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14340 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER , CITY OF CUPERTINO 14340 / ' INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION 'JOB ADOR ESS o?oR �.'ri-� IiL�Q�I�LG Ly ��f' -UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER h GGL CONTRACTOR �Q��i7 �. IS NOT STARTED WITHIN INSPECTION DATE I INSP CTOR INSPECTION RECORD iBO DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION -Zy NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION PREGUNITE CUPERTINO STANDARDS. GARAGE SLABS N POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 91 J UNDERGROUND /SLAB PLUMBING ® ELECTRICAL - ISSUANCE DATE MECHANICALfit^ ELECT PLG, 1ITCH El j 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED VMMILILUINU PERMIT INFORMATION WOOD FLOOR C`� ALUATION s/FT. PLUMBING MECHANICAL_ - A � PERMIT TO ' ELECTRICAL FRAMING �(, ^2 58 - INSULATION �- l STORIES TYPE CONSTR. 3-b6OCC GROUP RES. UNITS CJ PLACE NO SUBFLOOfl UNTIL ABOVE HAS BEEN SIGNED SO.FT FLOOR AREA •TOTAL ACREAGE ' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE i THE CONSTRUCTION TAX IS PAID DIAPHRAGM _ ��•'� - I IBUILDING USE ROOF SHEATHING RES IND CON PB 00- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑' ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY -'O . TRACT NO, PARCEL NO. %09181 SHOWERPA PLUMBING ENERGY ,70,f MECHANICAL MECH.ENERGY .jO ELECTRICALBUILDING ENERGY ACC DATE ACC,FILE NO -t/- � _ FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBINGGAS TEST GAS FIRE SPRINK ENERGY T.24 -1 MECHANICAL (/ ,�'.`jp COVER NO WORK UNTIL ABOVE HAS BE SIGNED HEATING Y ❑ "❑ v "❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD LONE A UA. . . INTERIOR SHEAR FIRE DEPT. Y❑ N❑ v ❑ NO SHEETROCK- 'I - GRADE FEE SUMMARY EXTERIOR LATH BUILDING5107 INTERIOR LATH -I - G. TEMPORARY APPROVALS BUILDING � YdT,,,,f SCRATCH COAT - ELECTRIC PLAN CHECK - . GAS FEE ` NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTI LBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESSWHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL 1 CONST,ONST,TAX PLEASE READ REVERSE SIDE BEFORE TOTAL L4--.tF i CALLING FOR FINAL INSPECTION. OFFICE COPY e , APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION ,PERMIT NUMBER aUILDING - APPLICATION & PERMIT ADDRESS/ /JCr14340 C BUILDING—ELECTRICAL—PLUMBING—MECHANICAL OWNERS ( O 7 PLAN CHECK VALy^fION spi / 1^ 7 V. ELECTRIC PERMIT FEE corvTRACTO 'S OUTLETS-SWITCHES-PIECED 10.00/1,00 M?z 4a LIC,NO., LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S APPLIANCES RESIDENTIAL , 4.0 ADDRESS _ ' Uri - PRONE �— PANELS 10.00 CJ DATE OF APPLICATION V ( OOgcwiECi a/�`'i1 I ^��J� - uv(k PANELS (OVER 200 AMPI 20,00 PLAN CHECK FEE P.O.NO. y ENGINEER r�7� {/ LIC NO SIGNS TRANS, 3.00 \ ARCH.OR ENG. - PERMIT VALIDATION �l ADDRESS ., Y/ SPECIAL CIRCUIT 5,00 061st , 7iD ZIP EMP. METER OR POLE INS. 20.00 Pp�® ADDRESS APPLICANTS MOTORS SEE FEE SCH. / " SERVICE CHANGE 20,00 w 02 LICENSED CONTRACTORS DECLARATION ^ • 37p p ace,u Lti 1 hereby affirm that I am licensed under provisions of Chapter 9ATE H G w (commencing with Section 7000)of Division 3 of the Business and ELECT. PLG.- MECH. r o z Professions Code, d my license is in full force' drll'e / 2 o H R Licens£CI ss Lin.Contractor om r Date_ Controcmr tW� a¢ a OWNER-BUILDER DECLARATION BUILDING PERMIT a M U INFORMATION w 1 hereby affirm that 1 am exempt from the Contractor — REFER TO ORD 's License MISC. Huoj Law forthe following reason.(Sin,7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. Code:Anytityormuntywhichrequiresapermittaconstruct,alter, Q I -s ,u•�n 2 M sr Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC, n / Tla( 4 O u requires the applicant far such permit to file a signed statement that TOTAL d 1p PERMIT TO a x he is licensed pursuant to The provisions of the Contractor's License = za Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe JE1�uf�/7GON 4 O Business and Professions Code)or that he is exempt therefrom andV. PLUMBING PERMIT FEE I-m the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR. i ; _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5,00 of not more than five hundred dollars(55001): ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS 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 thereon,and who docs such work FIXTURES-PER TRAP 5.00 ,( SO]FTT.FF�L/OOR AREA TOTAL ACREAGE himself re through his own employees,provided that such improve- ✓ T 7F' hients mself a through ot or employeeffered for sa provided that s,the building GAS-EA.SVSTEM-l1NC.40UTLET$ 6.00 orimprovement is Sold within one year of completion,the owner- builder will have the burden of proving that he did not build or fm, GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL'WASTE INTER. 30.00 RES IND CON PB Omar ❑ 1,as owner of the property,am exclusively contracting with ® ❑ ❑ 0 ❑ licensed contractors to construct the project(Sec. 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 contracts for such projects with a contentions)licensed pursuant to SEWER-SANITARY-STORM EA.200f1/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ lam exempt under See. ,B.&P.C.for this reason WATER HEATER W/VENT 6.00 Owner - Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent Io self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation In, or a certified copy thereof, Lah.C.l .� Policy No. IpanyU ❑ CeRitred cpy is hereby f.RusteJ. FIRESPRINK ENERGY T-24 Z Z ❑ Cerci ' d cofl4� i�s� Pled with the city inspection division. MISC.- REFER TO ORD. Applicant {2H6�^'� V 0 N Y N in CERT'IFICA'TE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 O-- FLOOD ZONE A.L.U.C. . L COMPENSATION INSURANC17 PLG.CONTR. LIC.NO. PLG. PO Y 1 INC] Y ❑ N CL Z (Tills section need not be completed-if the permit is for one TOTAL 5,4 L) O hundred dollars IS 100)or less.) I certify that in the performance of The work for which this perV MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not employ any person in m any anner"' s t0 U become subject to the Workers'Compensation Laws of Californaia. GO Dam Applicant ALTER OR ADD TO MECH. 5.00 BUILDING a } to NOTICE TO APPLICANT: If,after making this Certificate of Ex- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Cade, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=11F.M.) 6.00 SEISMIC FEE .2,9 1 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(See. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lenders Address ELECTRIC 1 certify that I have read this application and stole That the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and countyPLUMBING 00 ordinances and state laws relating to building construction, and BOILER-GOMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this inspection ths city purposeto s.enter upon the above-mentioned property for BOILER-COMP (Over 100,000 BTU)SEE F EE SCH. MECHANICAL p�p2 es (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. uperlino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 p— CONST.TAX ay in any way accme against Said City in consequence of the ranting of ilii ermu MECH.CONT. LIC.NO. MECH. f My 4z;_ < y�� TOTAL ,Zd� TOTAL �D4 Signature of Applicant/Contractor )a[d OFFICE COPY