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8387 POST THISCARD NEAR FRONT OF BUILDING ' CITY OF. CUPERTINO PERMIT NUMBER INSPECTION,DIVISION r' 8387 JOB INSPECTION RECORD . �d �� 'S• '-'✓"'rTU�' -"�yNN�✓-r�NlT tk.i PERMIT EXPIRATION JOB'ADDRESS _LOT# " PERMIT EXPIRES IF WORK OWNER %v ��. ✓C U CDNTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM UFER _ �Z6'F]� yy -.Jf' /..p- LAST CALLED INSPECTION. H f d K, PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ezk. el-,., UNDERGROUND /SLAB -,F- PLUMBING PLUMBING ELECTRICAL 3 i ( r IS PNC ATE MECHANICAL - - a/ys� BLD & ELECT. PLO. YMECH, r At DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR.., INFORMATION F=AiVALUATION $IFT. PLUMBING - � � - . MECHANICAL ELECTRICAL - PERMIT o FRAMING ' INSULATION - - - , 's RIES • TYPE CONSTR. ♦ Y. ' OCC.GROUP REs.UNITS ' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED _ - ROOF S FT,FLO AI114 TOTAL ACREAGE ti+ DIAPHRAGM iyt BUILDING USE y - ® RES 1 NPB❑ % pOI zfiAPPLV NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ' ' ROUGH 5P RCELNO, PLUMBING - GASTEST , - TRACT NO, PARCELND. MECHANICAL 9XV �• Cex.�wc�i'x ELECTRICAL - FIN S DATE INSP. tNG FRAMING 0 SANINSULATION 0. PLUMBING �p ENG.SITE No. ,90 O fV GAS MECHANICAL D_ �J FIRE SPRINK ENERGY T2< II COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING'-a �(O Y,❑ N❑ Y ❑ - No LATH-INTERIOR ' ELE TRICALFLOOD ZONE A.L,uc..' a- LATH-EXTERIOR (o-4 FIRE DEPT. Y❑ N❑ Y ❑ N❑ SHEETROCK GRADE - FEE SUMMARY SHEAR INTERIOR ' BUILDING SHEAR EXTERIOR (J TEMPORARY APPROVAL BUILDING FIREWALLS ELECTRIC - PLAN CHECK GAS FEE ..,�.✓ NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE _ OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ' . ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC imoIW- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING e za� ' PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! coNsr.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY • - /f APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY M �r PERMIT NUMBER BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT \/ •//// ADDRESSILOING' /DOREag 1- 1 • 3� •StzaIixYO -S U y'' N VR�p BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 8387 OWNERS ./ ' PLAN CHECK VALIDATION TY. ELECTRIC PERMIT .FEE PNONE `� r� NAME CONTRACTORS NAME UTLETS-SWITCHES-RECEP 10.00/1.00 LIC.No. LIGHTING FIXTURES 10.00/1.00 ADDRESS DRs PPLIANCES-RESIDENTIAL 4.00 Egg PHONE PANELS 10.00 DATE OF APPLICATION oARLH(TECT�^ �-1•`V�� PLAN CHECK FEE P.C.NO. R R' PANELS (OVER 200 AMP) 20.00 ENGINEER LIC.No. SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION DOo s� sI�VQQAIO Aye d1 2. SPECIAL CIRCUIT 5.00 c4 ZIP EMP.METER OR POLE INS. 20.00 ADDHEssTg n MOTORS SEE-FEE SCH. 0 N Q P� SERVICE CHANGE 20.00 I �31 /G,(� woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 �� !4L}Airsl•Y < ea I hereby affirm that I am licensed under provisions of Chapter 9 YIgS ANCE DATE y a vAWi (commencing with Section 7000)of Division 3 of the Business and BLD ELECT 8}y;p MECH. F N z Professions Code,and my license is in full force and effect. Q b Z i m o License Class Lie.Number 'It m H j Date Contractor is y E J BE ¢ m 4 OWNER-BUILDER DECLARATION BUILDING PERMIT MISC.- REFER TO ORD INFORMATION E ;LL m I hereby affirm that I am exempt from the Contractor's License VALUATION E/FT. F a_ o j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 LE -7.Code:Any city or county which requires o permit to constn oL.11eq earto improve,demolish.or repair any structure.prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. AD n requires the applicant for such permit to rile a signed statement that TOTAL wm he is licensed pursuant to the provisions of Dm Contnmmr s License PERMIT TO Low(Ch.pter9(commencing with Section 7000)ofDivision 3 ofthe - /Ie-s r"7O/� e F z o Business and Professions Code)or that he is exempt therefrom and CITY. - PLUMBING PERMIT FEE 1001 { e ,1 MI- the basis for the alleged exemption.Anyviolation affection703L5 STORIES TYPE CONSTR. by any applicant fill a perm it subjects the applicant to a eivilpen.lty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(8500)): ❑ I,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 r intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 5.00 Cade: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 gp,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended car of feted for sale.l f,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 • or improvement is sold within one year of completion,tire owner- GAS EASYSTEM OVER 4 IEA) 200 builder will have the burden of proving that Ise did not build or ire - . - . . BUILDING SE prxe for purpose of saE.) - INDUSTRIAL WASTE INTER. 30.00 Eg IND PB Omer A I,as owner of the property,am exclusively contracting with 1:1 E El licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESS7 PARCEL NO. and Professions Code:The Contractor's License Low 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 contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I exempt under Sec. B.M.for this WATER HEATER W/VENT 6.00 reqs s Own r DF1 WATER SYSTEM 5.00 ALL.DATE ACC.FILE NO. RKIiR ' OMPENSA'f10N DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certi0cate of consent m self-insure. or a certificate of Workers'Compensation Insurance,Or.certified ZONING ENG.SITE NO. copy thercof(Sec.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-74 Z Z ❑ Certified copy is riled with the city inspection division. MISC.- REFER TO ORD. O Applicant Y(] IN Y F] N� L5 CERTIFICATE OF EXE MP'fION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. LU 1 COMPIiNSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL O (Phis section need not be completed if the permit is for One TOTAL Y N Y 0 IN =) Z hundred dollars IS 100)or less) L) O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE' FEE SUMMARY" i:I - UL 1- mit is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of California. y Date Applicant BUILDING fJt3 } to NOTICE TO APPLICANT': If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 vr/ Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK prmisions of the Labor Code, you must forthwith comply with FEE �- U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4,00 CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER IQWOC.EM.) 6.00 SEISMIC FEE I 1 hereby affirm that there is a construction lendingagency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sea MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) '8.00 Lender's Nddr H EATING UN IT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC y`^f•-y 1 certify that 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING 1 'ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authentioed representatives for ins inspection this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE-SCH. MECHANICAL r�) above-mentioned property for inspection Purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,j gmeats, costs nd expenses which CONST.TAX in any way .ecru r S.id City in 'onse fence of the PERMIT ISSUANCE' 10.00 gm g Of this perm'. ,l ( - MECH.CONT. LIC.NO. MECH. �� ClY Q TOTAL re of t/Contractor Date TOTAL OFFICE COPY ��GJ /5-,al