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14275 ! POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 14275 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOBADDRESS 6072 WILLOWGROVE LN - UNIT# Lor# PERMIT EXPIRES IF WORK OWNER ALBERT RUNRES CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PREGUNITEPERMIT VALIDATION dPOUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' UNDERGROUND /SLAB PLUMBING ELECTRICAL L. IssuANCE GATE MECHANICALbLOC. ELECT. PLG. MECH. e a�j ❑ ❑ '00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED y BUILDING PERMIT INFORMATION WOOD FLOOR vn wnnoN $1FT. PLUMBING MECHANICAL PERMIT To ELECTRICAL FRAMING .. STORIES 'TYPE CONSTR. INSULATION OCC GROUP RES.UNITS -PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO,FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING 115E RES IND CON PB Oinn, • APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED Q ❑ Q El ❑ ASSESSORS PARCEL NO ROUGH PLUMBING GAS TESTI TRACT NO. PAR CEL NO MECHANICAL . ACC,DATE ACC.FILE NO. ELECTRICAL / FINALS DATE INSP. FRAMING SAN # INSULATION PLUMBING ZONING ENG.SITE NO, GAS EF]IREPRINK ENERGY T2< MECHANICAL N� vCOVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ZONE A.L.U.C. LATH—INTERIOR ELECTRICAL 'LATH—EXTERIOR FIRE DEPT. - N Yo N❑ SHEETROCK - GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPOR ALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS Sit P FEE yI 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 OPLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPi_ICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER 0 LDIss APPLICATION & PERMIT I 4,(172 A//1-L0W(; ,6V& L BUILDING — ELECTRICAL—PLUMBING—MECHANICAL 14275 OWNER'S PLAN CHECK VALIDATION DTV. ELECTRIC PERMIT FE= {� V KESHBNE(y `/D� NAMQRacrOWs UTLETS-SWITCHES-RECEP 10.00/1.00 16 LIC,No. LIGHTING FIXTURES 10.00/1.00 CONTRACTORre APPLIANCES-RESIDENTIAL 4.00 ADDRES S PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.NO. ISIGNS TRANS. 3.00 ARCH.OR ENG.' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS. 20.00 ADRESS r9 ADDRESS MOTORS FEE SCH. /j SERVICE CHANGE20.00 woo LICENSED CONTRACTORS DECLARATION G it w I herehy affirm that I am licensed under provisions of Chapter 9 ��Q - ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Businessand BUILDING PERMIT BLDG. ELECT. PLG. MECH. y i Professions Code,and my license is in full force and effect ❑ ❑ E]z D w License Class Lie.Number r n o l2 t:w Date Contractor - a f ce 2 M ¢ OWNER-BUILDER DECLARATION INFORMATION wo a'a MISC.— REFER TO ORD ; LL w I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. H a- 04 Lawforlha followingreoson.(See,7031.5,Businessuod Professions PERMIT ISSUANCE 10.00 p — Code:Any city or county which requires a permit to const RlcL alter, ¢ 2 Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NQ ELEC. �Q ca O u requires the applicant for such permit to file a signed slatemeat that TOTAL PERMIT TO whe is licensed pursuant to the provisions of the Contractor's License iii Law(Chapter 9(commencing with Section 7000)ofDivision3 ofthe ¢ Business and Professions Code)or that he isexempt therefrom and DTV. PLUMBING PERMIT FEE M=$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5,00 of not more than five hundred dollars(5500).): ❑ L as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE ,4,00 OCG.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,GOND. 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 awn employees,provided that such improve. _ ments are not intended or offered for sale.if,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- ) GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will phaveurpose the burden of proving that he did not build or ins- ptspvy 1,as owner of sale)' INDUSTRIAL WASTE INTER. 30,00 RES IND CON PB oroar �g d as owner of the property,ani exclusively cool race ing with ❑ ❑ ❑ ❑ ❑ licensed contractors :o 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 s th does not apply to tr owner of property who ba cont r improves Thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with u contractor(s)licensed pursuant to the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C.fa this WATER HEATER W/VENT 6.00 reason Owner WATER SYSTEM 5.00 ACC.GATE ACC.FILE NO. WORKERS'COMPI:NSA'FION DECI.ARATIO WATER TREATING EQUIP. 5.00 1 hereby affirm that I have acertMeateofconsenl toself-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO, copy thereof(See.3800,Lab.C.). Policy No. - Company O ❑ Certified copy is hereby furnished. FIRESPRINK ENERGY T 24 Z Z ❑ Certified copy is filed with the city inspeclion division. MISC.- REFER TO ORD. 1-' Q Applicant Y ❑ N Y ❑ No CC W CI!RTIFICATEOF I:X[:MI91ON FROM WORKI:RS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. d a (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ D Z hundred dollars 1$100)or less.) U 0 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued, I shall not employ any person in any manner en as to O become subject to the Workers'Compensation Laws of California. i Date Applicont ALTER OR ADD TO MECH. 5.00 BUILDING } w NOTICE TO APPLICANT: If,after making this Certificate of Ex L.. Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code• you must forthwith comply with FEE L) such provisions or this permit Shull be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction Iundiog agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Cis C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lenders NamAddress HEATING UNIT(OVER 100,000 B.T.U.)9.50 a70 00 Lender's Address ELECTRIC 0 1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLEI 4,00 information is correct.I agree to comply With all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to cnmr upon the above-mentioned property for inspection purposes. BOILER-COMP (0.,100,000 BTU)BEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may ' ny way accrue,against id City in consequence of a PERMIT ISSUANCE 10.00 gr mg i ermiL MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Signature of Applleunt/Contract r Dote OFFICE COPY