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119060. 0 POST THIS CARD NEAR FRONT OF BUILDING ^ CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD �D�"`� / I V`C/ UN # LOT JOB ADD LOT:;!t_ OWNER CONTRACTOR INSP I INSPECTOR IN ECTION RECORD PfRMIT NUMBER 11906 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- -A CE OR 180 DAYS FROM LAST CALL ED INSPECTION. FOUNDATIO S=zo. r '� UFER PREGUNITE WAGE dPERMIr VALIDATION ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING , CA8 WASTe� 3.7-0 7 (j3-13047 Ce tr ce, %2o ELECTRICAL MECHANICAL Aft-1�d L•r ��Wli 'BLDG. ELECT. I PLG. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ^'b% ou /! 2cT fo ? BUILDING PERMIT INFORMATION WOOD FLOOR - VALUATION ,p OQd $/FT. PLUMBING z)owI4)srA1les AlS aM ,S/S6lVC�f�pylS k�uAsC�og11D MECHANICAL ELECTRICAL 7 X ^01— MCiJ 6fsJQRATOIC e-;po#,C &.17-3 1W I'D fj� /) FRAMING INSULATION /D_247>nAoo/¢A ro / ,/`ao K ( STORIES TYPE CONSTR. ' h(Sr r e G14G OCC. GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF / *�'i �� OK NRN SO. FT, FLOOR AREA TOTAL ACREAGE DIAPHRAGM ^ O • (� BUILDING USE RESIND CON PB O,nn, 0 0 0 E-1 1:1 APPLY NO R00 NG UNTIL ABOVE HAS BEEN SIGNED ASSESSORSPAHCELNO, ROUGH PLUMBING p 1 .,Z GAS TEST MECHANICAL TRACT NO. PARCEL NO. ELECTRICAL FINALS DATE INSP. ACC DATE ACO FILE NO. FRAMING SAN * I SU C ATI PL MBING ZONING ENG. SITE NO: / a FIRE SPRINK Y No ENERGY T 24 Vo N❑ MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE YN[] A.L.U. C. Y� IN LATH—INTERIOR _ ELECTRICAL LATH -EXTERIOR FIRE DEPT. SHEETROCK GRADE FEESUMMARY SHEAR INTERIOR BUILDING BUILDING ,r -'• SHEAR EXTERIOR '•APPROVALS TEMPORARY FIREWALLS ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. Fw- ONE WORKING DAY BEFORE RE ARRANGE FOR INSPECTION BY P=PHONING. z PLEASE GIVE JOB ADDRESS WHESEE PERMIT FOR EXPIR MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY * BUI LDI NG PROJECT I DENTI FICATION APPLICATION & PERMIT ELECTRICAL- PLUMBING PERMIT NUMBER 11906 BUILDING AOORE55/0 T�re /�c OWNER'S NAME PHONE QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION coNTRACTOR Y NA E /•� /��/�� •J. id LIC. NO. 331a71� OUTLETSIG- SWITCHES -RECEP 10.00/1.00 LHTI NG F IXTURES 10.00/1.00 CONTRACTOR'S dry (•�+-� X414' ADDRESS �[) 0 APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 9 ARCHITECT �% �O,f MPUA900 C�. on 1 i ENGINEER,LLGD- �/� LIC.FFFIt1G. I! c. NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 All Ervc' ADDDDRESSSS ' ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 AADDRESSDDRESS ' MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000) of Division 3 Of the Business and Poolfessions Code it my license is in full fore a Bef Licen la Lic. Number BLDG. ELECT. ❑ PLG. MECH. ❑ ❑ Date - Contractor41 or BUILDING PERMIT OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also INFORMATION MISC.- REFER TO ORD VALUATION // a N (9 Ii7%O $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTE. LIC. NO. ELEC. requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 TOTAL PERMIT TO QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant too civil penally of not mare than five hundred dollars ($500).): ALTER -DRAIN & VENT -WATER (EA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended Or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC, GROUP RES. UNITS 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 SO. FT. FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im- prove 1, aso nee of the.). ❑ d as owner of the property, he exclusively contracting with licensed contractors: construct the project (Sec. 7044, Business and Professions Code: The Con builder's License Law does not apply improves thereon, and who owner of property who ba co to anContracts GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING USE RES IND CON PB Osier ❑ ❑ E] 11 ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS -1 INC5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 (EA.) 1,00 ASSESSORS PARCEL NO. tr the Contract suchprojects Lwith aconlraclorls)licensed pursuant In the Contractor's License Lew. - SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-, BAP.C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ALC. FILE NO. WORKF.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self -insert, or a certificate of Workers' Compensation miaouce, or a cerlifeJ ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab.C.I. Policy No. Company FIRESPRINK Y E] N ENERGY T-24 Yo No ❑ Certified Copy is hereby furnished. `plicaB tifie co `s file�,fwith t_ he-cjty inspection division. A•�Pbcant � & MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG.CONTR. LIC. NO. PLG. TOTAL COMPFNSATION INSURANCE (This section need not be completed if the Permit is for one Y[] IN Y[3 N❑ QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars ($100) or less.) 1 certify that in the performance of the work for which This per- mil is issued, I shall not employ any person in any manner so as to BUILDING become subject to the Workers'Compeasation Laws of California. Date Applicant NOTICE 10 APPLICANT: If, after making this Certificate Of Ex- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK emption, you should become Subject to the Workers Compensation provisions of the Labor Code, you most forthwith comply with such provisions or this permit shall00be deemed revoked. FEE AIR HANDLING UNIT (TO 10,0C.F.M.) 4.00 AIR HANDLING UNIT(OVER IO,ODOC.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which This permit is issued (Sec. 3097, Civ.C.). EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT ITB 100,000 B.T.U.) 8.00 HEATI NG UNIT(OV ER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Lender's Address I ",lily diet I have read this application and state that the above inforomrion is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING -BOILER H.P.Dr 100,000 B.T.U.) 6.00 BOILER -COMP Over 100,000 BTUI SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL granting" of this permit. m- Signadure of Applicant/Contrail Date 1JP'PIVC GVYY