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09789POST THIS CARD NEAR FRONT OF BUILDING ' CITY OF CUPERTINO • INSPECTION DIVISION /n%n II� II JOB INSPECTION RECORD ' JOB ADDRESS �Uq� t 16 _UNIT# LOT owNER CONTRACTOIrl PERMIT NU M1,RER. 0 9 7rc . PERMIT EXPIRATION ' PERMIT EXPIRES IF WORK. IS NOT.STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLEDINSPECTIONI INSPECTION DATE I INSPECTOR IN P CTION RECORD FOUNDATION -' ' - LIFER PR EGUNITE PERMIT VALIDATION ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICALE MECHANICAL LD ELECT. PLG. ME - DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION ' WOOD FLOOR PLUMBING VALUATION r. MECHANICAL,' ELECTRICAL - P MIT,To I' FRAMING INSULATION - STORIES ' TlrPEc NSTN. 4 OCC. GROUP RESI�UNITS' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF ' SO, FT. FLOOR, AREA TOTAL ACREAGE DIAPHRAGM • ' BUILDING USE It F IND CON, PB Omr, IA ❑ ❑ , ❑ ❑ ' ASSESSORS PARCEL NO. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH - PLUMBING GAS TEST TRACT NO. PARCEL NO: I. " MECHANICAL ELECTRICAL FINALS DATE IN P. ACC.DATE ACC. FILE,NO, FRAMING SAN # INSULATION � PLUMBING ZONING. ENG. SITE NO. _ GAS MECHANICAL FIRE SPRINK Y ❑ 'N❑ ENERGY TZR I, Y ❑ No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH -INTERIOR - ELECTRICAL - FLOODZONE, Y ❑ N❑ A.L.0C. , Y ❑ N❑ LATH -EXTERIOR' . - FIRE DEPT. SHEETROCK - GRADE - FEE SUMMARY SHEAR INTERIOR _ BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVAL FIREWALLS ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNEDOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ' ARRANGE FOR INSPECTION BY PHONING 252-4505, IW— :ONE WORKING DAY BEFORE REQUIRED INSPECTION. .. PLEASE GIVE JOB ADDRESS WHEN PHONING. 'SEE PERMIT FOR EXPIRATION DATE - 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 BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT -ELECTRICAL-PLUMBING-MECHANICAUILDING PERMIT NUMBER 09789 amLOlry RFs�s AOD1 AUC OWNER'S NAME p � V R F ON QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTORS OUTLETS -SWITCHES -RECEP 10.00/1.00 ACI LPFI� LIC. NO. v DATE OF APPLICATION LIGHTING FIXTURES 10.00/1.00 no0eesa ons PHONE ' ♦ APPLIANCES- RESIDENTIAL 4.00 - PANELS - 10.00 ARCHITECT 08 ENGINEER / / uc. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARC., OR ENG. ADDRESS ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATION /; - / / 1,01 - l TEMP. METER OR POLE INS. 20.00APPLI CANTS aOOREss MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION TEMP. POLE 30.00 I hereby affirm that I am licensed under provisions of Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Co e, nd. i Leis Nr full for License Cla ^ Y LIC. NuntM1eln7 2 ISSUAIIINCE DATE ELECT. B ELECT. P G. MECH. ❑ ❑ Date ContraRor -e'i'• BUILDIN PERMIT IPUQRWTION OWNER -BUILDER DECLARATION I hereby affirm that I ant exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Business and ProfessionsPERMIT Code: Any city or county which requires a permit to construct alter, improve, demolish, or repair any structure, prior to its issuance, also rcquires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License MISC. - REFER TO ORD ISSUANCE 10.00 VALU $/FT. ry pE MIT T ELEC. CONTR. LIC. NO. ELEC, TOTgL 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 by any applicant for apermcddolears the applicant tuacivil penalty of not more than five hundred dollars (my OTY. PLUMBING PERMIT FEE ST ju- 5 ONS R. ALTER-DRAIN-WATER(EA.) 5.00 em): Cl I, as owner at the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP HE UNITS intended or offered for Sale (Sec. 7044, Business and Professions Code: The Contractor's License law does not apply to an owner of DRAINS -FLOOR, ROOF, AREA, GOND. 5.00 FIXTURES - PER TRAP 5.00 GAS- EA. SYSTEM• I INC. 4 OUTLETS 6.00 property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarcnotintendedoroffercd for sale. If, however, the holding so. FT. FLOOR AREA TOTAL ACREAGE or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did n riot build or iso- prove for 1. -1 cl poseoic, Grille.). ❑ licensed as owner of the property, heli rojectiv Se contracting with adPcontractor:'to constructthe project (See. 7G44, Business and Professions Contractor's License Law does not apply • . GAS EASYSTEM -OVER 4 (EA.) 2.00 BUILDING USE E I❑ ❑N ❑ O❑` ASSESSORS PARCEL NO. INDUSTRIAL WASTE INTER. 30.00 - LAWN SPRINKLERS- V.B. 6.00 LAWN SPRINKLERS R 5 (EA.) 1.00 loan owner of property who builds property improves thereon. and who for such projects with a contrucmr(s) licenud pursuant to tr the Contractor's the Contractor's License Law. ❑ 1 :un exempt under Sec, , B.&P.C. for this reason SEWER-SANITAR V- F f, /10.00 TRACT N0. PARCEL NO, WATER HEATERWIlVIENT 6.00 Owner Date WATER SYSTEM 1 5.00 B ACC. DATE ACC FILE NO. WORKfiRS'COMI'CNSATION DECLARATION WATER TREATIN 5.00 1 hereby affirm that I have a certificate ofcome it to self -insure• ZONING ENG. SITE NO. or a certified or a certificate of Workers' Compensation "JA,, copy (her fS3,00. Lab.CJ."JPolicy Noompa y �/❑ Cetl.tiehere yfurn'hy�fliis ed wi he cit inspection division. Abplicunt MISC- REFER TO ORD. FIRE SPRINK ❑ N ❑ -ENERGY T 24 Y ❑ N ❑ PERMIT ISSUANCE 10.00 CERTIFICATE OP F.MPTION ROM WORKERS' COMPS ATION IN RANCE (This Section need rat be conhple •d if the Permit is for one FLOOD ZONE V N� A.L.U.O. Y ❑ NO PLG. CONTR. LIC. NO. PLG. i' TOTAL hundred dollars (S 100) or less.) 1 certify that in the performance of the work for which this Par - Not is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant BUILDING ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=CF.M.) 4,00 PLAN CHECK FEE emption, you should become subject to the Workers' Compensation provisions of the Labor Code, YOU must forthwith comply with such provisions Gr this permit shall be deemed revoked. AIR HANDLING UNIT (OVER 10=CF.M.) 6.00 SEISMIC FEE ! CONSTRUCTION LENDING AGENCY I 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.), Lender's Name EXHAUST HOOD (WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Address HEATI NG UN IT (OVER 100,000 B.T.U.) 9.50 ELECTRIC 1 certify that I have read this application and stale that the above information is correct. 1 agree to comply with all city and county mdinances and state laws relating to building construction, and this city es enter upon the hereby authorize representatives for ins inspection above-mentioned property tarvesp ofth i purposes. VENTILATION FAN (SINGLE) 4,00 BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 PLUMBING „m (�(J BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL (We) agree In save• indemnify and keep harmless the City of Cupertino gains) liabilities, judgments, costs and expenus which may in a Way cerue og inst said City in consequence of lire granting this pe iI. MISC. - REFER TO ORD. PERMIT ISSUANCE 10,00 CONST. TAX MECH.CONT. LIC. NO. MECH. Si aI of Applic t ontract r ate TOTAL TOTAL UO I OFFICE COPY