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8890 POST THIS CARD NEAR FRONT OF BUILDING :PFRMIT NUMBER ' et I CITY. OF; CUPERTINO, 8390 INSPECTION.DIVISION JOB INSPECTION ECORD r PERMIT EXPIRATION ?. JOB ADDRESSI' -4 41N T LOT# PERMIT EXPIRESIF.WORK.. OWNER cONTR ACTOR IS NOT STARTED WITHIN INSPECTION DATE ' INSPECTOR. y IN CT NR CORD, �i80'oAYS.OFPERMITISSU , ANCE OR 180 DAYS FROM FOUNDATION ' �' •LAST CALLED INSPECTION': • UFER ' PREGUNITE - _ -,PERMIT VALIDATION S POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' UNDERGROUND /SLAB' PLUMBING' - C%�✓ ^ i ELECTRICAL, - - . $SsU41NCE DATE MECHANICAL, - - 'BLPkG. ELECT' PLG. .MECH.' , El .DO NOT POUR,FLOOR UNTIL ABOVE HAS BEEN SIGNED :.,' >s, '/`, : Bu DING PERMIT, I' NFORMATION d ' WOOD FLOOR. VALUATION $IFT.. - PLUMBING' .� - - - - - ,i / r, • MECHANICAL .° .. � `•.�'la I - PERMIT O� ELECTRICAL � ' - .i ° 'q; - •'"( FRAMING INSULATION - ,3 I 'r, STORIES -"y CONSTR.' t • ` OCC,GROUP 'RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ROOF - ` • + SOFT4LOORAFEA TOTAL ACREAGE DIAPHRAGM. - - BUILDING USE IF IND' CON PB DII APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑` " ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST •• IPACT NO,:J PARCELNO. MECHANICAL - �ACC.'DATE ACC.FILE NO, ELECTRICAL FINALS DATE INSP. FRAMINGa SAN NSULATION # ' s ` •I. Sk L; ZONING •ENG SITE N0. I � PLUMBING. �' • GAS ' - - MECHANICAL " - -FIRESPRINK ENERGY T�24 ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` ❑.r,Y"❑ sv ❑ -"❑ ' FLOOD ZONE A.L.U.C. LATH-INTERIOR �� _� ELECTRICAL LATH-EXTERIOR -' FIRE DEPT. v❑ N❑ .Y�, ry❑ SHEETROCK - • GRADE 'FEE SUMMARY i SHEAR INTERIOR BUILDING" - , BUILDING a SHEAR.EXTERIOR TEMPORARY APPROVAL'S. P'�' r •• FIREWALLS ELECTRIC •PL'AN CHECK , - f' - . GAS. ' NO-TAPE OR PLASTER UNTIL ABOVE HAS.BEEN SIGNED- OCCUPANCY. , :,, .SEISMIC FEE,, ` UCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY 6UILOING INSPECTOR. 4MICR.0FILM uJ ` ARRANGE FOR' B .INSPECTION _ Y PHONING-,252-4505,.` ELECTRIC o�+ ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING A- t GSWHEN PHONING Z PLEASE. IVE JOB ADDRESS . - SEE PERMIT FOR EXPIRATION DATE -, , MECHANICAL IMPORTANT! CONST ,TAX } '`PLEASE.,READ REVERSE SIDE BEFORE - TOTAL ' CALLING FOR FINAL IN . ' i • :'OFFICE COPY! - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .BUILDING PROJECT. IDENTIFICATION I - PERMIT NUMBER BUILDING APPLICATION & PERMIT 'POOR S O O(V'J 11 O /�33 BUILDING -ELECTRICAL-PLUMBING-'MECHANICAL fVl y OwNER'S • - PLAN CHECK VALIDATION NAIVE - - OTY. PHONE ELECTRIC PERMIT • FEE 36~71 OOONTERACTOR5 - UTLETS-SWITCHES-RECEP 10.00/1.00 ' ^�ke LIGHTING FIXTURES - 10.00/1.00 -r-oU N RA T48;,5, ,C PPLIANCES-RESIDENTIAL 4.00 Pb Q:�B/�?O/VT /1 vL. S /C TO PHONE PANELS , 10.00 DATE OF APPLICATION ORcmTEcr PANELSIOVER200AMP) 20.00 PLAN CHECKFEE- P.C.NO. ENGINEER - ,uC.NO. S(GNSTRANS. 3.00 ARC" OR ENG. - PERMIT VALIDATION ADDRESS ' SPECIAL CIRCUIT 5.00 ' + Zn, TEMP.METER OR POLE INS. 20.00 ADDRESS - MOTORS SEE FEE SCH. �n > SERVICE CHANGE 20.00 wo o' LICENSED CONTRACTORS DECLARA'T'ION TEMP.POLE - 30.00 u u I hereby affirm that I am licensed ander provisionsof Chapter f) - ISSUANCE DATE vHi a m (commencing with Sect 7000)of Division 3 of the Business and 'BL G. ELECT. PLG. MECH. - H N z Professions Code,an, license is in full for�L�1�f pi,n License Class _ Lie.Numher_i7_T.QS,.a�� ❑ Date ContractorL� -�/� a L f 0 � E/r�"- BUILDING PERMIT a O NI' BUILDER DECI HA'TI )N Eoa" MISC.- REFER TO ORD N O TION - w ; LL w I hereby affirm that 1 am exempt from the Contractor's License L O FLLNj Law for the following reason.(Sac.7031.5,Businessund Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requiresa permit toconstruct,alter, rtae c 20 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO.. ELEC. I i w m u requires the applicant for such permit to file a signed statement that - TOTAL PE MIT TO he is licensed pursuant to the provisions of the Contractor's License 1 - HiQ Law(Chapter 9(commencing with Section 7000)of Division 30fthe 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. w. by any applicant for u permit Subjects aim pplitmrt too civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 of not more than five hundred dollars($5001.): ❑ 1,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 It is not OCC:GROUP RES.UNITS intended or offered for sale(See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code'.The Contractor's License Law docs not apply to an owner Of ' property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP :5.00 SO.FT.FLOOR AREA, TOTAL ACREAGE himself or through his own employees,provided that such improve- I memsare not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 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 Moving that he did not build of int- ' prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 IND - CON PB Omer O I,as owner of the property,am exclusively contracting with RE ❑ ❑ ❑ ❑ licensed 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 LAWN SPRINKLERS-OVER 5(EA.) 1.00 - contractsforsuchprojecis with a contractod0liceawd pufacaut to SEWER-SANITARY-STORM EA.2001t/10.00 Om Contractor's License Law. TRACT NO. PARCEL NO. ❑ 1 am excnnpt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 - masoT .Owner , Date WATER SYSTEM 5,00 ACC.DATE ACG FILE NO, WORK ERS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00 - I hereby affirmthatI have a certificate of Consent to self-Ilbare, - ZONING ENG.SITE NO. _ or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3900,Lith.C.). Company �KAo - O O. Cil liOed copy is her by furnished FIRE SPRINK ENERGY T-24 Z ZO p Ce tified co 's tiled will he inspection division. MISC.- REFER TO ORD. yN ,v 14, ❑ ❑ ❑ N❑ ~ rn f PERMIT ISSUANCE - 10.00 2 > .IiRTIFICATI>OP P11 I )NRO 7 VOI $' FLOOD ZONE, A.L.U.C.• W _ COMPF. ATION INSURANCE PLG.CONTR. LIC.NO. - PLG. v❑ N❑ v ❑ N❑ - d This section need t be completed if the mit is in), one TOTAL - Z hundred dollars($100) rlessA U O • l certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY IL I- mit is issued,I shall,not employ any person in any...Ther so as to Q Wbecome subject to the Workers'Compensation Laws of California. y Dute Applicant _ ALTER OR ADD TO MECH. 5,00 BUILDING - } Do NOTICE TO APPLICANT: If,after making this Certificate of Ex- ♦- Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK -�s provisions of the Labor Code, you must forthwith comply with - FEE (� such provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0OOOCEM.) 6.00 SEISMIC FEE' ' 1 hereby affirm that there is a cca strurim 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.). H EATING UN IT(TO 100,000 B.T.U.) 8.00 Lender's r H EATING UN IT(OVER 100,000 B.T.U.)9.50 . Lender's AddAddress ELECTRIC 'I certify that I have read this application and state that the shove VENTILATION 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-COMP(3 H.P.or 100,000 B.T.U.) 6.00 , hereby authorize representatives o1' this city to enter upon the BOILER-COMP (Ove,100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes.- ' (Wu) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. r' Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any accrue against Sas sty in consequence of the PERMIT ISSUANCE 10.00 granting of tl s' a it H.CONT."' LIC.NO. MECH.' TOTAL TOTAL Signa cof Applicant/ it - Date .. - OFFICE COPY