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11524 POST THIS CAF NEAR FRONT OF BUILDING PFulai•.UCB[q CITY SOFCUPERTINO T11524 • JOB INSPECTION RECORD ,�^/ /' PERMIT EXPIRATION JOB ADDRESS �` 1 �I✓ �feVens C►''ef? K UNIT# _LOT# b 1\, J PERMIT EXPIRES IF WORK OWNER 1✓��. L'c�r ; CONTRACTOR �JQ�C61 �j� IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL aLD�.. ELEc PLC , +IEC. Ill���jttt ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I ,,BUfLUINU PERMIT WOOD FLOOR INFORMATION VALUATION $IFT. PLUMBING 3,, oitz ' ELECTRICAL ER MIT FRAMING INSULATION ' �t- STORIES TYPE GONSTR, OCC.GROUP RES.UNITS . PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO Li FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON vB Onr.r APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 7 ❑ ❑ ❑ E ❑ ASSESSORS PARCEL NO, ROUGH PLUMBING GAS TEST TRACT No. PARCEL No. MECHANICAL 4CC.DATE ACC.FILE NO ELECTRICAL FINALS DAIrE INSP. FRAMING SAN # ZONING ENG.SITE NO. INSULATION PLUMBING GAS MECHANICAL FIRE SPPINK ENERGY T ZA , COVER NO WORK UNTIL"ABOVE HAS'BEEN SIGNED HEATINGY ❑ N[3 Y [3 NE LATH—INTERIOR ELECTRICAL _rbl aAl FLOOD ZONE A U.C.Y ❑ N❑ YC� N❑ LATH—EXTERIOR FIRE DEPT. _ , SHEETROCK GRADE ,.p/G FEE SUMMARY SHEAR INTERIOR BU LDIN SHEAR EXTERIOR TEMPO RARYAPPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM • ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST. ONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY 4PLICANT TO FILL IN INFORM"TION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NG PROJECT 1 DENTI FICATION PERMIT NUMBER .ILDING APPLICATION & PERMf mORESS ( J S'IL/N CR DJ,-f \ BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 11524 OWNER'S J ^ o PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE �c GA R L IPHONE o2 CONTRACTORS RikOUTLETS-SWITCHES-RECEP 10.00/1.00 fn1 pp GOC F 1 uc.No. ��Z LIGHTING FIXTURES 10.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 - AOOREss � nryf� �f'Iy' ' �'� '',� f � '/vRONE K}`V-I 13 PANELS 10.00 DATE OF APPLICATION C.NO. OR ENGINEER ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CH ECK FEE P.,� uc.No. SIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ��DADDRESS ZIP EMP.METER OR POLE INS. 20.00 APPLICANT'$ ADDRESS MOTORS SEE FEE SCH. "J) o' SERVICE CHANGE 1 /I w a o LICENSED CONTRACTORS DECLARATION - < v u , . LI{Y of /• �� y l�� 1 hereby affirm that I am licensed under Provisions of Chapter ISSUANCE DATE m< H Icommen<ing with Section 70001 of Division 3 01 the Business and BL E C PLG. MECH. H y z Professions C-odaynd my license is in full lar rr���el{�,� z o m z License Class b I Lia Number `y /�Z. ,. 9 w Cify of u 1 ' ❑ ❑ / ate Contractor a Y s J BU DING PERMIT re ¢ w OWNER-BUILDER DECLARATION O MISC.- REFERTOORD INFORMATION E ; e H I hereby affirm that 1 am exempt from the Contractors License LLoa Law for the following reason.(See,7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION SIFT. - Cade:Any city or county which requires❑permit to construct.alter, p� Q Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. / �V ? 3 , F. , requires the applicant for such permit to the a signed statement that TOTAL PER T Tq n w S m he is licensed pursuant to The provisions of the Contractor's License ( _ r Law.(Chapter 9(commencing with Section 7000)of Division 3 ofthe z 4 Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE -L• r$ the basis for the alleged exemption.Any violation of Section 7031.5 DRIES TYPE C NSTR. by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(S500).): ❑ I,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 the structures not intended or offered for sale fSec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 5.00 s0.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenotintendedorofferedforsale.If.however.the building GAS-EA.SYSTEM-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 am. RES IND CON Pe 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,BusinessLAWN 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 LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contmetorl s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,B&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. i copy thereof(Sec.3800,Lab C.)./ l • Policy No. Company • 'Tyd& ;-,i r 0 ❑ Car F d COpy I It b furnished. it y CATV J-. FIRE SPRINK ENERGY T.24 ❑ Cenite pG d `with�t =aty ins ection divisi n. Z p 7 Applicant!�<� p MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ 2T CE RTI FICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U,C. LU COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. Z This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ hundred dollars(S 100)or less.) 0..1 O I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT - FEE.- FEE SUMMARY LL I- mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. IS, Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING C } m NOTICE TO APPLICANT: If,after making this Certificate of Ex. F Z emption,you should became 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 10,000CF.M) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE r S� 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,Civ C.). HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address '. I certify that I have read this application and state that the aboveVENTILATION FAN (SINGLE) 4,00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER•OOMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP IOvar 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (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 10.001CONST.TAX may in an"yme gainst said City in co sequence of the gra MECH.CONT. LIC.NO. IdECH._ TOTAL TOTALSigna eotractor Date OFFICE COPY " APPLICANT TO FILL IN INFORMION WITHIN REDLINES — USE BALL POINT PEN ONLY BUILDING PROJECT IDENTI FICATIO PERMITNUMBER BUILDING APPLICATION &PERM '� / ADDRESS ^ ( � f A BUILDING — ELECTRICAL—PLUMBING—MECHANICAL GONER'S - - PLAN CHECK VALIDATION rvamE OTY. ELECTRIC PERMIT 'FEE ! d. ...[f�y/) / v PHONE O L ® „` CONTRACTORS ppp _- ES-RECEP 10.00/1.00 NAMEUTLETS-SWITC —ApGOp_ LIC.NoILIGHTING FIXTURES, 10.00/1.00 CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 ADOREaS ,r r2 - Zj �Y3/Znlf LQ �� rvE ry�-1 113 PANELS 10.00 DATE OF APPLICATION ARCHITECT - PANELS (OVER 200 AMP) 20,00 PLAN CHECK,FEE P.C.NO. OR ENGINEER, _ sec.No. SIGNS TRANS. 3,00 ARCH.OR ENG. - S 00 PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT- FAR) ' . ZIP EMP.METER OR POLE INS. 20:00 /I J nooee�ss Ts—a " MOTORS SEE FEE SCH. �QI y xCONI FA-C,I D 1� SERVICE CHANGE p /1 UQf�/1/1 E���` F o o LICENSED CONTRACTORS DECLARATION _ - !sl}U[Of l/UOyA`(I�IIIO ¢ U I hereby affirm that 1 am licensed under provisions of Chapter 9 1 (j " V ISSDA E DATE w< N (commencing with Section 7000)of Division 3 of the Business and - BL E C PLG. MECH. F m z Professions Codaayyn�d my license is in full for krr�r1� z 0 m W License Class tel_Lic.Number -`Y �-' /�{ Of ppEr 1 ❑ ❑ Q w F ate Contractor - (;Ity ¢ n s tBUALDING PERMIT ¢ ¢ w 4 OWNER-BUILDER DECLARATION .0 INFORMATION wo A� REFER TO ORD I hereby affirm that I am exempt from the Contractor's License M ISC.— uoa Law for the followingreason.(Sec.703 1.5,Businessund Professions PERMIT ISSUANCE ,10.00 VALUATION $/FT. E - Code:Any city or county which requires a permit to construct,alter, - ac a p improve,demolish,or repair any structure.prior to its issuance.also ELEC.CONTR. LIC.NO. ELEC. K0, requires the applicant for such permit to file a signed statement that TOTAL PER T T n w m he is licensed pursuant to the provisions of the Contractor's License- _ r z 0� Law(Chapter9(contmencingwith Section7000)of Division3ofthe I Q Business and Professions Code)or that he isexempt therefrom and QTY. PLUMBING PERMIT FEE ¢=$ the basis for the alleged exemption.Any violation of Section 7031.5 ORIES TYPE a; by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(S500)J: ❑ I,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 FIXTURES-PER TRAP 5.00 - SO.FT,FLOOR AREA TOTALACREAGE mepas f or are ugh intends ownemployees,for side. If,ed however, the improve- GAS-EA.SYSTEM-1 6.00 ' rents are not intended or offered for sale.If,however,the building of Gnprovemenl 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 .CON PB Omer prove for purpose of sale.). , 0 INDUSTRIALWASTE INTER. 30.0 '❑ ❑ 11 1:1 ID 1,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 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a conlmctorls)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10:00 TRACT NO. PARCELNO. ❑ I am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner - Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 ' 1 hereby affirm that I have a certificate of consent to vel prison, ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE N0. copy thereof(Sec.3800;Lab.C). ,0 , Policy No. Company ❑ Certif JrC Cppy is be (urnishC p (A T� - FIRE SPRINK ENERGY T 2 Z'Z ❑ Certific J with tl Cil ins coon divly n. MISC.- REFER TO ORD. Q Applicant � 7 Y ❑ N❑ V ❑ N❑ � N CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE - 10.00 FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. PLG. d Q (This section need not he Completed if the permit is for one _ TOTAL Y[:] N C] Y[:] N F]Z) Z hundred dollars IS 100)or(ess) t L) O - I certify that in the perfunnmceof the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL l- mit is issued, I slmall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. W Dam Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE TO APPLICANT: If,after making this Certificate of fix- - 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 V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.1 4.00 CONSTRUCTION LENDING AGENCY ' AIR HANDLING UNIT(OVER 10=1C.F.M.) 6.00 SEISMIC FEE r S 1 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.).ddr Lender's ess HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Address An ddr HEATING UN IT(OVER'100,000 B.T.U.)9.50 - - ELECTRIC ! �Vs � 1 certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 ' info nsintion is correct. I 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 aulhorite representatives of this city to enter upon the BOILER-COMP Over 100,000BTUI SEEFEESCH. MECHANICAL _ above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- > - REFER TO ORD. - Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any ay rue gainst cord City in co sscyuen a of the PERMIT ISSUANCE ANCE 10.00 gra o erm MECH.CONT. LIC.NO. MECR. {})1 _ 2z �/ TOTAL TOTAL Signa a at Applicant/Contractor Date b OFFICE COPY °POST THIS CAEAR FRONT OF BUILDING, - f TERM ITNUMBER �/ CITY:`OF CUERTINO I4o 11524 INSPECTION D'IVISION ' , JOB INSPECTION RECORD /�D �j�eyens are I� - , � PERMIT EXPIRATION:+ JOB;ADDR ESS UNIT# LOT# -' - //'� PERMIT. EXPIRES IF WORK TO , •OWNER W(�6d CONTRACTOR •1.,/QrJ t,E/1 ,' IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD' - . 180 DAYS DE PERM-IT ISSU FOUNDATION- - ANCE'OR 180 DAYS.FROM , , LAST CALLED INSPECTION. UFER PREGUNITE' I • I• PERMIT VALIDATION POUR NO'CONCRETE UNTIL ABOVE HAS BEEN SIGNED ✓ ° r � UNDERGROUND /SLAB �/J�//I• PLUMBING` ELECTRICAL - ` ISSUANCE DATE i' MECHANICAL - BE E EC . PLG. MECH. El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED /,,4BUfLDING PERMIT a INFORMATION WOOD FLOOR'. ' ° _y IVALUATION $/FT. PLUMBING , MW MECHANICAL - r - ELECTRICAL' RMIr I - FRAMING INSULATION ' 'STORIES TYPE NSTR OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED t (�. '..• n} ,ROOF SO.FT.FLOOR AREA TOTAL ACREAGE f DIAPHRAGM ' ` BUILDING USE 'HES IND' CON PB Omv APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El ❑ El1:1 El ASSESSORS PARCEL NO. ROUGH .PLUMBING • .TRACT'NO, PARCEL NO, GAS TEST F F MECHANICAL ELECTRICAL FINALS DATE INSP. ncc.,DATE , Aca FILE,No, , ,FRAMING SAN'# ' ZONING ENG.SITE NO. - INSULATION PLUMBING - .I GAS. - ' FIRE SPRINK ENERGY T$9 MECHANICALY E] •. NE] ro No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR - ELECTRICAL' . . FLOOD ZONE aL.u.c. LATH—EXTERIOR:. FIRE DEPT. _ Y ❑. . N❑. v N❑ SHEETROCK GRADE ,.O_!L FEE SUMMARY I, SHEAR INTERIOR BUILDIN - 7 , F" SHEAR EXTERIOR r TEMPORARY APPROVALS BUILDING �. FIREWALLS "- - ' ELECTRIC - -PLAN CHECK " GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY, SEISMIC FEE r OCCUPANCY OF BUILDING IS NOT PERMITTEDUNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC,LU • ". ,ONE WORKING.DAY�BEFORE REQUIRED.,INSPECTION PLUMBING z " . .. PLEASE GIVE JOB ADDRESS WHEN PHONING. `'SEE PERMIT'FN;D OR EXPIRATIOATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE'READ,REVERSE'SIDEBEFORE TOTAL ^ '%f F • CALLING'FOR FINAL INSPECTION • OFFICECOPY �',