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13396 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO RMIf NUMBER DIVISION IJJyb JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 10340 WESTACRES DRIVE UNIT# LOT# PERMIT EXPIRES IF WORK OWNER M.C. MCKENZIE CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- - FOUNDATION • - ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. UFER � PREGUNITE - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE BATE MECHANICAL eLOG. ELECT. PLO. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ` c BUILDING PERMIT WOOD FLOOR \�1, W INFORMATION J TION - $/FT. PLUMBING G D4 MECHANICAL ELECTRICAL PERMIT TO FRAMING Y STORIES TYPE CONSTR. INSULATION OCC'GHOUP RES.UNITS PLACE NO SUBfL00R UNTIL ABOVE HAS BEEN SIGNED ROOF 50.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB Other APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED �✓� ❑ Q ROUGH f��i ASSESSORS PARCEL N0. yfV/` PLUMBING GAS TEST rHncT NO. PAHceL No. MECHANICAL .- - 'ELECTRICAL FINALS RTEINSP. ACC.DATE ACC.FILE NO, FRAMING- SAN # INSULATION PLUMBING ZONING ENG.SITE NO. GAS ' - MECHANICAL FIRE SPHINK ENEHcv T.Za COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NE] Y ❑ No LATH—INTERIOR - ELECTRICAL FLOOD ZONE A,L,U,C. LATH—EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N❑ SHEETROCK GRADE 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 NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE —. MECHANICAL IMPORTANT! CONST.Tax PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPV APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDINGAPPLICATION & PERMIT ADDRESS le-?,44 �i(/FS r,G`C/lES �t BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 13396 OWNER'S PLAN CHECK VALIDATION rvam e eG QTY. ELECTRIC PERMIT FEE NAso cTons� OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME /,/r// LIC.NO, LIGHTING FIXTURES 10.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 ADDRESS / PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc.No. SIGNS TRANS. 3.00 AARCH OR DDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP rrEMP.METER OR POLE INS. 20.00 ADDRESrvrs MOTORS SEE FEE SCH. 11 //(.- SERVICE CHANGE g 20.00 o O LICENSED CONTRACTORS DECLARATION ((v'� M.v W I hereby affirm that Sec I n licensed under provisions of Chapter 9 QV) ISSUANCE DATE N 4 e (commencing with Section 700e)i of Division 3 of the Business and L SLOG. ELECT. PLG. MECH. IN i Professions Code,and my license is in full force and effect. ❑ ❑ ❑ o w - License Class Lic.Number e� o z r D Date Contractor \ a y s Ot CVQ BUILDING PERMIT ¢ a w a: OWNER-BUILDER DECLARATION INFORMATION X ;A y I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD S. Law for lire following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00,40 VALUATION $/FT. - 0J Code:Anycity orcounty which requimsa permit to construct, ter, a an < FO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC N0. ELEC. !0 in - O 0M requires the applicant far such permit to file a signed statement final TOTAL PERMIT TO e' w $ he is licensed pursuant to the provisions of the Contractor's License i Law(Chapter 9(commencing with Section 7000)of Division 3 ofllie 1 i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE n the basis for the alleged exemption.Any violation of Section 7031.5 I STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER -WATER (EA.) 5.00 of not more than five hundred dollars(5500).1: ❑ I,as owner of the property,or my employees with wages as BACK FLOW 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 does such work FIXTURES,PER TRAP 5.00 SO,FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-1 6.00 meats are not intended or offered for sale.If,however,the building or improvement is old within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CDN PS Other . . ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ 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 Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a conlractods)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. >f[I am cam I der ec._ ,B,&P.C.for this WATER HEATER W/VENT 6.00 reason X Owner " Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WOI CERS'COMPE I N DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or u certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. O Applicant Y ❑ N❑ Y ❑ N[] XT CERTIFICATE PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. Lu FROM WORKERS'' Lu COMPENSATION EXEMPTION INSURANCE PLG.CONTR. LIC.NO. PLG. Q. 0Z (This section need not be completed if the permit is lot ane TOTAL V❑ N❑ Y C] N❑ hundred dollars(S 100)or less.) U 0 I certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL h mit is issued, I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of Calilbrnia. a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } 0 NOTICE T'O.APPLICANT: If,after making this Certificate of Ex- Z emption•you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of lire Labor Cade, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.) Lender's Name Lender's Address HEATI NG UELECTRIC IT ER 100,000 B.T.U.)9.50 a I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, an J BOILER-DOM' (3 H.P.of100,000B.T.U.) 6.00 hereby entioed representatives of this city U enter upon the BOILER-COMP(0ver 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property tar vespofthi purposes. ' (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, casts and expenses which - CONST.TAX may in any way accrue agains said C'ty in consequence of the PERMIT ISSUANCE 10.00 granting of it MECH.CONT. I.G.NO. MECH. 7 �7� TOTAL TOTAL i of Appian( 1)ate OFFICE COPY