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13051u POST THIS CARD NEAR FRONT OF BUILDING, CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS, UNIT# LOT 4t OWNER /y 'd 1./CONTRACTOR L, L . ��W aur 7 PF'RMIT NUMBER 13051 PERMIT EXPIRATION ,PERMIT EXPIRES IF WORK IS NOT STARTED. WITHIN 180 DAYS OF PERMIT ISSU- " ANCE OR 180 DAYS FROM LASTCALLED INSP CTION.' INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION LIFER PREGUNITE PERMIT VALIDATION r y, 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 'INFORMATION BUILDING PERMIT • WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL ELECTRICAL _ PERMIT To �'' : 't I " � /' 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 Rlis IND CON PB OFnu! 0 ❑ ❑ ❑ 0 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH" ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT No. PARCEL NO MECHANICAL ELECTRICAL FINALS DATE INSP. ACC.DATE .. ACC. FILE NO. FRAMINGk&n] SAN # INSULATION w PLUMBING ZONING ENG. SITE NO. GAS MECHANICAL ', FIRE SPRINK Y ❑ N[-] ENERGY T�24 Y ❑ No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNM HEATING LATH -INTERIOR ./f - ELECTRICAL FLOOD ZONE Y ❑ NE:l . A. LLLC. Y ❑ N❑ LATH -EXTERIOR FIRE 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 PER UNTIL BUILDING FINAL ISSIGNED BY BUILD ING INSPECTOR. MICROFILM 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 - 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 'BUIL-DING PROJECT IDENTIFICATION APPLICATION & PERMIT - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 13051 BUILDING ADDRESS(7 AL)FBUILDING 1, 21"A K OWNER'S NAME - PHONE OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION coNTRacTOR's N - ME � Lt., No. 455tf3 UTLETS-SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S L,0S i• S ,4.(5) Aoo Ess �3o PHONE "y I APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR ENGINEER LIC. NO. � PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENG.SPECIAL ADDRESS CIRCUIT 5.00 PER MIT VALIDATION EMP. METER OR POLE INS, 20.00 ZIP �..� n^ /� _ x4 &VA_ � 74-7 APPacANra ADDREss (� W,S 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 and TPProfessions Code, A mr license is in lull force s f feu ass - Lic. Number Dale Contractor _ ISSUANCE DATE BLDG. ELECT. PLG. MECH, ❑ ❑ BUILDING PERMIT MATION ATION $/FT, OWNER -BUILDER DECLARATION I hereby affirm that I um exempt from the Contractor's License law for the following reason. (Sec. 703 1.5, Business and Professions Code: Any city or county which re9uiresa permit toconstrua, alter, improve, demolish, or repair any structure, prior to its issuance, also resluens the applicant for such permit 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 oftheo Business and Professions Code) or that he is exempt therefrom and Yl r- MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO �'",Vq /ON QTY. PLUMBING PERMIT FEE TORIES TYPE CONSTR, 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: ALTER -DRAIN -WATER IEA.) 5.00 ❑I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the slrubture is not BACK F LOW PROTECT. DEV ICE 4.00 OCC. GROUP RES. UNITS DRAINS -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 thereon, and who does such work himself or through his awn employees, provided that such improve. ments are not intended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.00 50, FT. F 0008 AREA TOTAL ACREAGE GAS-EA.SVSTEM-11NC.40UTLETS 6.00 0r improvement is sold within one year of completion, the owner- builder will have the burden o' proving that he did not build or inr- prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING USE RES IND CON PB Otho, ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct line project (Sec. 7044, Business and Pmfesslons Codu The Contractor's License Low Anus not Imply, to an owner of property who builds or insproves 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(s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. .200tt/10.00 TRACT NO. PARCEL N0. ❑ Iamcxemptunder. Sec. ,B.&P.C. for flus reason li WATER HEATER W/VENT 6.00 Owner Dae WATER SYSTEM 5.00 ACC. DATE ACC, FILE N0, WATER TREATING EQUIP. 5.00 WORKF.RS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate ofconsent to sel Ginsure, or a certificate of Workers' Compensation Insurance, or It certified , ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab.CJ. Policy No. Company 1YA FIRE SPR INK Y❑ N❑ ENERGY T 24 I Y❑ N❑ ❑' Certified (�' Is hereby hinflaw. �Cerllfied (I is li d 'tin city inspection dlvleiun. Apphcanl t e MISC.- REFER TO ORD. -Cfi FICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ioNE 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 dollar, ($ 100) or less.) I certify that in the performance of the work for which this per- mit is issued, 1 shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ("/ .izi �/ r/� become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this CeRiticale of Ex- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10p00C.F.M.) 4.00 FEE AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE S7D CONSTRUCTION LENDING AGENCY I 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.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT (OVER 100,000 B.T.U.) ELECTRIC Lender's Address I certify that I have read this application and state that the above 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(3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE BCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of Curer agin I I at' I s, judgments, costs and expenses which may n any wa occr a against said City in consequence of the CONST. TAX PERMIT ISSUANCE 10.00 d _ $-2i -� MECH. CONT. LIC. NO. MECH. TOTAL TOTAL OeD r7 Signature of Applicant/Contractor Date OFFICE COPY