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12719
1 10 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS � IT# LOT # OWNER - CONTRACTOR' - PFRMIrNUMBER 12719 PERMIT EXPIRATION pERM1T EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION �� _. p✓ KGT' To S�� A o4� LIFER PREGUNITE PERMIT VALIDATION ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL i BLDG, l ELECT. El PLG MECH, ©, 1❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION '/FT. PLUMBING MECHANICAL ELECTRICAL _ vERMlr ra 1 FRAMING INSULATION STORIES TYPE CONSTR. 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 00", ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL FINALS DATE INSP. ACC. DATE ACG FILE NO, FRAMING SAN # INSULATION PLUMBING ow fns ZONING ENG. SITE NO. • GAS RE SPRINK v [] N ENERGY T-24 N� v � C] MECHANICAL Ss8 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING / LATH—INTERIOR ELECTRICAL FLOOD zame Y❑ N[_] A.L.u.0 Yo N❑ LATH—EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING _ SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ' ELECTRIC PLAN CHECK FEE ' GAS SEISMIC FEE j NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY UCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL 19SIGNEO BY BUILDING INSPECTOR. MICROFILM . ARRANGE FOR INSPECTION BY PHONING 252.4505, Z ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLEASE GIVE JOB ADDRESS WHEN:PHONING. -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING f MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING, FOR FINAL INSPECTION. TOTAL OFFICE COPY CITY OF CUPERTINO P.G. &E c COPY ri GAS SERVICE NOTICE I ' To You are hereby authorized to connect the GAS service for Owner or Tenant - f. Ar_ 9 ��st • +• - v New Service -� • .� e No. of Meters Reconnect _ No. of Add. Meters Move Service- " •. Mov eter - PLUMBING INSPECTOR O• w W 2 FOO QVU Gia zoi .0 DyFO BE y BE J 60 w u w3aG FLLo¢ N< J at oma A w in Ie a 3 I A APPLICANT TO FILL IN INF�MMATION_RITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIF TIO APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMITNUMBER 12 719 BUILDING ADORES q ,�s - Lf/ OWNER'S AsOZI QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHONE DATE OF APPLICATION CONTRACTOR NAME NAME �C.Z7 uC.No OUTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 GONTRACTORs AD Ess I ' 1/ 3 TO ��N �W PRONE l 33 APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT - OR ENGINEER LIC. NO. PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. ISIGNS TRANS. 3.00 ARCH. OR ENG. ADDRESS ZIP SPECIALCIRCUIT $,00 PERMIT VALIDATION �L+x / (0 ALICENSED EMP. METER OR POLE INS. 20,00 A ADDRESS MOTORS SEE FEE SCH. 0,00 SERVICE CHANGE RAW CON'TRACT'ORS DECLARATION pQ,B.�j I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cod and my license is in full forCu. gcf c . • License C Lie. Number «f Date Contractor QQ IICS DATE �LDG. ELECT. PLG. MECH. ❑ •*a •iEpE�E./jIE BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (See. 7031.5, Businessand Professions Code: Any city or county which reyuiresa permit to construct, alter, 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 ofthe Business and Professions Code) or that he is exempt therefrom and IREl11,o MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 -O VALUATION $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO ^^ /` � 49/owl �7 Iv OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Seclion 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ALTER -DRAIN -WATER IEA.) 5.00 ❑ 1, as owner of the property, or my employees with wages as their Sole compensation, will do Ole work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR, Code: The Contractor's License Law does not apply to an owner of property who hadds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenotinlendedorofferedforsale. If, however, the building FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTALACREAGE GAS- EA. SYSTEM -1 INC.4 OUTLETS 6.00 or improvement is Sold within Beoyear of completion, the owner- builder will have the burden of proving. that he did not build or im. prove fors owner of sole)' ❑ L as owner of the property, exclusively with GAS - EA. SYSTEM - OVER Efl 4 IEA.) 2.00 BUILDING USE RES IND CON PB Omar ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors m construct the project (Sec. 7044, Business he . 7044,Bu and Professions grope The Contractor's License Law docs not apply to owner of property who builds improves whot LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. rased uand tr to contracts for such projects with a contracmr(sl license) pursuant to tr the Contractor's License La.. SEWER -SANITARY -STORM EA. 2001t/ 10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-, BAP.C. for this ons., l WATER HEATER VPAW 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILENO. WORK ERS'COMPF.NSATION DECLARATION WATER TR EjJftfJ E .l 5.00 1 hereby affirm that I have a certificate of consent to self-instm' or a Certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereo((Sec. 3800, Lab.C.).�r Policy No. Company FIRE SPRINK Y ❑ Not ENERGY T 24 Y ❑ N❑ ❑ Cert it d copy is hereby fumisle J/ ❑ Certif copy fee with IN ty inspection dis iom Applicant MISC.- REFER TO ORD. CER 1 'KATE Op EXEMP'T'ION I. -IOM WORKERS' PERMIT ISSUANCE 10.00 U _ FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLG. � TOTAL COMPENSATION INSURANCE (This Section need not be completed if the permit is for one Y ❑ N ❑ Y ❑ N ❑ handled dollars (S 100) or less.) I certify that in the performance of the work for which it"s per mit is issued, 1 sha11 not employ any person in any manner so as to CITY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING -O 3Jr- s become subject to the Workers' Compensation Laws of California. Date Applicant - ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of E.- candion, you should become subject to the Workers' Compensutiml APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. FEE AIR HANDLING UNIT TO 10=C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10MC.F.M.) 6.00 SEISMIC FEE CONSTRUCt'ION L17NDING AGENCY 1 hereby affirm that there is a construction lending agency fur EXHAUST HOOD (WITH DUCT) 5.00 the 3097 eCi C.)nce of the work for which this permit is issued (Sec. MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC X41- la Lender's Name Lender's Address I certify Ilial 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 relating to building construdion, and VENTILATION FAN (SINGLE) 4.00 PLUMBING O'U BOILER- COMPI3H.P.Or100,000B.T.U.) 6.00 BOILER -COMP (Over 100.000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgnwntS, co Stsand cxpensns which may in any way accrue against said City in c0 sequence of the granting of this permit. CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. PtIrTOTAL TOTAL C U G 6 %g a are fApplican onlraclor Dat OFFICE COPY r