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13219o, POST THIS CARD NEAR FRONT -OF BUILDING, - - CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD • G'7 „„%%�� JOB ADDRESS ! / 3a� �i�//%/�iI L^ -"y �+ UNIT# LO OWNER - CONTRACTOR' _ of �' �/ L. PERMIT NUMBER 13219 PERMIT EXPIRATION DERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- •ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION - _ , , qc ' UFER PREGUNITE PERMIT VALIDATION ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL BLD ELECT, 0 PLG, MECH. I ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED J ` BU I L'DING PERMIT .. INFORMATION WOOD FLOOR vALunnpp p SIFT. PLUMBING MECHANICAL ELECTRICAL PERMITTO I FRAMING INSULATION STORIES TYPE CONSTR. - - OCC. GROUP RES, UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - 50. FT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM OUI LOI USE RES ANO CONPB Omur Cl El El 1:1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDEl ROUGH ASSESSORS PARCEL NO. , PLUMBING GAS TEST 1 TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL FINALS ACC.OATE ACC. FILE N0. FRAMING SAN * INSULATION - PLUMBING ZONING. ENG. SITE NG. EDATEINSP. GAS MECHANICAL FIRE SPRINK Y N� ENERGY T-74 Y❑NEE]LATH—INTERIOR COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - ELECTRICAL FLOOD zorvE Y ❑ No A.L.u.c. Y ❑ N❑ LATH—EXTERIOR. FIRE DEPT. SHEETROCK SHEAR.INTERIOR GRADE BUILDING FEE SUMMARY BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC i PLAN CHECK FEE . GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, ARRANGE FOR INSPECTION BY PHONING 252-4505, o�ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE'GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - MICROFILM. ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE, BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .� BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 13 219 BUILDING AOD ss � o NEB's "AME OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHONE CONAcrOR's r N M Cs_lO OUTLETS-SWITCHES-RECEP 10.00/1.00 A.,- FIXTURES 10.00/1.00 'LIGHTING DATE OF APPLICATION CONTRACTOR'SPPLIANCES•flESIDENTIAL s L 2oH L 4.00 PANELS 10.00 ARCHITECT OR ENGMEEfl LIC. No, PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. N0. SIGNS TRANS. 3,00 AARCI+, OR DDRESS ENG, SPECIAL CIRCUIT 5.0Q PERMIT VALIDATION EMP. METER OR POLE INS. 20.00/1'_. ZIP APPLICANT'S ADDRESS MOTORS I }- SEE FEE SCH.L�IMi"�-', SERVICE CHANGE 20.00 �xi LICENSED CONTRACTORS DECLARATION PAID A ,q I hereby affirm Ihat 1 am licensed under provisions O f Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force ey{.?� License Mass 1 Lia Number _ .-l1 Date _L�- Contractor �V1'S F� C / �jx-/V I�SUANCE'DATE" 1 s J BLDG. ❑ I ELECT, I PLG. MECH. ❑ ❑ of Cupertino BUILDING PERMIT OWNER -BUILDER DECLARATION I herebyaffirm that I am exempt from the Contractor's License Law p Business and Professions followingreason- ch req 031.5. Code: Any city Code: Any City Dr Coun pair any structure Permit prior tots issuance, alsoter, improve, demolish, or repair any structure, prior tD its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions at 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 INFORMATION MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 Q � VALUATION $/FT. ELEC. CONTR. LIC. NO. ELEC. W TOTAL t�--- PERMIT TO C '� EL A� OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for rise alleged exemption. Any violation of Section 7031.5 by any applicant to, a permit subjects the applicant roacivil penally of not more than five hundred dollars (55001.): ALTER -DRAIN & VENT -WATER (EA.) 5.00 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended Or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 Code: The Contractor's License Law does not apply to an owner of property who builds Or improves (hereon, and who does such work himself or through his own employees, provided that such improve- mentsarenotintendedoroffered for sale. Il', however, the building F IXTUR ES - PER TRAP 5.00 SO. FT, FLOOR AREA TOTAL ACREAGE GAS-EA.SVSTEM-11NC.40UTLET$ 6,00 or improvement is said within one year of completion, the owner- builder will have the burden of proving that he did not build or im. prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON. PB Otha, ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 - 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 (hereon, 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(s) licensed pursuant ID the Contractor's License Law. SEWER -SAN V -STORM EA. 200ftI10.00 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 ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORK 17RS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent (o self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thertt•[[tf f5e 00, Lab.C.).��ss Policy Narye Company _L..li'l�i'� ❑�, titled copy is hereby intrusted Certifi• c y, is RI w' t peel�y division. Applicant (KIN _ e e LL/y_ FIRE SPRINK Y❑ N❑ ENERGY T-24 Y❑ N❑ MISC.- REFER TO ORD. ' CERTIFICATE OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. COMP17NSAI ION INSURANCE (This section need not be completed if the permit is for one PLG.CONTR. LIC. NO. PLG. TOTAL Y ❑ N❑ Y ❑ N❑ hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per- mit is issued. I shall not employ any person in any Insurer so as In OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Date ApplicantALTER -1'O . . OR ADD TO MECH500 NOl'ICE APPLICANT: If, after making this Certificate of lux emption, you should become subject to the Workers' Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm (hal 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.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Name Lender's Address VENTILATION FAN (SINGLE) 4.00 I certify that I have read I is application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING BOILER- OOMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP Over t00,000BTU) SEE FEE SCM. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned properly tativsp of this purposes. misc.- REFER TO ORD. (We) agree. to save, indemnify and keep harmless the City of C rtim aganst liabilities, judgments, costs and expenses which m y in any way aceagai in consequence of the gr n ng of this per tit. I CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. 6 TOTAL TOTAL Sig ture of pplicant/Contrach Dule OFFICE COPY