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12492Ii ��► POST THIS CARD NEAR FRONT OF BUILDING ' CITY OF CUPE'RTINO PERMIT NUMBER 12492 INSPECTION DIVISION JOB INSPECTION RECORD { � PERMIT EXPIRATION s� �LdJ,-/ J08 ADDRESS UNIT# LOT#� / n_ Gr'vj- PERMIT EXPIRES IF WORK OWNER / (/G FIC/._. ✓^�% CONTRACTOR C�-�l3'�i=d2 IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION _y _1r- �' � p. QLL ,evz TCANL,' y% LIFER PREGUNITE C&Le- o [w 1 Psjr aT � PE RMIT VALIDATION PAID A 2�" ('7 D G DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICALt MECHANICAL ' SLOG. rr� ELECT. PLG. MECH. ❑ o ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION W WOOD FLOOR VALUATION SIFT. PLUMBING M MECHANICAL ELECTRICAL PERMIT TO j FRAMING INSULATION STORIES i TYPE CONSTR. OCC. GROUP REQS. UNITS PLACE NO SU BFLOOR UNTILABOVE HAS BEEN SIGNED . - ROOF .. SO)iFTPL.COR AREA TOTAL ACRVAGE DIAPHRAGM BUILDING USE RES IND CON PB Oro. Cl ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH • ASSESSORS PARCEL NO. PLUMBING GAS TEST •, PITTA r,e p!F('. TRACT No. PARCEL NO MECHANICAL ELECTRICAL -'-FINALS DATE' INSP. ACC. DATE'- ACC. FILE NO. FRAMING SAN * INSULATION PLUMBING,ZONING � � het' _ jG� ENQSITENO. GAS MECHANICAL -y_ , FIRE SPRINK Y "� ENERGY T ZE ° "� - COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED., HEATING LATH -INTERIOR - ELECTRICAL _ FLOOD zorvE Y ❑ N❑ A. L. u.a Y ❑ No LATH -EXTERIOR _ FIRE DEPT, SHEETROCK GRADE FEESUMMARY SHEAR INTERIORBUILDING j :. _ - BUILDING SHEAR EXTERIORy TEMPORA Y APFPROVALS FIREWALLS - ELECTRIC 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 SIGNED BY BUILDING INSPECTOR. MICROFILM i ARRANGE F,OR INSPECTION BY PHONING 252.4505, ELECTRIC 0�ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. . PLUMBING -SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST. TAX • IMPORTANT! TOTAL f PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY APPS.ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LD1 NG PROJECT I DEN I FICATI ON APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER UMBER ^ 1249 OWNER'S NnmE {NTH TY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION //////�����1 L/ yf`-J", 37- DATE OF APPLICATION corvrRAcroRs NA E _ ppy /eCG©L� LIC. NO. 3/h �/O/ OUTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 f CONTRACTORS ADDR Ess p/ aa�� ��jj`` ^-jj t /IIE,(� /ff/t PRONE D P-35re l PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR d11A&&1iO ENGINEER ��//� TII II 01)671 �rVl/L' LIC. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH, OR ENG. A ,.,) NdP®/'1,4,et 1!W zIP la SPECIALCIRCUIT 5.00 PERMIT VALI DATION PAIp t'1 G / EMP. METER OR POLE INS. 20.00 APIA ADOREasr'S ADDRESS /a�oel./AYDyi.� fyy(p�j�j9 j�5� MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I :un licensed under provisions of Chapter 9 fAt Af Una•AC'r� E DATE (commencing with Section 7000) of Division 3 of the Business andLDG. Professions Code ad my license is in full for a d Ifec{, License Cl ss / Lic. NumM1er / ✓/ ELECT. PLG. MECH. ❑ ❑ ❑ Dmc Contractor BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION " I hereby affirm that I am exempt lions the Contractor's License Law far tireVALUATION following reason. (Sec. 7031.5. Bushossand Professions Code: Any city or county which requires a permit to construct, alto" .MISC.- REFER TO ORD pERMIT ISSUANCE 10.00 p-� S/FT. CONTR. LIC. NO. ELEC. C ELEC. TOTAL improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to Ole 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 ofthe Business and Professions Code) or that he is exempt therefrom and O PERMIT TO A � X'1.10 ��/O w -VI OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation ul'Section 703 L5 by any applicant for a permit subjects the applicant toacivil penalty of not more than five hundred dollars (5$00).1: ALTER -DRAIN -WATER (EA.) 5.00 ❑ 1, as owner of the property, or y employees with ..,as as their sole compensation, will do the wilds, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: Tire Contractor's License Law dnot 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. Stotts are not intended or offered for sale. If, however, the building BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP U_ocs 3 BEs. UNITS / DRAINS -FLOOR, ROOF, AR EA,COND. 5.00 FIXTURES - PER TRAP 5.00 SO, FT. FLOOR AREA / .S (0 3 TOTAL ACREAGE GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or ire- of sale.). prove 1for , aso as oing with ❑ wnernee am of the property, exclusively .7044, GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON Pa Other 0. EIlicensedd INDUSTRIAL WASTE INTER. 30.00 contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law docs not apply owner of who builds r improves thereon, and who to ancontracts LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. h projects t the Cont for such projects with a contortions) licensed pursuant to the Cammcexe License Law. SEWER -SANITARY -STORM EA. 200f1/10.00 TRACT NO. PARCEL N0. ❑ Iwo exempt under Sec. ,li.&P.C. for this rC 18011 WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.OATE ACC. FILE NO, WATER TREATING EQUIP. 5.00 WORKERS-COMPENSA-1'I0N DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, r a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab.CJ.-,ay�.r y,� Policy No. Company ME ❑ Certified copy is hereby furnished ❑ Certifie c p is J w' the city iu edion division. Applicant FIRE SPRINK Y ❑ N ENERGY T]4 Y 0 N[] MISC. - REFER TO ORD. CERTIFICATE 017 EXF.MMQ PROM WORKIiRS' PERMIT ISSUANCE 10.00 FLOOD ZONE A. L. U. L. COMPENSATIONINSURANCE. (Phis section need not be completed if the permit is for one V N V N PLG. CONTR. LIC. NO. PLG. TOTAL hundred dollars (S 100) or less.) I certify that in the performance of the ..,it for which this per- mit is issued, I shall not employ any person in any manner so as m OTV. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING �' become subject to lire Workers' Compensation Laws of California. Date ApplicantALTER NOTICE 'f0 APPLICAN'P If, ufit, making this Certificate of Ex- OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 PLAN CHECK FEE emon, You should become subject to the Workers' Compensation pti provisions of the Labor Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 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 dor whish this permit is issued (Sec. 3097, MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address H EATI NG UN IT (O V ER 100,000 B.T.U.) 9.50 ELECTRIC I certify that I 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 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 100,000BTUI SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harndcss the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the Starting of this 'L 6;11y Q7 �+ MISC. - REFER TO ORD. pERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL TOTAL-� Sign of Applann /Contra [)/a W OFFICE COPY .