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11785 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY' OF CUPERTINO 11785 INSPECTION DIVISION JOB INSPECTION RECORD • � PER 1(v 1T EXPIRATION JOBADDRESS_``�•�� SIF uE"� UNIT 4;&--LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPEC 0 ATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. UFER PERMIT VALIDATION PREGUNITE - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ' ELECTRICAL - - ISSUANCE DATE � MECHANICAL- - BLDG. ELECT. PLG. ECH. aI ❑ El ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT, PLUMBING MECHANICAL PERMIT TO ELECTRICAL :•.Y J FRAMING T' _ STORIES TVP[CONSTRT INSULATION, ' OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO,FT.FLOORAREA .TOTAL ALREAG DIAPHRAGM �\l HES IND BUILDINGUSEUSEPB Omer APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST TRAcI No. PARCEL NO. MECHANICAL - ELECTRICAL FINALS DATE INSP. ACC DATE ACC.FILE NO. FRAMING SAN * - ZONING ENG.SITE NO. INSULATION - - PLUMBING GAS MECHANICAL. FIRE SPRINK ENERGY T2-COVER NO WORK UNTIL-ABOVE HAS BEEN SIGNED HEATING Y ❑ NO Y ❑ No LATH-INTERIOR - � � ELECTRICALS FLOOD ZONE A.L.U.C. LATH-EXTERIOR - FIRE DEPT. Y[:] NO Y0 N SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING -2. BUILDING ' SHEAR EXTERIOR 4 TEMPORARY APPROVALS I,' I FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINALISSIGNEDBYBUILDING INSPECTOR. MICROFILM. I I ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC • Fw- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 7 z PLEASE GIVE'JOB ADDRESS WHEN PHONING: I ' — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.rax PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER BUILDING APPLICATION & PERMIT 11785 ADDRESS 203&10 Y� �� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME PHONE OTY. ELECTRIC PERMIT FEE PWO 'C �;St y Ss�`J, d9 I z , �( ` - NAME croRs UTLETS-SWITCHES-RECEP 70.0011.00 NAME G/tRL3C�tJ' C.NO.Q"• LIGHTING FIXTURES 10.00/1,00 CONTRASDDRESS OR's APPLIANCES-RESIDENTIAL 4.00 PHONE 2571 PANELS 10.06 DATE OF APPLICATION RCH?ECT PANELS (OVER 200 AMP) 20,06 PLAN CHECK FEE P.C.NO. O OR ENGINEER HOK uc.No. SIGNS TRANS. 3.00 ,ys . ADDRESS ENc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION \ �rlDRtcO JC, :FI "p-tArr,% TEMP.METER OR POLE INS. 20.00 " 'I} 7 APPLICANT'S MOTORS SEE FEE SCH. •U v �-4L-y-� ADDRESS 2CCK= gCrg-_� SERVICE CHANGE 20.00 oO LICENSED CON TRACTORS DECLA RATION a v I hereby aftirn that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE 2 (commencing with Section 7000)of Division 3 Of the Business and BLDG. ELECT. I PLG, MECH. Professions Code,and my license is in full force and effect z 00.-- License Class Lie.Number ❑ ❑ ❑ mH w Dale Contruclor m f - BUILDING PERMIT a wat OWNER-BUILDER DECLARATION w ;y I hereby affirm that I um exempt from the Contractor's License MISC.- -REFER TO ORD INFORMATION uoj Law for the fallowing reason.(Sec.703 1,5,Businessand Professions - PERMIT ISSUANCE _ 10.00 VALUATION $/FT. � - Code:Any city orcounty which requiresa permil to construct,alter, SC Q Q Q Improve,demDhsh,or repair any structure,prior to Its issuance,also ELEC.CONTR. LIC NO. ELEC. 1 D LL requires the applicant for such permit to file a sighed statement that TOTAL v PERMIT TO u w m lie is licensed pursuant to the provisions of the Contractor's License is rz> Law(Chapter 9(eommencingwith Section 7000)of Division 3 of the Iq W rSJ1hl (� a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE r $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER=DRAIN&VENT-WATER IEA.) 5.00 of not more than five hundred dollars(S500)J: ❑ [,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS 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 F IXTUR ES-PER TRAP 5.60 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve men's are not intended or offered for sure.l r,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 , or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or intGAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE- provy r purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES WD CON PB Omer Ne I,as owner of tire property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed Contras to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions de:The Contractor's License Law does not apply _ to an owner of roperty who builds or improves thereon,:rad who LAWN SPRINKLERS-OVER 5(EA.) 1,00 contracts fo ch p ojects or a convactods)licensed pursuant to SEWER-SANITARY-STORM EA.200h/10.00 the Contra is cnec .TRACT NO. PARCEL NO. ❑ la re d ,BAP.C,fur this WATER HEATER W/VENT 6.00 reason owner - DueIF WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconamu to sell'-insure, -' ZONING or a certificate of Workers'Compensation Insurance,or a Certified ENG.SITE NO. copy thereof(Sec.3800,LaRC.). Policy No. Company Q ❑ Ce,ifiedcnpyishCrebyfu...shed. FIRESPRINK ENERGY T 24 Z Z ❑ Certified copy is filed with the city inspection division. REFER TO ORD MISC.- . O Applicant Y ❑ N❑ Y ❑ N❑ ~ rn CERTIFICATE PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU W COMPEIiNSA'1'ION EXEMPTION PROM WORKERS'INSURANCE. PLG.CONTR, LIC.NO. PLG. YE] N❑ Y ❑ NE]Z (This section need not be Completed if the permit is for one - TOTAL hundred dollars($100)or IC,) L) O 1 certify that in the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,I shall not employ any person in any manner so as to become Subject to the Workers'Compensation Laws of California. 0 Or. Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING )- to NOTICE '10 APPLICANT. If,alter making this Certificate of Ex- F-. ? emption;you should become subject to Bre Worked Compensalion APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE C.) 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 10MC.EM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the pei roretance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name Lender's AddressHEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC �• I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) r 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construclion, and BOILER-COMP(3 H.P.Or i00,000B.T.U.) 6.00 I_ / hereby author" representatives of this cite to cote,,upon the BOILER-COM P(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-menlio ed property for inspection purpoS S. (We) agr a to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. I` Cupertin gains'WaaslIaiust jdgments, costs and expenses which CONST.TAX may in y ynsaid City in consequence of the PERMIT ISSUANCE 10.00 grand 1 MECH.CONT. LIC.NO. MECH. OTAL TOTAL NIP 33 g alureof App canl/Contractor Un[ ' OFFICE COPY I