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13917Ll THIS CARD NEAR FRONT CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION JOB ADDRESS 1182 STAFFORD DR - OWNER HENRY CONTRACTOR OF BUILDING RECORD 1 UNIT# _LOT# OMEGA RNUT NUMBERPOST 13917 PERMIT EXPIRATION + PERMIT EXPIRES IF WORK{ IS NOT STARTED WITHIN'', 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM . LASTCALLED INSPECTION. INSPECTION DATE I INSPECTOR INSPECTION RECORD FOUNDATION UFER PREGUNITE '• P-PERNart VALIDATION ISSUANCE ONTE� POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL MECHANICAL ' BLDG. . ❑ ELECT. PLG. AECH. ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL ELECTRICAL arL--P R/�N+ITTO �L.!"7L FRAMING INSULATION STORIES TYPE CONSTR. OCC. GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF iO. IT FLOOR AREA IOTALACREAGE DIAPHRAGM BUILDING USE HES IND CON PB OMI, ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH A55ESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL EL ELECTRICAL -2Y`S FINALS DATE INSP. ACC.DATE ACC PILE No. FRAMING SAN # INSULATION - PLUMBING ZONING ENO. SITE No. GAS MECHANICAL FIRE SPRINK Y ❑ N 1 ENERGY TQE Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL PLOODZONE Y❑ N❑ A. L, DC. 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 OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING 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 4-;1 = OFFICE COPY w¢Z. H00 QUU N2w Hyi ZOy- QO Y � 0 a¢¢U X 3 A� HULLO] Fw ? F ar ¢_st0 se no �'o Hz40 o U APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING-ELECTRICAL-PLUMBING-MECHANICAL PERMIT NUMBER 13917 BUILDING A°°/aa HOppZ ¢FfDa� D,e. Sij OWNER'S "amEL / C�F PHONE CITY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION CONTRACTOR'S NA mE / 32,UTLETS-SWITCHES-RECEP 10.00/1.00aD LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S DRE5q5 p / p .Q,<J Z00 SOSE PHONEs,.f %80D PPLIANCES-RESIDENTIAL 4.00 PANELS IO.00 ARCHITECT °R ENGINEER LIC. No. PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENG. ADDRESS ZIP - SPECIAL CIRCUIT I 5.00 PERMIT VALIDATION .. .. 1 1 vy'..«'J ISSUANCE DATE BLDG. ELECT. PLG. MECH. ❑ ❑ ❑ TEMP. METER OR POLE INS. 20.00 APPLICANT'S( ADDRESS MOTORS r SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed ander provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, agJ myy license is in full for rId kZtLp License ffyj,Tss GV Co Noor, 3�+G%a(`�- Datc_ y-15-$7 Contractor OWNER -BUILDER DECLARATION I hereby affirm lh at I am exempt from the Contractor's License Law for the following mason. (Sec. 7031.5, Business and Professions Code: Any city or county which requiresa permit to construct, alleq improve, demolish, or repair any structure, prior to its issuance, also requires 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 of the- Business and Professions Code) or that he is exempt therefrom and 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 titan live hundred dollars ($500).) ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code The Contractor's License Law don not apply to an owner of property who builds or improves thereon, and who does such work himselfor through his own employees, provided that such improve- mentsarenotintendedorofferedforsale. If, however, the building or improvement is sold within one year of completion, the owner - builder will [rave the burden of proving that he did not build or im. prove for purpose of the.)' ❑ d as owner of the property, a.he exclusively contracting with licensed contractors to fine C.Dtcn the project (Sec. 7044, Business and n owner of Code: The Contractor's License Law Joos non apply to tr owner of property who builds tr improves thereon, and who contracts for such projects with a cantrumorl s) license.) pursuant to the Contractor's License Law. ❑ lam exempt under Sec. ,B.&P.C. for oris reason "<'.P"-s�•'n'•`I BUILDING PERMIT INFORMATION MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION $/FT, ELEC. CONTE. LIC. NO. ELEC. TOTAL PERMIT To OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN -WATER (EA.) 5.00 BACK F LOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA, COND. 5.00 FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES ❑ I❑ ❑N ❑ Omer INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS -OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 200tt/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 WORK ERS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab.C.). Policy No. Company 's ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 ZONING , ENG. SITE NO. ❑ Certified cap hereby furnished. �Certified y s filed wi le ci pecf t division. Ayp ,Cc C,t FIRE $PEINK Y E] NE] ENERGY T24 Y ❑ NE] MISC. - REFER TO ORD. CERTIFICATE OF E%L'MPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars IS 100) or less.) I certify that in the performance of the work I'or which this per- mil is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of E.- 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 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). Lender's Name Lender's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws mlaliny to building construction, and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in an ay accrue against en ice- m consequence of the granling his Permit' _ oo p PERMIT ISSUANCE 10.00 FLOOD ZONE Y ❑ N A.L.U.C. Y ❑ IN PLG. CONTE. LIC. NO. PLG. TOTAL OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10MOCF.M.) 4.00 AIR HANDLING UNIT (OVER 10MCF.M.) 6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC A OU VENTILATION FAN (SINGLE) 4.00 BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 PLUMBING BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 TAX JCOTNST. MECH. CONT. LIC.NO. MECH. TOTAL OTAL �p ignaturc App t/Contractor t�o� OFFICE COPY