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11273 POST THIS CARD NEAR FRONT OF BUILDING CITY, OF CUPERTINO -IFIIMITNUMRER . - INSPECTION DIVISION 11273 • JOB INSPECTION RECORD ` PERMIT EXPIRATION ' JOB ADDRESS ao7y5 Stevens Creek UNIT# _LOT# / • 1_bIa eelI,,��,,��//�� PERMIT EXPIRES IF WORK OWNER (2lemµ CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR SPECTION RECORD ppp 180 DAYS OF PERMIT ISSU- FOUNDATION Ccv-SIL Pwtfh/� V ,F,r, ANCE OR 180 DAYS FROM UFER L �-GG 2.ch AO ILoC' V LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB / PLUMBING r S F,D• - J~ ELECTRICAL- .. ISSUANCE DATE MECHANICAL eL c. ELECT. PLO, MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING - VALUATION $/FT. MECHANICAL ELECTRICAL - - PERMIT To ,INT �� FRAMING - - " Afeb,d L_� INSULATION , STORIES TYPE CONSTR. OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED l ROOF , SO.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM - euIL u$E ' .. IVES IND CON GON 'PB Ortlrtr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El 0 0 ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT NO. PARCEL NO, GAS TEST MECHANICAL " ELECTRICAL FINALS DATE INSP, ACC,DATE ACC.FILE NO. ., FRAMING SAN # INSULATION PLUMBING - ZONING 'ENG.SITE No. GAS MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y [:] NE] Y C] N� F LOOD ZONE A,L.U.C. LATH—INTERIOR - � ELECTRICAL � v� N� v �] N� LATH—EXTERIOR FIRE DEPT. SHEETROCK * GRADE - - FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY'APPROVALS BUILDING FIREWALLS ' ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY 7 SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN;PHONING. • Z - MECHANICAL -,SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX 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 ' r BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BAPPLICATION & PERMIT ADDR ,1Z aDILD80"Lo iss "No 2O'7F15 ,57VVOV5C/ZK. (?�V BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 11 273 OWNER'S J PLAN CHECK VALIDATION NAMrE� l� EA TY. ELECTRIC PERMIT FEE CONTRACTOR'S NC p/ OUTLETS 10.0011.00 NAME '1 LIC.NO Q/ LIGHTING FIXTURES 10.00/1.00 r-oNTRAc OR's ESS APPLIANCES-RESIDENTIAL 4.00 AlDDjR� y/J�R / V ]lV J,L. PHONE /'ti-✓`� PANELS - ' 10.00 DATE OF APPLICATION AR OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. C,HITEC� /y• L• 'S Lie No. SIGNS TRANS. 3.00 ADDRESS ENG' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 PAID ADDRESrvr$ MOTORS SEE FEE SCH. II' SERVICE CHANGE 20.00 w o o LICENSED CONTRACTORS DECLARATION f�j CG e' In� ac u 1 hereby affirm that I am licensed under provisions of Chapter 9 CI 19511 ANILE DATE h Q a (commencing with Section 7000)of Division 3 of the Business and BLD ELECT. PLG. MECH. H m i Professions Code,a d my license is in full force' J e feet. ❑ ❑ ❑ Z.O u,-. License loss o w L o ]ate. -� Contractor a m f BUILDING PERMIT as OWNER-BUILDER DECLARATION IF u, u INFORMATION X 0 e N 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD H a. oJ Law forthe followingreason.(Sec.7031.5,Business and Professions - pERMIT ISSUANCE 10.00 VALUATION $/FT. m� Code:Any city orcounty which requires a permit to construct,alter, / T ac Q a 20 Improve,demolish,Or repair any structure,prior to Its issuance,also ELEC.CONTR. LIC.NO. ELEC. o� as c u requires the applicant for such permit to file a signed statement that TOTAL PER MIT TO m m he is licensed pursuant to the provisions of the Contractor's License i La. 9(commencing with Section 7000)of Division 3 of the 1,V7; f��1.fQ�erL. a Business and Professions Code)or that he is exempt therefrom:uuf OTY. PLUMBING PERMIT FEE the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. n ;m by any applicant for a permit subjects the applicant toacivilpenalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(5500).1: ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and tine structure is not intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:'fine Contractor's License Low does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- - GAS-EA.SVSTEM-11 6.00 meats are not intended or offered for Sale.If,however,the building of improvement is sold within one year of completion,.tine owner- GAS EASYSTEM OVER 4 IEA.) 2.00 builder will have the burden of proving that lie did not build Or Ind- - . - - BUILDING USE prove l'or purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other ❑ I,as owner of the property,am exclusively contracting with EJ ❑ 11 1:1 1:1licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who ILAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with it contractous)licensed pursuant t0 SEWER-SAN V-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO, PARCEL NO. ❑ lain exempt antler Sec.-,K&P.C.for this WATER HEATER W/VENT 6,00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKF.RS'COM PENSATION DECLARATION 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 cerlifieJ copy thereof(Sec.3800,Lab.C.). Policy No. Company ❑�J�+eertified�,o y h us d. FIRE SPRINK ENERGY T 24' Z 2 fd'Certifjs:ryled - ' .pec Hoa division. MISC.- REFER TO ORD. z APPhcunl- v ❑ N❑ V ❑ N❑ CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. L COMPENSATION INSURANC17 PLG.CONTR. UC.NO. PLG, v❑ N❑ Y❑ ❑ EL Z (This section need not be completed if the permit is for one TOTAL N hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work I'ur which per- CITY MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not employ any person in any manner TiMas to O w become subject to the Workers'Compensation Laws of California. a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING �/e� } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- F ? 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.FM.) 6.00 SEISMIC FEE 9 I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Cie C.), HEATING UNIT.(TO 100,000 B.T.U.) 8.00 Lender's Name HEATI NG UN IT E R 100,000 B.T.U.)9.50ELECTRIC_ Lender's Address 1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and roarmy 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 (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (WB) 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 may in any wayccrue against said City in consequence of the gran W g th p- MECH.CONT. LIC.NO. MECH. q C. �' 8� TOTAL TOTAL Sign um of Applicant/Contractor Date OFFICE COPY