The URL can be used to link to this page

12105• POST THIS CARD NEAR FRONT OF BUILDING ' CITY OF CUPERTINO. "FRMIT NuMBEn 12105 INSPECTION DIVISION JOB INSPECTION RECORD ;PERMIT,EXPI RATION JOB ADDR ' V UNI LOT# PERMIT EXPIRES IF WORK OWNER C NTRACT IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. PECTION DATE INSPECTOR INSPECTIReECORD FOUNDATION - • UFER PREGUNITE PERMIT VALIDATION - - �I�//' '•� ' l { NCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - - - - - UNDERGROUND/SLAB PLUMBING ELECTRICAL - DT. PLG. MECH. MECHANICAL )INLFORMATION ❑ ❑. - DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ING PERMIT ` WOOD FLOOR - . VALUATION $/FT. PLUMBING ' MECHANICAL • ELECTRICAL PE r'••: FRAMING - STORIE PE CONSTR. INSULATION - OCC. GROUP ES. UNITS ' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - e SO FT, FLOOR AREA iOTALACREAGE DIAPHRAGM - BUILDING USE RES IND CON PB OF' ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. ROUGH PLUMBING- - - 1 �`2 .. ' GAS TEST T a� S'8�s'NKLtr, �-1D "' TRACT NO. PARCEL NO. MECHANICAL I ELECTRICAL . - FINALS DATE INSP. ACC. DATE ACG FRE NO. FRAMING SAN INSULATION ING L'� ZONING ENG. SITE NO. • FIRE $PRINK ENERGY T 24 NICAL ��11 ^�i Y N❑ - Y ❑ "❑ G COVER NO WORK UNTIL ABOilk LATH—INTERIOR ICAL _ FLooD zoNE Y ❑ "� A. L;u.c. Y ❑ No LATH—EXTERIOR ' EPT. - SHEETROCK FEE SUMMARY SHEAR INTERIOR UNG } _ :A0 BUILDING L !i„' -� SHEAR EXTERIOR 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. MICROFILM - ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC , ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 010 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z — SEE PERMIT FOR'EXPIRATI'ON DATE MECHANICAL CONST. TAX . - IMPORTANT! TOTAL 1 el `. PLEASE READ REVERSE SIDE BEFORE . CALLING FOR FINAL INSPECTION. -� OFFICE COPY, APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER aUILDING ADDRESS12105 �q OWNER'S - NAME 1, OTV. ELECTRIC PERMIT FEE PLAN HECKVALIDA7JON �-✓ly)` NAMERperoRs - OUTLETS-SWITCHES-RECEP 10.00/1.00 DATE OF APPLICATION LIGHTING FIXTURES 10,00/1.00 ,C&Nkpoz ADDRESSPPLIANCES AL. -id 7 [ �'` -c PHONE I'1'I-)(J - RESIDENTIAL 4.00 PANELS 10.00 OflRCXITEDT GH\L�t G-1aj ENGINEER LIC. NO. PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH.SS ENG. xlv SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ,�j /� ,�(/r (vv/l('i1 EMP. METER OR POLE INS. 20.00 ADDRESS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20,00 ' w r . LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 Commencing with Section 7000) of Division 3 of the Business and Professions Cod and my license is in full fore and effect 01 �ouL License Class Lie. Numbed I TE MECH. L PLG. 17 ❑ Q DaIe9Ge Contracto3l 1 III IC15ING PERMIT INFORMATION OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason. (See.uires a,Businessand Professions construct, alter, ter, Code: Any mulish county my wh icy structure, requires permit o is issuance, improve, demolish, or repair any structure, prior to its issuance, also 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 ofthe Business and Professions Code) or that Ise is exempt therefrom and MISC.- REFER TO ORD VALUATION /�V ✓ �7 $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO /.vTGR ion "MavE OTY. PLUMBING PERMIT FEE STORIES •TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by anyapplicant Cora permit subjectsthe applicant ton civil penally of not more (hen five hundred dollars (S500f): ALTER -DRAIN -WATER IEA.) 5.00 - ❑ I, as owner of the properly, or my employees with wages as (heir sole compensation, will do the work, and the structure is not BACK FLOW 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 propertywhobuildsorimprovesthereon, and who dues such work himself or through his own employees, provided that such improve. mentsarenotintendedorofferedforsale. If, however, the building - FIXTURES - PER TRAP 5.00 SO. FT, FLOOR AREA TOTAL ACREAGE - GAS-EA,SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion, the O.T.S builder will have the burden of proving that he did not build or int prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING uSE - RES IND CON PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE 1 NTE R. 30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Codc: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracb for such projects with a conlmclons) licensed pursuant to (he Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. O lam exempt under She.-, BAP.C. for this anon WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC, FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate ofconsenl to self -insure' or a certificate of Workers' Compensation Insurance, or u cerlil'ied ZONING ENG. SITE NO. copy thereof(Sec. 3800, Lab.CJ. _ P Company Ce fled copy is hereby furnished. ❑ C., e i 'fled it the cit inspection division. Applicant FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ MISC.- REFER TO ORD. F: RTI FICATE OF EXE M�X[�ON ION FROMW KERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANC (This section need not be completed if the permit is for one Y ❑ N ❑ Y ❑ N❑ CITY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or h..) I 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 10 BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- 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 shall be deemed revoked. AIR HANDLING UNIT (TO 10=r-F.M.) 4.00 FEE ' AIR HANDLING UNIT (OVER 100MC.EM.) 6.00 - SEISMIC FEE p,(' CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which (his permit is issued (Sec. 3097, Civ.C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 6.00 HEATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Lenders Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 ' PLUMBING BOILER -COMP 13 H.P. Or 100,000 B.T.U.) 6.00 BOI LER-COMP (Over 100.000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. Misc.- REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of, Cupertino against liabilities, judgments, costs and expenses which lay in any way eccme against Said City in consequence of the anting of this permit. CONST. TAX PERMIT ISSUANCE 10.00 MECH.CONT. LIC. NO. MECH. TOTAL. TOTAL s� Signature of Applic n Contracto Uate OFFICE COPY