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13022 1ti1, POST THIS CARD NEAR'FRONTOFBUILDING : CITY OF CUPERTINO RMIT NUMBER INSPECTION DIVISION 13022 JOB INSPECTION RECORD I ^ ^ p PERMIT EXPIRATION JOB ADDRESS _ / �lJ L/�/ ;A/ 6/uj ��}N IT# -•LOT# n PERMIT EXPIRES IF WORK OPREGUNITE £ J/,G� �(�G! .CJi D� rZ�`j . IS NOT STARTED WITHIN CONTRACTOR ION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- - ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. PERMIT VALIDATION CRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUN_DJ cI,AB__ PLUMBING _ - '� ELECTRICAL - ISSUANCE DATE - MECHANICAL - BLDG. ELECT. PLG. MECH. w4. ❑_ ❑ Fv ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED' - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATIONSIFT. PLUMBING MECHANICAL ELECTRICAL PERMIT TO FRAMING INSULATION STORIES 9 TYPE CONSTR. - OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED PAID DIAPHRAGM ROOF " I MFT.FLOOR AREA TOTAL ACREAGE A 9�. I BUILDING USE .RES IND CDN PB Ornur APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED City of Cupertino ❑ ❑ ❑ ❑ ❑ ASSESSORS PAR CEL NO. PLUMBING ROUGH - ' GAS TEST - TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL - ACC.DATE ACC.FILE NO. FINALS DATE INSP. FRAMING SAN * - INSULATION PLUMBING ZONING ENO.SITE NO. - GAS FIRE SPRINK ENERGY T2 MECHANICAL v ❑ N❑ Y ❑ N❑ ,COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOODZONE A.L.U,C. LATH-INTERIOR ELECTRICAL LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC i PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM 1 ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Iw-� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. f ' — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICECOPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 13111 LDI NG PROJECT IDENTIFICATION PERMIT NUMBER BU R 'DINc APPLICATION & PERMIT ^ 0 ^ ^ ADDRESS ,1t. t,� �� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I GG OwNER'S U LD PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE 00 PHONE craHs NAME UTLETS-SWITCHES-RECEP 10.00/1.00 NAME q P/ el LIC.ND, LIGHTING FIXTURES 10.00/1.00 ACONTRACTOR PPLIANCES-RESIDENTIAL 4.00 ADDRESS irrt 40of HONE a PANELS 10.00 DATE OF APPLICATION ARCHITECTPANELS (OVER 200 AMP) 20.00 - PLAN CHECK FEE P.C.NO. OR ENGINEER LIc.No. SIGNS TRANS. 3.00 ADORESSs ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 PAID APPLICANT'S - ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 MAY 2 01987 r C O LICENSED CONTRACTORS DECLARATION ¢u u I hereby aft inn that 1 am licensed under provisions of Chapter 9 y2 w (commencing with Section 7000)of Division 3 of the Business and ¢y BLDG. E MECH. F H Z I'rol'Cssions Code, d y in use is in lull force an Q fe L ❑ Z, O m - License Gloss_ •^ Llc,Number-y� o m L Datc_I=L Contractor BUILDING PERMIT ¢ ¢o u OWNER-BUILDER DECLARATION INFORMATION E: g ;u w I hereby infirm that I am exempt from the Contractor's License MISC.- REFER TO ORD ac J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 1000 VALUATION $/FT. w� Code:Any cityorcounty which requires a permit to construct,alter, QSt ¢ Improve,demolish,or repair any structure,prier to Its Issuance,also ELEC.CONTR. LIG NO. ELEC. 4 iL m, requires the applicant for such permit l0 file a Signed statement that TOTAL y�1 PERMIT TO he is licensed pursuant to the provisions of the Contractor's License 1Y1I Hii Law(Chapter 9(commencingwhh Section 7000)of Division 3 ofthe X o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ r m the basis for the alleged exemption,Any violation of Section 7031.5 STORIES TYPE CONSTR. La by any applicant fora permit subjects the applicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars($500).1: O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of . property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 so.FT PLDOR AREA .TOTAL ACREAGE himself or through his own employees,provided that such improve- Dome am not intended or offered for talc.IL however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer O 1,as owner of the property,am exclusively contracting with �' licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASBESBOR$PARC 1:NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who huilds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects will,a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10,00 the Contractor's License Law. D TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6,00 00 reason Owner Date WATER SYSTEM ID 5.00 ACC.DATE ACC.FILE NO. WORKIiRS'COMI'fNSATION DECLARATION WATER TREATING O 15.00 I hemby affirm that I have a cerlllicule of consent to scl Ginwra, or a Certificate of Workers'Compensation Insurance,or a cent.led ZONING ENG.SITE NO. copy thercof(Scc.3800,Lub.Q), ni f_ _/J r Lv Policy ere Company ZQ1t(/S� , 0 ❑ Certi Bed copyis hereby fun she I Z Z 004Ct,nifie B � I city Inspection division. FIRE$PRINK ENERGY T-Z4 O ApplicaMISC.- OORD. nt Y [] N� Y NE] W CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 V40 IV V FLOOD ZONE A.L.U.C. LU COMPFNSA'I ION INSURANCE PLG,CONTR. LIC.NO. PLG. - ? Z (This section need not he completed if the permit Is for one TOTAL `-" Y� N Y E] N hundred dollars IS 100)or less,) U O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is hulled,I shall not employ any person in any manner so as to OW become subject to the Workers'Compensation Laws of California. d Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE TO APPLICANT: If,after making this Certificate of Ex Z sorption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 hereby affirm, that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which thispermitis issued(Sec. MICROFILM 3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC . 1cei-thy that l have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 .information is correct. I agree to comply with all city and county PLUMBING d71 ordinances and state laws relating to building construction, and BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives for ins inspection this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property tativespo fion puity to • (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the 'PERMIT ISSUANCE 10.00 granting of this permit. MECH,CONT. LIC.NO. MECH. TOTAL TOTAL Signature of A pplican t/Contractor Data OFFICE COPY