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13309 POST THIS CARD NEAR FRONT OF 'BUILID ING PERMIT NUMBER CITY OF CUPERTINO 139 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 22045 WALLACE DRIVE UNIT# LOT# • PERMIT EXPIRES IF WORK OWNER R. 0. BLAZER CONTRACTOR .R. PEDORSEN IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ✓ UNDERGROUND /SLAB PLUMBING � 7 t' ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECt. PLG. MECH. 0'. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION S/FT. PLUMBING MECHANICAL 'AID ELECTRICAL PEReuT TO FRAMING l NSU LATIGN STORIES TYPE CONSTR. CIIv of Cupertin OCC,GROUP RES.UNITS PLACE 0 SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF $O.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE HES IND CON PB OO,er APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 0 0 ❑ ❑ ROUGH ASSESSORS PARCEL NO, PLUMBING p. TRACT NO., PARCEL No GAS TEST . MECHANICAL ' p J ELECTRICAL FINALS DAT INSP, ACC.DATE ACC.FILE NO. .FRAMING SAN 7i ZONING ENG.SITE NO. INSULATION PLUMBING - GAS FIRE SPRINK ENERGY T-24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y❑ Ni] Y ❑ "� LATH-INTERIOR ELECTRICAL FLOODZONE aL.u.c. LATH-.EXTERIOR FIRE DEPT. Yo N❑ Y❑ No A SHEETROCK GRDE - FEE SUMMARY SHEAR INTERIOR - BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ooONE WORKING DAY,BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESSWHEN PHONING. - SEE PERMIT FOR-EXPIRATION DATE - MECHANICAL IMPORTANT! CONST,TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 6 BUILDING PROJECT I DENTIFICATI ON PERMIT NUMBER aUILDING APPLICATION & PERMIT r "OO�"E`o Sc1J '1 tP a(�( /•Y� � BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 1 330 OWNER'S T %-xVt PLAN CHECK VALIDATION "A ` Qd QTY. ELECTRIC PERMIT FEE fk7o • � 1 PHONE)4!5- CONTRACTORS E MOUTLETS-SWITCHES-RECEP 10.00/1.00 I LIC.NO. �(/011� LIGHTING FIXTURES 10.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 ADDRESS (3 I ) = PHONE 10 PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.IVO, SIGNS TRANS. 3.00 ARCH.Ess ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP rrEMP.METER OR POLE INS. 20.00 Arvrs MOTORS SEE FEE SCH. ✓� a4u-x . ADDRESDDRESS I F¢ SERVICE CHANGE 20.00 ` 0 0 LICENSED CONTRACTORS DECLARATION /�V 6 7 <u v I hereby affirm that I am licensed under provisions of Chapter - ISSUANCE GATE (commencing with Section 7000)of Division 3 of the Business and ¢ BLDG. ELECT. PLG. MECH. r m y Professions Co n s my license is in full for z o - Licens•Class �Q@@��'pp Lic.Number O F G Date /tlContractur a y E BUILDING PERMIT ¢ m w ¢ OWNER-BUILDER DECLARATION INFORMATION " MISC.- REFER TO ORD w 3 n H 1 hereby affirm that I am exempt from the Contractors License VALUATION $/FT. r u.w J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 w Y Code:Any city or county which requires a'permit to construct,alter, ¢ to¢SO improve,demolish,or repair any structure,prior to its issuance,atm ELEC.CONTE. LIC.NO. ELEC. O IS requires the applicant for such peril to file a signed statement that TOTAL PERMIT TO o. w$ he is licensed pursuant to the provisions of the Contractor's License / Fii 4..(Chapter 9(commencing with Section 7000)of Division 3 of the �(Y z o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE 2 f$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a ; _ by any applicant for a permit subjects the applicant fair civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than Ove hundred dollars($500).): ❑ I,as owner of the property,or my employees with wager's 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 Code:The Contractor's License Law does not apply to an owner of property who builds or improves Ihereon,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. menta an not intended or offered for sale,if,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner. GAS•EA.SYSTEM- VE (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build ser iso- RES IND CON PB Other prove for purpose of sale.). INDUSTRI AL WASTI TER. 30.00 ❑ [,as owner of the property,am exclusively contracting with - ❑ ❑ ❑ ❑ ❑ licensed contractors to constmet the project(Sce.7044,Business LAWN SPRINKLERS-1 IN `6 VB 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 Ihereon,and who LAWN SPRINKLE_S.-OVER 5(EA.) 1.00 contracts for such projects with u contracmrts)licensed pursuant to - - )( t/10. tit,Contractors License Law. SEWERSANITAR VSTO M00 11110 TRACT NO. PARCEL N0. Cl 1 am exempt under See. ,B.&P.C.for this WATER HEATER WtVIINT 6.00 rcuson Owner - Dare WATER SYSTEM 5.00 ACC.GATE ACO,FILE N0. WORK I'RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconsent toself-insure, ZONING or o ce tificate of Workers'Compensation Inst etice,o o ecriFied ENG.SITE NO. ?' copy thereDf(Sec.3800,Lab.C.). Policy No. Company _ _ O ❑ CurtifiedcoPyisherebyfmomsud. FIRE SPRINK ENERGY T-24 Z Z ❑ Cetli cppy i1filed with the'cily inspection division. MISC.- REFER TO ORD. Applicant I--TX�'� Y ❑ N❑ Y ❑ N❑ COTCE RTII9CATI>vO-FeIIiXF.A1PT1oN FROM WORKERS' PERMIT ISSUANCE 10.00 Q FLOOD ZONE A.L.U.C. L COMPI-NSATION INSURANCE PLG.CONTR. LIC.NO. I.G.P (� C Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ PIC] hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per, CITY. MECHANICAL PERMIT FEE FEE SUMMARY L F mil is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. y Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE TO APPLICANT: If,alter making this Certificate of Ex. r Z emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Cotte, you must forthwith comply with FEE V shah provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.N0 4.00 .CONSTRUCTION LANDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 Lender's Address - ELECTRIC 1 certify that I have read this application and stale tlmt the.above VENTILATION FAN (SINGLE) 4.00 �e information is correct.1 agree to comply with all city and county PLUMBING CIO C. ordinances and state laws relating to building COnSIRlntion, andBOIP I LER-COMPI3 H.P.or100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMOver 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against Inabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the grap(jngo f.[h^p rmf[. MECH.CONT. LIC.NO. MECH. not ofApplica�h ,.)nets\ TornL TOTAL Signature of Applicant/Contracmr Date OFFICE COPY