PERMIT NUMBER 12431 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE I INSPECTOR I SECTION RECORD FOUNDATION - - UFER PREGUNITE PERMIT VALIDATION �i, ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND / SLAB PLUMBING ELECTRICAL MECHANICAL BLDG ELECT. ❑ PLG. MECH, ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED • BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION S/FT. PLUMBING - MECHANICAL ELECTRICAL - - PERMrc O_ FRAMING INSULATION ST RIES TY CONSTR.- -- OCC. GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILOING USE R F.S .IND CON PS Other ❑ ❑ ❑ El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PARCEL NO. - PLUMBING GAS TEST TRACE NO. PARCEL NO MECHANICAL ELECTRICAL FINALS DATE INSP. ACC.DATE ACC. FILE NO. FRAMING 'J SAN # INSULATION � PLUMBING ZONING ENO, SITE NO. GAS MECHANICAL FIRE SPRINK Y [:] N� ENERGY T.y< Y 0 N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH -INTERIOR ELECTRICAL FLOOD ZONE Y[] N A,L.U,C, Y•❑ No LATH-EXTERIORFIRE DEPT, SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR - BUILDING BUILDING . SHEAR EXTERIOR' TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN,CHECK FEE - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, �• ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST. ONST. TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL 71 OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - LISfIORALL POINT PEN ONLY BUILDING PROJECT I DENTI ION APPLICATION & WMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 12431 BUILDING ADDRESS oREss OWNER'S NAME 6/ /1A.4o: q//uiO�)J. PHONE 2SS � aS. QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTORS UTLETS-SWITCHES•RECEP 10.00/1.00 NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTORS CCONCTORS TRA ADDRESS APPLIANCES- RESIDENTIAL 4.00 PANELS 10,00 PHONE DATE OF APPLICATION ARCHITECT OR ENGINEER ' Lie. No. PANELS (OVER 200 AMP) 20,00 'PLAN CHECK FEEF.C. NO. SIGNS TRANS. 3.00 ARCH, OR ADDRESS ENG, I SPECIALCIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 ZIP APPLICANT 5 ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION��e/� I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) Of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. Numher ISSUANCE DATE BLDG. EELLEECT. I PLG. MECH. ❑ ❑ Date I Contractor MIT OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Businessand Professions Code: Anycity orcounty which requires a permit to construct, alter, improve,demolish. or repair any structure, prior to its issuance, also requires file applicant for such perllllt 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 %1111 �J(If� ION TION MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION �/ �,f•W�r[rW�•r{� i1`W7w� g/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO �� / G� /tel TO 9 OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a pemlit subjects the applicant Ina civil penalty of not more than five hundred dollars (5500).): ALTER -DRAIN -WATER (EA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAWS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves therenn, and who does such work himself or through his own employees, provided that such improve- mentsarenotintendedoroffered for sale. If, however, the building FIXTURES - PER TRAP 5,00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM -11 NC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have tire e burden of proving that he did not build or Ise- prove for purpose Of sale.). O 1, as owner of (he property, am exclusively contracting with - . GAS EASYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PS Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER, 30.00 licensed contractors m 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 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a contractor(,) licensed pursuant to the Contractors Lieonse Law. SEWER-SANITAR V -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,BAP.C. for this reason WATER HEATER W/VENT 6.00 .Owner Date WATER SYSTEM 5.00 ACC. DATE ACG. FILE NO. WATER TREATING EQUIP. 5.00 WORKP SCC,PENSATION DECLARATION . I hereby affil I that 1 have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. COPY thereof )Sec. 3800, Lab.C,). Policy No. Company ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city inspection division. Applicant FIRE SPRINK V ❑ N ❑ ENERGY T-24 Y ❑ N❑ MISC. • REFER TO ORD. CERTIFICATE OF: ExrmpT1ON FROM WORKERS' 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 ❑ N❑ hundred dollars (S100) 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 QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING/fa become subject to the Workers' Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 NOTICE. TO APPLICANT: If, after making this Certificate of Ex- emption, you should become subject (o the Workers' Compenmtion provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. APPLIANCE 5.00 AIR HANDLING UNIT TO 10,000C.F.M.) 4.00 PLAN CHECK FEE -7 7 AIR HANDLING UNIT (OVER 10,000CF.M.) 6.00 SEISMIC FEE sa CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued (Sec. 3097, Civ.C.L MICROFILM H EATING UN IT (TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT (OVER 100,000 B.T.U.)9.50 .ELECTRIC Lender's Address I certify that[ haveread this application and stale that theabove VENTILATION FAN(SINGLE) 4.00 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING BOILER -COMP I3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC. - REFER TO ORD. Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 CONST. TAX granting of this petal if. C, « MECH.CONT. LIC. NO. MECH. TOTAL TOTAL G Signature ofA icaml ontructor Data OFFICE COPY