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10940
. OFFICECOPY .. ... n - .. • NEAR POST THIS AR FRONT OF BUILDING � PTR MIi NUMBER ITC1 c1CF t 10940 r INSPECTION DIVISION. , .. JOB INSPECTION RECORD �f/7 PERMIT EXPIRATION —.-�j]/� JOB ADDRESS, �'��u UNIT,* —LOT# _ - PERMIT EXPIRES IF: "WORK OWNER CONTRACTOR ' ." IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSO- ANCE' OR 180 DAYS -FROM UASTCALLED INSPECTION: INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION p /3-� 'n/UK UFER - PREGONITE- ! • PERMIT VALIDATION 'ISSUANCE GATE POUR NO CONCRETE UNTIL ABOVE'HAS BEEN SIGNED UNDERGROUND/SLABc, PLUMBING ELECTRICAL MECHANICAL ��-�' 1 LOG.' ECI. ,'� 'PLG.. MECH. 0... ❑, DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED "+ - BUILDING PERMIT INFORMATION - ' ` WOOD F. LOO v LUATION $/FT. N F PLUMBING MECHANICAL- ELECTRICAL.'- PERMIT TO 1/ FRAMING—�� STORIES rvae coN TR. INSULATION _ II t OCC. GROUP RES. UNITS PLACE,NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED .•ROGF - ^ .S_0FT.FL0ORAR[A TOTALACREAGE DIAPHRAGM.: NUNO USE f H.RIND ' N'ES "ICON PB OIRe! 1:113 �' _11:1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. ROUGH PLUMBING < GAS TEST, f- *"uc fa EW CZO, IAeWa✓ .. TRAcI No, 'r PARCEL. No. - MECHANICAL. ELECTRICAL "' -/T-lq v FINALS DATE INSP. ^cc.onre AIC. flLeNO, FRAMING - ( SAN #- :,};; ZONING 'ENG. SITE NO. _ INSULATION', • - r ,'� '" ,I PLUMBING ' GAS PIRE SPRINK y ❑. No •.-ENERGV T24 Y.[:) NE] - - MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED " HEATING LATH -INTERIOR ELECTRICAL!— FLOGG ZONE E) 'NO A.L.uc. 0 ND .S �� LATH—EXTERIOR � � , - FIRE DEPT. SHEETROCK -/S GRADE FEE SUMMARY SHEAR INTERIOR BUILDING - BUItowG SHEAR EXTERIOR - ,' .TEMPORARY'APPROVALS -. FIREWALLS '' "ELECTRIC x" PLAN CHECK FEE ' - GAS, SEISMIC FEE "UP NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDINGINSPECTOR.'MICROFILM ARRANGE FOR INSPECTION BY PHONING:252-4505, LECTRIC E1. q , PLUMBING o�ONE WORKING DAY BEFORE REQUIRED INSPECTION:'; PLEASE GIVE JOB ADDRESS WHEN, PHONING. Z — SEE PERMIT'FOR EXPIRATION DATE - MECHANICAL coNST. TAx' IMPORTANT'!' PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. . OFFICECOPY .. ... n - .. 11 0 W z Foo �zn a z Ro = Z o z w p o w U is ; F FU04 set� R Wp 0 U. va a w i a fzo S, R a 3 O, z FO ir - LL > CL O Uo LL U Oa } GO u v APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -.USE BALL POINT PEN ONLY BSI I LDING PROJECT I DENTIFICATM . , APPLICATION & PER BUILDING -ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 10940 BWI.�DINgyG�� OWNElERs✓`"'11 " WQTY. � PH y- ELECTRIC PERMIT FEE PLAN CHECK VALIDATION ciOFs CONTRACTORS 'OUTLETS - SWITCHES -RECEP 10,00/1.00 LIGHTING FIXTURES 10.00/1.00 sec. NO, CONTRACTORS ADDRESS APPLIANCES - RESIDENTIAL 4,00 PANELS 10.00 . PHONE. •- DATE OF APPLICATION BRCHITECT OR ENGINEER - sec. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3,00 ADDRESS ENG. SPECIAL 'CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE1 20.00 ' ZIP n b APPLICA ADDRESS - MOTORS EE FEE SCH. SERVICE CHANGE 1.G 20.00 �I(jtjl'I F f LICENSED CONTRACTORS DECLARATION tnn 1 hereby affirm that 1 am licensed undoprovisions ol'Chopmir,9 • feommencing with Section 7000) of Division 3 of the Business and Professions Code, and my licenseis in full force and effect. License Class Lic. Number BLDG. L H. ❑ ❑ ❑ 1 Date Contractor BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION I herby collo that I so exempt from the Contractor's License Law for the followingreason.(Sec.uires a,Business and Professions Code: Any city Or county which requiresa permit toconstruct,, also tore, prior to its issuance, also improve, demolish, or repair any permit requires the applicant for such permit to file a Signed statementisLithat he is licensed pursuant to the provisions of the Contractor's License MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 Q-•� V LUATION / $/FT. ELEC. CONTR. LIC. NO. ELEC. OL TOTAL Q �� PERMIT TO QTY. PLUMBING PERMIT FEE Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 703 E-5 by any applicant i'or a permit subjects the applicant to a civil penalty of not more than five hundred dollars (55000.): ALTER -DRAIN -WATER (EA.) 5.00 ❑ 1, as owner of the property, or my employees with wages as their anle compensation, will do the. Work, and'th0 Structure is not BACK F LOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, 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 FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE himself or though his own employees, provided that such improve- memsamart intended oroffered for sale. If, howeveq the holding GAS-EA.SYSTEM-111NC.4OUTLETS 6.00 or improvement is sold within one year oI' completion, the owner- builder will have the burden of proving that he did not build or im- 'roveforpurposeofsale.)' ❑ 1, as owner of the property, am enclusively contracting with GAS - EA. SYSTEM -OVER 4 IEA,) 2.00 BUILDING USE RES IND CON PB Omer ❑ - ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 IEA.) 1.00 ASSESSORS PARCEL No. _ 3� / _S 6-010 S� licensed contractors to construct the project (See. 7044, Business and Professions Late; I hiContractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts forsuch projectswith a contractors) licensed pursuant to the Con tmclot s License Law. SEWER -SAN V -STORM EA. 200ft/10.00 TRACT N0, PARCEL NO. ❑ I n melt, er Sec. ;BAP.C. tar this reason WATER HEATER W/VENT 6.00 Owner f Date ,WATER SYSTEM 5.00 ACG DATE - ACC. FILE NO, WATER TREATING EQUIP. 5.00 WORKERS'C MPI;NSA'f ON DECL ATION I hereby affirm that 1 have a certificate of co sent to sel6lnsum, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy t iereof (Sec 3800, Lab.C.). Policy No. Company ❑ Certified copy is hereby famished. ❑ Certified copy is filed with the city inspection division. Applicant FIRE SPRINK Y ❑ N ENERGY T-24 Y ❑ N❑ MISC. - REFER TO ORD. CIIRTIITICA'1'1:OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.Cf PLG, CONTR. LIC. NO. PLG. TOTAL - COAIPF:NSATION INSURANCE-- ('Phis section need not be completed if -the permit is for one Y ❑ -No, Y ❑ N❑ hundred dollars IS 100) or less.) - I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in :my manner so as to OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING J become subject to the Workers' Compensation Laws of California. Dale ApplicantALTER OR ADD TO MECH. 500 . . NOTICI7 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 such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10=C.F.N1.) 4.00 AIRHANDLING UNITIOVER 10=C.F.M.) 6.00 SEISMIC FEE Z CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for I EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued (Sec. 3097, CR.C.). MICROFILM HEATING UNIT (TO 100,000 B.T-.U.) 8.00 Lender's Name 'Lender's Address - HEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC © O� I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 - - information is correct. I agree to comply with all city and county ordinances and stale laws relating to building conslmction, and PLUMBING BOILER - COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP lover 100,000 BTU) SEE FEE SCH. - MECHANICAL hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC. -' REFER TO ORD. Cupertino against liabilities, .grunts, costs and expenses which may any way accrue agar t aid City in co equence of the gof [h erml(. I -� CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL "OT Signature of App and/Con ractor Date OFFICE COPY " .,