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10120A POST THIS CARD NEAR FRON �. CITY OF CUPERTINO-' INSPECTION DIVISION JOB /INSPECTION � RECORD JOB ADDRESS `` `�'4'lVe UNIT# LOT# ' OWNER CONTRACOR /CPFRMITNUMBER 10120 PERMIT EXPIRATION PERMIT EXPIRES IF WORK, IS .NOT STARTED WITHIN; 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. PER T ION, ��QN x' z','�S CltyyOfCD PBlfIDOJ� `ISsu cATE IN PECTION DATE INSPECTOR INSPECTION RECORD I UFER Th PREGUNITE 7-4-rl& 74/05— POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/ SLAB _ _PLUMBING ELECTRICAL MECHANICAL - RLDc. E r PLC. MECR. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLO R PLUMBING MECHANICAL :%- VALUATION $/FT. ELECTRICAL. - PERMIT TO - ✓'� ' FRAMING INSULATION _ STORIES" TYPE CONSTR. C 'E, OCC. GROUP I RES. UNITS l LACE NO SUBFL R UNTIL AB V<E AS BEE S GNED ROOF SO FT, FLOOR AREA TOTAL ACREAGE DIAPHRAGM No��//� — — APPLY NO ROOFING U IL ABOVE HAS BE GNED RVESO ILUCON USEPR OtRei �❑ ❑ ❑ ROUGH JASSESSORS PARC/EL NO. PLUMBING 17 GAS TEST- ./ `Y MECHANICAL TRACT NO / ; I PARCEL NO. ' ELECTRICALACC.DATE 3Q— FINALS DATE INSP. ACC- FILENO. FRAMING INSULATION SAN # PLUMBING zowNc ENG. SITENO. GAS MECHANICAL %-5 FIRE SPRINK Y ❑ N ❑ ENERGY T 24 Y ❑ N ❑ COVER NO WORK UNTIL ABOVE HAS BEEN S GNED HEATING LATH -INTERIOR - ELECTRICAL ,• FLOOD ZONE Y ❑ N❑ A.L.0C. , Y ❑ N[]SHEETROCK LATH-EXTERIORFIRE DEPT. ..� ,,$-- GRADE FEE SUMMARY SHEAR INTERIOR L BUILDING SHEAR EXTERIOR •/%-£rL - TEMPORARY APPROVALS FIREWALLS •ELECTRIC ,2 PLAN CHECK .FEE GAS ' NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGN ED BY BUILDING INSPECTOR. MICROFILM Lu ARRANGE FOR INSPECTION BY PHONING 252.4505, ONE SE VE JOB ADDRESS WHEN PHONING. DAY BEFORE REQUIRED PEcrION. Z'� PLEA =SEE PERMIT FOR EXPIRATION DATE — ELECTRIC PLUM6ING MECHANICAL CONST: TAX IMPORTANT I - PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY , .APPI ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT 10ENTI FICATI ON vd3- APPLICATION &PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER I PAcy, 0 A1:oNEss J0 OWNER'S NAME . CONT W PRONE �f{I o-�V OTY, ELECTRIC PERMIT FEE P AN ff��H K VALIDATION IJ /d 1906 City Of Cupertino DATE OF APPLICATION CONTRACTORS NAME ! CR+RSAK. k l -O uc. No. -SWITCHES -RECEP 10.00/1.00 LIGHTING LIGHTING FIXTURES 10.00/1.00 ADDRESS TOR's OVIBIDNE 74 PPLIANCES'-RESIDENTIAL 4.00 PANELS 10.00 ogcwrecT ENGINEER LIC, NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. ISIGNS TRANS. 3.00 ADDRESSS eea ZIP SPECIALCIRCUIT 5,00 PERMIT VALIDATION 1 SU/ANNCE DATE ELECT. PLG. MECH. ❑ ❑ ❑ TEMP. METER OR POLE INS. 20.00 ADDRESSTs MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business andBLDG. Professions Code, my license is in full force and effect. License Class Le. Number Date Contractor OWNER -BUILDER DECLARATION I hereby affirm that I so exempt 031.5 the Contractor's License Professions Law for the following reason. (Sec. 7031.5, permitto Cade: Any city or county which structure, u tune p riort m consuance, also p structure, prior to its issuance, also improve, demolish, or for such requires n e applicant for such permit to file a signed statement that he is licensed pursuant 10 the provisions of the Contractor's License flue (Chapterand Business Professions Business and Professions Code) or that he is exempt therefrom and Codeng with Section is exempt therefion o 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 of not more than five hundred dollars ($500).) ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not 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 thereon, and who does such work himself Or through his own employees, provided that such improve- mentsarenotintendedorofferedforsale. If, however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving tlsa( he did not build or im- prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, BusinessLAWN 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 contractor(s) licensed pursuant to the Contractor's License Law. ❑ tum exempt under Sec. .0.&P.C. for this Aron TEMP. POLE 30.00/jam(\)/'/{�//WVt - BUILDING PERMIT INFORMATION MISC.- REFER TO ORD PERMIT ISSUANCE. 10.00 VALUATION /^ / �J 000 S/FT. ELEC. CONTR. LIQ NO. ELEC. TOTAL PERMIT TO ✓T l/ DTV. PLUMBING PERMIT FEE STORIES �� TYPE CONSTR. a 1 6 HIZ ALTER-DRAIN&VENT-WATER(EA.) 5.00 BACK F LOW PROTECT. DEVICE 4.00 OCC. GROUP b�' /� RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 5.00 GAS-EA.SYSTEM-11NC.40UTLETS 6.00 50. FT. FLOOR AREA 1/a J TOTAL ACREAGE GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 ILDING RES D CON USE PS Oma, INDUSTRIAL WASTE INTER. 30.00 SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PAR EL NO. on -6#-` Gu SEWER-SANITAR V -STORM EA. 200ft/10.00 R CT O. v-7 PARCEL NO. WATER HEATER W/VENT 6.00 Owner Dote WORKERS'COMPF-NSATION DECLARATION 1 hereby affir th ve a certificate of consent to self -insure, or a cer 'fcate o War ' Compensation ITSu ranee, or a certified copy th r b C Policy AY ❑ Certified c py is hent f fnishe lQCertified cop RI i sty inspection division. AI'fplicant WATER SYSTEM 5.00 ACC. DATE ACC. FILE N0. WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. MISC.- REFER TO ORD. FIRE GPOINK YE] N[] ENERGY T-24 v[] N� CERTIFICA .OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (S 100) or less.) 1 certify that in the performance of the work for which Ibis per- mit is issued, I shall not employ any person in any manner An as to become subject to the Workers' Compensation Laws of California. Date ApplicantALTER PERMIT ISSUANCE 10.00 FLOOD ZONE V N� A.LU.C. Y N� PLG. CONTR. LIC. No. PLG, TOTAL OTY MECHANICAL PERMIT FEE FEE SUMMARY BUILDING G70 -1:L OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of F-x- emption, you should become subject to the Workers'Compensalion provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shull be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.CJ, Lender's Name NamAddress APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=11F.M.) 4.00 PLAN CHECK FEE AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM Lender's 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 stale laws relating to building construction, and hereby authorize representatives of this city to enter upon the .hove -mentioned properly for inspection purposes. (We) agree to save, indemnify and keep hannleu the City of Cupertino against liabilities, judgments, costs and expenses which may is any way accrue ag inst said City in consequence of the granting f this a mll' I�t9 *llA HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC VENTILATION FAN (SINGLE) 4.00 BOILER-COMP(3 H.P. Or 100,0008.T.U.) 6.00 PLUMBING BOILER -COMP to., 100,000 BTU) SEE FEE SCH. MECHANICAL misc.- - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX flew �� MECH. CONT. LIC. N0. MECH. TOTAL TOTAL Signa plicant/Contractor Date OFFICE COPY