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12267 POST THIS CARD NEAR FRONT OF BUILDING PF,RMIT NUMBER CITY OF CUPERTINO 12 - INSPECTION DIVISION 267 JOB INSPECTION REC RD PERMIT EXPIRATION JOB ADOR S v IIT#` LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU- FOUNDATION, ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED- UNDERGROUND/SLAB PLUMBING ELECTRICAL IssuANce DATE MECHANICAL I BLDG, ELECT. I PLG. MECH. ❑ © ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - INFORMATION VALUATION $/FT. PLUMBING - MECHANICAL ELECTRICAL 'PERMIT TO - FRAMING IlivivId og000 INSULATION - sTORIEy' TYPEDrvsTR. i r c nvl" OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - SO.FT,FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB Other APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ 'El ROUGH ASSESSORS PARCEL NO, - PLUMBING - GAS TEST - - TRACT NO. PARCEL NO, MECHANICAL . .. ACC.GATE r ACG FILE NO. ELECTRICAL �rf.-'9- FINALS . DATE INSP. ' FRAMING SAN # INSULATION PLUMBING - ZONING ENG.SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY Th PA COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE Y [:] Y [:] NE]A.LU.C. LATH—INTERIOR ELECTRICAL ' 'LATH—EXTERIOR ". FIRE DEPT. Y ❑ N❑ Y ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING. SHEAR EXTERIORTEMPORARY APPROVALS BUILDING FIREWALLS ELECTRICPLAN CHECK GAS FEE _. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING S� PLEASE GIVE JOB;ADDRESS WHEN PHONING. 2 - MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONS T`N. PLEASE READ REVERSE SIDE BEFORE CALLING FOWFINAL INSPECTION. TOTAL OFFICE COPY - e APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT nooREss 2 t� Z� I I SAQ7L-Vn pC•� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 1226 OWNER 'Y� N ]. /� (1 ` •' W .��r Zpyix• PLAN CHECK VALIDATION NAME QTY. " ELECTRIC PERMIT FEE fJI0_1 gJIIS PHONE 7-1QxLA CONTRACTORS UTLETS-SWITCHES-RECEP 10,00/1.00 !N NAME LIC.NQ LIGHTING FIXTURES 10.00/1.00 /,1411 ADDRESS DREScTORs DAPPLIANCES-RESIDENTIAL 4.00 CONTRA PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT I PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No. SIGNS TRANS. 3.00 ADDRESS ENS' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE I 20.00 APPLICANT MOTORS• E FEE SCH. •' aooREss "J2rj SO,IJ SERVICE CHANGE 20.0 o o LICENSED CONTRACTORS DECLARATION ¢is�, I hereby aflirm that 1 in licensed undr,po.viskN S of Ch qtr 9 a w (commencing with Section 7000)of Division 3 of the Business and B MECH. H y i Professions Code,and my license is in full force and effect Elo i m o License Class Lic.Number H w r a, Datc Contractor ¢ x s BUILDING PERMIT ¢ a a OWNER-BUILDER DECLARATION o a u INFORMATION w3 LL r I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD VALUa ION r LL o¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 8/FT. Code:Any city or county which requires"permit to construct,alter, �1 rci<a o improve,demolish,or repair any structure,prior m its issuance,also ELEC.CONTR. LIC:NO. ELEC. a, E: eo a requires the applicant for such permil to file a signed statement that TOTAL ZIJI/ PERMIT TO w m he is licensed pursuant to the provisions of the Contractor's License •� Law(Chapter 9(commencingwilh Section 7000)of Division 3 ofthe ¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ l=-$ [fIc basis for the alleged exemption.Any violation of Section 7031.5 STORI g.F`pONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 V-� of not more than five hundred dollars(15001.): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not 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 - s^ lyproperty who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE y; himself or through his own employees,provided that such improve. GAS-EA.SVSTEM-11NC.40UTLETS 6.00 menu are not intended or offered for sale.If,however.the building Or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE ip�holfesxions r will have the burden of proving that he did Got build or inry lorpurposcofsideJ' INDUSTRIALWASTE INTER. 30.00 RES IND CON PB Other I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑d contractors 10 construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contraCHOIs)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00 r- "e D-te6lfIC19r, WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0. WORKFRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconsenl to self-insure, ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Company 0 ❑ Cetlificd copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. O Applicant V ❑ N❑ V ❑ N❑ r2 PERMIT ISSUANCE 10.00 - CERTIFICATE OP'iAEIOTINS FROM WORKERS' FLOOD ZONE A.L.u.C. LU � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLc. CL Z (' Phis section need not be completed if the permit is for one TTOAL Y E] N❑ Y [:] NE] hundred dollars IS 100)or less.) U 0 1 certify that in the performance of the work for which this per, QTY MECHANICAL PERMIT FEE FEE SUMMARY LL F- mit is issued, I shall not employ any person in any manner so as to O W ale pNt°°nt become subject to the Workers'Compensation Laws of California. BUILDING y DAALTER OR ADD TO MECH. 5.00 >_ W NOTICE TO APPLICANT': IL after making this Certificate of Ex- F Z enption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 6 provisions of the Labor Cade, you must forthwith comply will& FEE O U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000C.F.M.) 6.00 SEISMIC FEE 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name Address- HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC t0 Lender's Address I certify door have read this application and state[flat the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and slate laws relating to building construction, and BOILER-OOMP(3H.P.Dr100,000B.T.U.) 6.00 Hereby above-mentioned representatives tunicsec this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL Hereb authorize property forinsp of tion purposes. (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 grialing of tuts permit. MECH.CONT. LIC.NO. MECH. - �•-+ r TOTAL TOTAL Signature of Applicant/Contractor Date OFFICE COPY