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12278 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 12278 INSPECTION DIVISION JOB INSPECTION RECORD -PERMIT EXPIRATION JOB ADDRESS 'O✓ NIT LO .# PERMIT EXPIRES IF WORK OWNER r AcroR IS NOT STARTED WITHIN - INSP CTI N DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 160 DAYS FROM FOUNDATIO4 LASTCALLED INSPECTION. UFER PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ^ '� PLUMBING UNDERGROUND /SLAB / ELECTRICAL ISSUANCE DATE BLDG. ELECT. PLG, MECH. MECHANICAL L ❑ 1:1 . 0 0 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING 1 MECHANICAL PERMIT o ELECTRICAL FRAMING ONIE TYPE CONBTH, INSULATION OCC,GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED •�,'J $O.FL.FLOOR AREP TOTAL ACR ROOFEAGE • DIAPHRAGM RES INGUILGCNON USE Onus Cl APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED SE Cl ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT NO, PARCEL NO, GAS TEST MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL / FINALS DATE INSP. FRAMING W-Ld _ SAN * ZONING ENG.SITE NO. INSULATION PLUMBING GAS ' FIRE SPRINK ENERGY T44 MECHANICAL Yo N[j v ElNEI COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLooDzoNE A.L.U.C. LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. `"[:] N� N ❑ _ ❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDINGS BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL � — SEE PERMIT FOR EXPIRATION DATE — CONST.TAX IMPORTANT! 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 BUJLDI NG PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT A / 12278 .-F o AE55 Wd '1 �p,v Q BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S l/ PLAN CHECK VALIDATION � 52 2 CITY. ELECTRIC PERMIT FEE J 6-7 "A � \ PHONE co"nvacrOR's UTLETS-SWITCHES-RECEP 10.00/1.00 Q - NA uC.NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR S ADDRESS PPLIANCES-RESIDENTIAL 4.00 370* PHONE PANELS 10.00 DATE OF APPLICATION ARCHITKT PANELS (OVER 200 AMP) 20.00 PLANCHECK FEE P.C.NO. OR / /141 EN !f(ffAJ�L. 2 uc.NO, V✓ SIGNS TRANS. 3.00 $ "' ARCH.OF EN SPECIAL CI RCUIT 5.00 �� PERMIT VALIDATION AS E55 EMP. METER OR POLE I 20.00 PAID,� APPLICANTS VfP Z P MOTORS E FEE SCH. ADDRESS �/J�'� (L�>G' •. f JrowS / (/, SERVICE CHANGE 0.00 .JAN' o ¢ i FOO LICENSED CONT RACI'ORS DECLARATION {{��L��{� a u v I hereby affirm that I am licensed under provisions of Chapter 9 CI OISSlNKR7=IPE to a"' (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H o i Professions Code,and my license is in full fo>�1-1 ��4r�G� ❑ ❑ ❑ Z,O v'"i - License Ian's_.g�-Lie.Number a ue,i O H w ate as=o-�-Con lructor a x s W - BUILDING PERMIT E x w OWNER-BUILDER DECLARATION INFORMATION A. 3 y I hereby affirm that 1 an exempt from the Contractor's License MISC.- REFER TO ORD g PERMIT ISSUANCE 10.00 0 VALUATION S/FT. H..o j Law for the following reason.(Sec.7031.5,Business and Professions Code:Any city or county which requiresu permit toconslruct,alter. C//p fie to <o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIF NO. ELE G(/b - O requires the applicant for such permit to file a signed statement that TOTAC.L 0 PERMIT TO X he is licensed pursuant to the provisions of the Contractor's License Hai Law(Chapter 9(commencing with Section 7000)ofDivision3oftBe /� u7o , 7-e-'[.Lz - Business and Professions Code)or that he is exempt there Of and CITY, PLUMBING PERMIT FEE IS the basis for the alleged exemption.Anyviolztion of Section7031.$ STORIES TYPE DONSTR. u ;m by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of nut more than five hundred dollars(85001.)'. ❑ 1,as owner of the property,or my employees with wages as 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 thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1 INCA OUTLETS 6.00 mems are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Orhe, prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ 1:1 11❑ 1,as owner of the property,am rsC)usively 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 Contractor's License Law does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts for such projects with a contortions)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Contractor's License Law. ❑ I am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofcmexcut to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation insurance,-or a certified copy thereof(Sec.3800.Lab.C.L` -"---� Policy No. Company_,`, - 0 ❑ Ce lifieJ 'opy is hereby fu niched. FIRE SPRINK ENERGY T-24 Z Z A CertifieQ�co�y rs lle�/.!'lir the Ion division. MISC.- REFER TO ORD. Y❑ N❑ Y ❑ NO Applicants 4_64fi�rAki(i LfbV (- v0-i PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. 0 - CERTIFICATE Of:EXEMPTION FROM WORKERS' LU COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. 1 0 TDTAL V❑ NE] Y❑ N❑ This section need not be completed if the permit is for one 0 Z hundred dollars(S 100)or less.) V 0 I certify that in lire pertormance ot'tire work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to O W beconmsabjem to the Workers'compensation Laws of California, BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 tan NOTICE TO APPLICANT: If,after making this Certificate of Ex- Z emption,you should becnnle subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with AIR HANDLING UNIT ITO 10=C.F.M.) 4.00 FEE V such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE t� I hereby affirm that then is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. ZBOILER-COMP UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.), Lender's Name UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify,Ilia,I have read this application and smm that the aboveION FAN (SINGLE) 4.00 PLUMBING information is correct.1 agree to comply with all city and countyIv1P(3 H.P.or 100,000 B.T.U.) 6.00 ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the granting of this Per IL MECH.CONT. LIC.NO. MECH. TOTAL TOTAL XSignat'm fApplicant/Contractor 1)atc OFFICE COPY