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10791 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PEP\tli NUMBER • 10T9i INSPECTION DIVISION JOB INSP CTION RECORD PERMIT EXPIRATION JOB ADDRESS m" UNIT# LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR / IS NOT STARTED WITHIN INSPECTION ."&,gG;, 4 ATEI:� !INSPECTOR' INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION � ANCE OR 180 DAYS FROM G UFER Ik- P6 � AST CALLED INSPECTION. }./�� ^ F PERMIT VALIDATION DATION K POUR NO CONCRETE UNTIL ABOVE HAS"BEEN SIGNED., 414&UNDERGROUND /SLAB ;L '�/�� "r°'� o- PLUMBING ELECTRICAL jssDAN CE DATE MECHANICAL elOG ELECT. PLC. MECR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION S/FT. MECHANICAL ` ELECTRICAL ERMIT T FRAMING INSULATION STORIES VP oNSTR. OCC GROUP RES.UNITS PLACE NO SUBFLOOWUNTIL"ABOVE HAS BEEN SIGNED'. ROOF SO FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM eulLDwc USE REsIND c ve DRIP,APPLYATROOFING UNTIL ABOVE HAS'BEENSIGNED" ❑ ❑ ❑ ❑ ASSESSORli PARCEL NO. ROUGH PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL G ACC DATE ACG FILE NO. ELECTRICAL :... . NALSY^-Y+° ?'*" DATE' INSP:" FRAMING SAN u INSULATPLUMBING ZONING ENG.SITE N0, ION GAS MECHANICAL �T FIRE SPRINK ENERGY T.Za Y ❑ N Y ❑ N❑ ;COVER NOIWORK UNI OVEMATRE N;SlGNEDOl HEATING LATH—INTERIOR ELECTRICAL _ F LOOD ZONE AL.U.C. LATH—EXTERIOR FIRE DEPT. d' -/�- Y ❑ N❑ Y I] N❑ SHEETROCGRADE :,",.1`l6PEE SUMIMARYr< SHEAR INTERIOR BUILDING _ 6 SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER,UNTIL ABOVE;NAS"BEEN SI ONEDi OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 0� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST.TAX IMPORTANT! 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 LOING PROJECT I DENTI FICATI ON PERMIT NUMBER BUILDING _ APPLICATION & PERMIT ADDROV ( �� STc In� � � 10 7 91 • 1L1`x..t` V BUILDING -ELECTRICAL-PLUMBING -MECHANICAL OWNER'S I ,f D pt( 11�L. e� t: PLAN CHECK VALIDATION NAME 'r Iv•- I"' L%f L�/Y _aj - GTV. ' ELECTRIC'PERMIT FEE' FS ct�a F IXDNE /J4- Ir NAME CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 NAME LIC.No. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR s ADDRESS APPLIANCES-RESIDENTIAL 4.00 A PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT ) PANELS (OVER 200 AMPI 20,00 PLAN CHECK FEE h ENGINEER Lc ,2ACtSSCYi I s 1 LIC.NO C-�SL` SIGNS TRANS. 3.00 ARCH.OR ENG n 01-0 HIDE�EFish1� PERMIT VALIDATION AD'" OF C L- SPECIAL CIRCUIT 5.00 I V ,L.j GFi zIPe)y EMP.METER OR POLE INS. 20.00 -� AESNr's ADDRESS MOTORS SEE FEE SCH. /J C /1e / H SERVICE CHANGE 20.00 � 3 w it o LICENSED CONTRACTORS DECLARATION a v I hereby affirm that 1 am licensed under provisions of Chapter 9 DANCE DATE b< w (commencing with Section 7000)of Division 3 of the Business and B ELECT. PLG. MECH. O i Professions Code,and my license Is in full force and effect. El El El z T W License ClassLie.Number N E J Date Contractor ¢ y IF ., ILMING PERMIT ¢ ¢ w OWNER-BUILDER DECLARA fION 'INFORMATION. X ;Aa.a 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD 1 vALugTjpry SIFT. F LL 0 4 Law for the following reason(Sec.703 L5,Business and Professions PERMIT ISSUANCE 10.00 •Uperll1,V Code:Any city orcounty which requires a permit to construct,alter, Q ez ¢ Lit Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. a F C u requires the applicant for such permit to file a signed statement that TOTAL IIT T F $m he is licensed pursuant to the provisions of the Contractor's License _ F > Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe -: _ r - _ " ' s E c Business and Professions Code)or that he is exempt therefrom and CITY.? 1 PLUMBING PERMIT:,; FEE•_- ¢ $ the basis for the alleged exemption.Any violation Of Section 7031.5 '. + STORIES TYPE ONSTR. d ; by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($500).): O 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS 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,and who does such work FIXTURES-PER TRAP 5.06 SQ FT.FLOOR AREA TOTAL ACREAGE himself through his own employees,provided that such improve- ments arere not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of Completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND O Pia Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed Contractors to construct the project(Sec. 7044.Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSOR PARCELING. 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-OVER 5(EA.) 1.00 contracts for such projects with a contractons)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam xempt under Se ,B.&P.C.for Ills WATER HEATER W/VENT 6.00 X reason Owner aY Dat WATER SYSTEM 5.00 /O/! ACC.DATE ACC.FILE NO. 'I O 5tY 'ATIdF7 EtLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a Certified copy thereof(See.3800,Lab.C.). Policy No. Company Q ❑ Certified copy Is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. MISC. REFER TO ORD. O Applicant Y❑ N❑ Y ❑ N❑ Fy PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. � CERTIFICATE E SATI NINS FROM WORKERS' IL COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG.CL Y❑ N❑ Y ❑ N❑ Z hundred dollars need not be completed if the permit is for one TOTAL hundred dollars(51001 less) N U O I certify that in the performance of the work for which this per. Y:T ,,7 - - FEE SUMMARY DTV:-,r - MECHANICAL.PERNIIT : ., '-FEE'. ly F mit is issued,I shall not employ any person in any manner so as m +.jx ,,:, " U become subject to the Workers'Compensation Laws of California. u Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICE TO APPLICANT: If after making this Certificate of Ex- ? emption,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 10=C.F.M.) 6.00 SEISMIC FEE C� I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the 3097.performance of the work for whish this permit is issued(Sec. HEATING UNIT ITO 100,000 B.T.U.) 8.00 MICROFILM 00 Lender's Na Lender' me HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC s Address I certify that I have read this application and state that the aboveVENTILATION FAN (SINGLE) 4.00 Information IS correct. 1 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 above-mentioned property for inspection purposes. BOILER-COMP love,100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX mBy in any way accrue against said City in consequence of the og'af t is P it MECH.CONT. LIC.NO, MECH. TOTAL TOTAL o A Signature pplic t/Con[racmr Date OFFICE COPY