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117274 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO. INSPECTION DIVISION JOB INSPECTION RECORD JOB v ADDRESS d.y�J5 Sf2viis Creel: UNIT# OWNER F�AIDATE CONTRACTO INSPECTION INSPECTOR I 4NSPECTIO UFER PREGUNITE PLUMBING ELECTRICAL MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED MECHANICAL ELECTRICAL FRAMING INSULATION DIAPHRAGM APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED PERMIT NUMBER 11727 PERMIT EXPIRATION' _ LOT# PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION It _PERMIT VALIDATION ELECTRICAL 91 -91 - VL I FINALS DATE INSP. FRAMING SAN # 'INSULATION PLUMBING GAS MECHANICAL ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH -INTERIOR ELECTRICAL LATH -EXTERIOR - FIRE DEPT. SHEETR OCK - -' GRADE - SHEARINTERIOR BUILDING SHEAR EXTERIOR - TEMPORARY APPROVAL FIREWALLS ELECTRIC - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED I OCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING I ARRANGE FOR INSPECTION BY PHONING 252-4505, REQUIREDONE WORKING DAY BEFORE ECTION. Z PLE SEE G VE JOB ADDREE S WH NPHONINGP - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY 01,11kol 11 -LE -1 BU L PERMIT INFORMATION I VALUATION SIFT. 4c PERMIT TO P�v,, e IAIM eMIDI HES IND Y❑ N❑I Y❑. N❑ FV O❑DD'ZO [:] VA0 C. NEI ❑ . FEE SUMMARY BUILDING =. PLAN CHECK FEE •- SEISMIC FEE MICROFILM ELECTRIC + PLUMBING MECHANICAL CONST. TAX TOTAL "y - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY BID LD1 NG PROJECT I DENT[ FICATION APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 11727 ADDRESS ©o Ulttvfrug2iz gsy0&ve9sEC. DWNER'$ NAME PHONE Q OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTOR St NAME p7 l3GNt3lZ!'?iC.NO. UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 0 TRA DDns ACONONESE APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 PHONE DATE OF APPLICATION ARCHITECT OR ENGINEER LIC. NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. ISIGNS TRANS. 3.00 ARC.. OR ENG, ADDRESS SPECIAL CIRCUIT 5,00 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 ZIP _ J .O l/L�»T�:,Ir•L�(L�/'� ✓� Q}�dfA(pc APPLICANT SN$ ADDRESS - MOTORS SEE FEE SCH. SERVICE CHANGE Mum LICENSED CONTRACTORS DECLARATION ):; r•' 1 hereby affirm that 1 am licensed under provisions of Clopler 9 (commencing with Section 7000) of Division 3 of the Business and PIOCessions Code, and Illy license IS In full OnCe and effect. License Class Lic. Number Date Contractor ISBUAN E DATE BLDG. EL Ti1 f ) OPIrCi 61F, t1 U r B el II City �� p BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 703 1.5, Businessand ProfessionsPERMIT Code: Any city or county which requiresa 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 MISC. - REFER TO ORD ISSUANCE 10.00 (/ VALUATION 3Jsbo , 00 $/FT. ' ELEC. CONTR. LIC. NO. ELEC. Ob TOTAL GTY. PLUMBING PERMIT FEE PERMIT T JJ 1i1reVQl01f, STORIES TYPE CONSTR. the basis for the alleged exemplion. Any violation Of Section7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Wnore than five hundred dollars(f500)J: IX 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not ALTER -DRAIN -WATER IEA.) 5.00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- meats are not intended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of Completion, the owner. builder will have Ilse burden of proving that he did not build Or im- prove for purpose ofsale.). O I, as owner of the property, ata Cx ClusivCly contracting with . .. GAS - EASYSTEM -OVER 4 IEA) 200 BUILDING USE RES IND CDN PB Coal, ❑ ❑ ❑ 1:1 .Q INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business 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 - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 IEA.) 1.00 ASSESSORS PARCEL NO. Contracts Cor such projects with a contractors) licensed pursuant to the Contractor's License Law. ❑ I am exempt under SSecc.. %n¢� ,BAP.C. for this SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6,00 Owner�•C-a v /'-�'r WATER SYSTEM 5,00 ACC.DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION I hereby affirm (hat I have a certificate Of Consent to sel Giosure' or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE N0. Copy thereoftSec. 3800, Lab C.). Policy No. Company ❑ Certified copy is hereby Nodded. ❑ Certified Copy Is filed with till' City inspection division. Applicant FIRE SPRINK Y C] N ENERGY T 24 Y ❑ NE] MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE (This section peed not be Completed if the Pe nn it is for one PLG. CONTR. I.C. NO. PLG. TOTAL Y CD NE] Y 0 N[3 hundred dollars IS 100),o less.) I certify that in the performance of the work for which this per- mil is issued, I shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING SLl�[.Sa become subject to the Workers' Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, alter making this Certificate of Ex- APPLIANCE 5,00 PLAN CHECK FEE O •3 emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forlhwi ll comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10)000CF.M.) 4.00 AIR HANDLING UNITIOVER 104100GflM.) 6.00 SEISMIC FEE S'D CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 - Ble performance of Ble work for which this permit is issued (Sec. 30 . MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lenader'sder's Name e Lender's Address H EATI NG U N IT (OVER 100,000 B.T.U.) 9.50 ELECTRIC 3 � 1 certify that I have read this application and state its, the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING BOILER- or 100,000 B.T.U.) 6.00 M711(H.P. BAILER -COMP (Oval 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above mmriioned property for inspection purpcle (We) agree to save, indemnify and keep harmless the City of MISC. - REFER TO ORD. Cupertino against liabilities, judgments, costs andexpenses which may in any way accrue against 'id City in Consequence of the r O Elis It. n> PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL TOTAL7 9; Q Signa ure of Appli Dnte OFFICE COPY