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11145 POST THIS CARD NEAR FRONT OF BUILDING NIaER CITY OF CUPERTINO PERMIT NO INSPECTION DIVISION 11145 JOB INSPECT ON RECORD PERMIT EXPIRATION JOB ADD S I IV� `� UNIT#no--& /� PERMIT EXPIRES IF WORK OWNER Y CONTRACTOR D - IS NOT STARTED WITHIN IN PECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUN DATI N ANCE OR 180 DAYS FROM I LASTCALLED INSPECTION. UFER I PREGUNITE PER NVp LIGATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB {�� ' PLUMBING CI'7 Of CUpertiro ELECTRICAL ISSUANCE,OAT MECHANICAL a UG ELECT. PL❑c. Tcicl F DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - INFORMATION VALUATION $/FT. PLUMBING # MECHANICAL ' " ELECTRICAL- - TTO FRAMING - INSULATION sTORlest T PE cONSTR. OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE HCSIND CON Pa OIl... APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ 0 0 A SESSORS PARCEL NO, - ROUGH PLUMBING Q Tyf - - -• GAS TEST /TRACT NO PARCEL NO. MECHANICAL - " •/ ELECTRICAL FINALS DATE INSP. ACC.DATE ACC FILE NO, FRAMING 2 SAN # . INSULATION � PLUMBING � � ZONING ENGSITE NO, ' GAS FIRESPRINK ENERGY T 24 MECHANICAL Y ❑ NE] P- Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL 'FLOOD ZONE A.LU.C. LATH—EXTERIOR - FIRE DEPT, 'v❑ N] Y I] IN SHEETROCK GRADE ' . FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY.APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE e j OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BYBUILDING INSPECTOR. MICROFILM, ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICLU f II— WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. f — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! �coNsr.rnx PLEASE READ REVERSE SIDE BEFORE ?. TOTAL CALLING'FOR FINAL INSPECTION. `;•/ OFFICE COPY • - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY BU LDING PROJECT IDENTIFICATION PERMIT NUMBER aUILOING APPLICATION & PERMIT Alae BUILDING-ELECTRICAL-PLUMBING-MECHANICAL y OWINeR'a r PLAN CHECK VALIDATION NAME ��Frr QTY. ELECTRIC PERMIT FEE S PMON CONTRACTORS NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 p Lm.NO ILIGHTING FIXTURES 10.00/1.00 CONTRACTORSpPLIANCES-RESIDENTIAL 4.00 ADDRESS] q �j / JZ C4 A QPRONE 7375a3 7 IPANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.0D PLAN CHECK FEE P.C.NO. OR ENGINEER LIC..No. SIGNS TRANS. 3.00 ADDRESS ENG' SPECIAL CIRCUIT 5.00 r� FERMI IDATION �- ZIP EMP.METER OR POLE INS. 20.00 MAT G ,5 1,086 APPLICANTS MOTORS SEE FEE SCH. 'L7 AOORESS SERVICE CHANGE 20.00 City of cumifina w o LICENSED CONTRACTORS DECLARATION Q U ~ I IICTehy affirm, that I am licensed ender provisions of Chapter B ISSUANCE DATE H < (Commencing with Section 7000)of Division 3 of the Business and LD ELECT. PLG. MECH. r ❑ i Professions Co -=nd my license is in full force an effect. b El El 1:12 0 License Class Lic.Number 9 L t w Date Contractor Q'* BUILDING PERMIT w u OWNER-BUILDER DECLARATION - INFORMATION wo> MISC.- REFER TO ORD r I hereby affirm that 1 am exempt from the Contractor's License 3 u y VALUATION $/FT. Fuca Law for the following reason.(he. uire a peminessond Professions PERMIT ISSUANCE 10.00 Code:Any city or county which structure permit to construct,alter. �M 2r G p improve,demolish,of repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 0 LL requires the applicenl for such permil to file a signed statement that TOTAL wm w he is licensed pursuant to the provisions of the Contractor's License RMIT TO ea Law(Chspter 9(commencing with Section 7000)of Division 3 ofthe a Business and Professions Code)or that Ire is exempt therefrom and QTY. PLUMBING PERMIT FEE 'V IS r$ the basis for the alleged exemption.Any violation of Section 703 L5 STORIES TYPE CONSTR. 1)14 i '; _ by any applicant fora permits objectsthe$500).licontmacivil penally ALTER-DRAIN -WATER (EA) 500 of not more than five hundred dollars(5500)) . . : ' ❑ I,as owner of the property,or my employees With wages as BACK FLOW PROTECT. DEVICE 4.00 Oce.GROUP RES.urvlTS 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 . property who builds or improves thereon,into who docs such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1 INC.40UTLETS 6.00 ments are not intended or offered for sale.If,however,the building Or improvement is sold within one year of Completion,the owner. GAS EASYSTEM-OVER 4 IEA ) 200 builder will have the burden of-proving - . . . proving that he did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RE IND CON PB Omer ❑ I,as owner of the property,am exclusively contracting with 0 ❑ 0 ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.8. 6.00 55ESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00 contracts for such projects with a contriclor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT N0. PARCEL NO. ❑ lam exempt under Sea ,B.&I'.C.1'nr Ibis WATER HEATER W/VENT 6.00 reason Owner Dam WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORK F.RS'COMPE:NSATION DECLARATION WATER TREATING EQUIP, 5.00 1 hereby affirm that I have a certificate ol'consenl to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance.or a certified copy thereof f5ec.3800,Lah.Clparty .��,-pl nCc �Company_d< h eby famished. FIRE SPRINK ENERGY LY4 Z Z B 'with tiro city inspection division. MISC.- REFER TO ORD.Q _ Y ❑ NY ❑ N[] IFICATI:OF EXEMPTION 1°ROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0C. 111 _ COhIPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. v N V N d O (This section need not be completed if the permit is for one - TOTAL DZ hundred dollars(S)00)or less) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,1 shall not employ any person in any trimmer to as to O W become subject to the Workers'Compensation Laws of California. y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING ,-D } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- ? Campion,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK provisions 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=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1OPMC.EM.) 6.00 SEISMIC FEE / 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the 3097,CivC once of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC • I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 mform don is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 STU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against y5bilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any ay accrue against said City in consequence of the gran tin of rmiL MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Iry W Signature of Applic ontracmr Dale Ir OFFICE COPY