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11930 *. ., POST THIS CXIRDAR'FRONT OF BUILDING NUMBER , y L .CtT O,F C.UPERTINO', .I � 1-1930 INSPECTION DIVISION " n'�\ JOB INSPECTION RECORD ,J;�F'/y/ -PERMIT EXPIRATION 4 JOB ADDRESS.'./ ,Jf '1 •l'�IJNI T# ; OT#. PERMIT EXPIRES IF WORK OWNER CONTRACTOR, + .IS NOT,STARTEO WITHIN INSPECTI DATE INSPECTOR INSPECTI NRECORD tgo_onvsOFPERMITIssu- FOUNDATION Lf,b$ ��,�. &r"'C ' ANCE OR 160 DAYS FROM LASTCALLED INSPECTION. 'LIFER PERMIT VALIDATION PREGUNITE c4- 647 W041-_ O• , POUR NO CONCRETE UNTIL AB VE HAS BEE SIGNED t UNDERGROUND /.SLAB PLUMBING .. ELECTRICAL'• .. Is ANCE DAT MECHANICAL - BLDG. LEcr, r c. CH. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT - - INFORMATION WOOD;FLOOR _,VALUATION $/FT. , PLUMBING Z - MECHANICAL - r PERMIT TO , ELECTRICALFRAMING - - TYPE corvsTR. INSULATION -� -J_ k/j bon f• , OCC-GROUP RE$/UNIT$ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEE SIGNED OtAALA 'ROOF DIAPHRAGM AF BUILDING USE RES IND CON PB Otho, - APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED •, ASSESSORS PARCEL NO., ROUGH _ S PLUMBING GAS TEST - yy TRACT No. PARCEL NO. MECHANICAL •• - Q Td �r 4d 45z tbac7i - '-ACC.OATE ACC•FILE NO. ELECTRICAL - _ $.�J FINALS DATEff DATEINSP. FRAMING �^ SAN #/,90j 2 ,ZONING ENG:SITE NO. INSULATION 6 PLUMBING GAS MECHANICAL - - .FIRE SPRINK :ENERGY,T24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ;,HEATING N� O N0. FLOOD ZONE A.L.U.C,. LATH—INTERIOR .ELECTRICAL LATH—EXTERIOR .� - + FIRE DEPT, Y'[] •N� v ❑' N� SHEETROCK '' GRADE, ' FEE SUMMARY SHEAR INTERIOR BUILDIN BUILDING SHEAR EXTERIOR TEMPORA Y,APPROVALS FIREWALLS ELECTRIC — PLAN CHECK GAS ,R FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY , SEISMIC FEE r OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR; MICROFILM , ARRANGE FOR,INSPECTI ON BY'PHO NING 252.4505, ELECTRIC X -� F ONE WORKING DAY BEFORE REQUIRED INSPECTION. I ' :PLUMBING ?� ' �• i z ' . ., PLEASE GIVE JOB ADDRESS WHEN,PHONING. SEE PERMIT FOR EXPIRATION,DATE MECHANICAL ' t ' rI IMPORTANTI CONST.TAX PLEASE READ REVERSE SIDE BEFORE .TOTAL 1 CALLING FOR FINAL INSPECTION. . • .. • OFFICE COPY, APPLICANT TO FILL IN INFORMATION WITHIN. RED LINES---,- USE BALL POINT PEN ONLY BU I L DI NG PROJECT I DENTI FICATION - PERMIT NUMBER BUILDING ' d APPLICATION & PERMIT AODREL! BUILDING MECHANICAL GQ} 11930 OWNERS • � , PLAN CHECK VALIDATION NAME WVr(� QTY. ELECTRIC PERMIT FEE LDNTflacTofl's UTLETS-SWITCHES-RECEP 10.00/1.00 0�� lQ� (od NAME . / 33 LIGHTING FIXTURES 10.00/1.00 U, LI C.NO. _ - FDDOFEss Tofls q1, q/ APPLIANCES-RESIDENTIAL 4.00 �� '! y (/ I✓��f� I PRONE-.I� 7�f"1� ' PANELS 10.00 Q F'V t DATE OF APPLICATION PLAN CHECK FEE P.C.NO. AOR RCHITECT - � /,r�eJ M l,({✓�f/�rf,(/^ PANELS (OVER 200 AMP) 20.00 r ENGINEER sec.NO SIGNS TRANS. 3.00 ARCH:OR ENO, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION aooREss 0 1I� G GOQ lO EMP.METER OR POLE INS. 20.00 (J A PLlCarvra - ADDRE11 MOTORS SEE FEE SCH. aa 0 ZG� •(� C.(�lJ'( G() 1J'(100 SERVICE CHANGE 20.00 �� BY w o a LICENSED CONTRACTORS DECLARATION a u u I hereby affirm that I am licensed under provisions of Chapter 9� ISSUANCE DATE Ir' (commencing with Section.7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECN. t' '6^ Professions Code,a my license is in full farce f ecL 'n( z-i=m/ License Class_Lic.Number 9 o m r Dale �' �)6�� ' Contractor_ j_{1Q/k. .Q m E BUILDING PERMIT ¢ ¢ w \ - OWNIiR-0UILDER DIiCLA RATION INFORMATION w0 LL U 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD .. 0. Low for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. S - Code:Any city or county which req ui resa pe nn it m const not,alter,' d S. improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. )'1 �� O¢ requires the applicant for such permit to file a signed statement that . TOTAL V PERMIT TO a w m" he is licensed pursuant to the provisions of the Contractor's License H z r Law(Cha ter9(commencingwith Section 7000)of Division 3 ofthe a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ =$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES .TYPE CONSTR. i by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00Q N of not more than five hundred dollars(5500).): ❑ I,as owner of doe 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 structure is not intended or offered for sale (Sec.-7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 e< 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 through his own employees,provided that such improve. 1 GAS-EA.SYSTEM-11 NC.40UTLETS 6,00 W ments are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner- .: GAS-EA.SYSTEM-OVER 41EA.) 2.00 BUILDING USE `"�.-••+1 builder will purpose of burden of proving that he did not huild or im- - RES IND CON PB Omar prove for purpose of sale.). INDUSTRIAL WASTE INTER.' 30.00 O d as owner of the property,he exclusively contracting with ❑ ❑ ❑ ❑ ❑ ' licensed contractors m construct the project(Sec. 7044,Business MI KLERS-.1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:1'Ite Contractor's License Law docs not apply - - p -f /to an owner of property who builds or improves thereon,and woo KLERS-OVER 5(EA.) 1.00 3aWcontracts for such projects with a contractods)licensed pursuant to , TAR V-STORM EA.200ft/10.00 Qthe Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&PC.for this ER W/VENT 6.0 �''reasonOwner Date EM 5.00 �(- ACC.OATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION TING EQUIP, 5.001 hereby affirm that I have o certificate ofconsent to self-insure, ZONINGor a certificate of Workers'Compensation Insurance,or a certifiedENG.SITE NO. copy thereof(Sec.3800.Lab.C.). g s , � - _ Policy No. Company Q IT Certified copy is hereby furnished. FIRE BETHINK ENERGY T-24 Z Z A' Certified copy is flied with Ihr,-, in pection division. O Applicant__ t_Ae. MISC.- REFER TO ORD. Y ❑ N❑ Y N❑ 0 y CIiRTIFICATI>Oh EWMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 G FLOOD ZONE A.L.U.C. LU >_ COMPENSATION INSURANCE PLG.CONTH, LIC.NO. PLG. ,1 p O_ Q (This Section need not be completed if the permit is for nueTOTAL // Y❑ N❑ Y ❑ N❑ 0 Z hundreddollars(S1000orless.) , 00 I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not employ any person in any,manner so as to U w become subject to the Workers'Compensation Laws of California. BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 (p >_ tail 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 Shull he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LizNDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency far EXHAUST HOOD (WITH DUCT) 5.00 Q the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.TT.U.) 8.00 MICROFILM 3097;Civ.C.). r Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address L.' I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00C, p'p -� Information is correct. I agree to comply with all city and county PLUMBING ll�_ -� r" ) Ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 1 / hereby authorize representatives of this city to enter upon the +F BOILER-COMP lover too,000 BTU)SEE FEE SCR. MECHANICAL - - 1' above-mentioned property for inspection purposes. (WB) agree to save, indemnify and keep harmless the City of MISC.,- REFER TO ORD. w Cupertino against liabilities,judgments, casts and expenses which CONST.TAX f q may in any way accrue against said City in consequence of the PERMIT ISSUANCE' 10.00 U ']_•�,( 9 grant of t is permit. MECH.CONT. LIQ NO. MECH OTAL S��' TOTAL 31 j J .a i^ Signa re of Applicant/Co actor _. Dale � r - 'OFFICE COPY