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09744 POST THIS CARD-NEAR FRONT OF.BUILDING• , PERMIT NUMBER CITY- OF CUPERTINO 09pr INSPECTION DIVISION JOB INSPECTION RECORD--- C �rj'6 PERMIT EXPIRATION JOB ADDRESS "/1 WOL�CT' /�� ,� -� UNIT# LOT# , PERMIT EXPIRES IF WORK' OWNER �''c a f CONTRACTOR C E�L E"/ C� IS NOT STARTED WITHIN INSPE91ION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE:OR ISO DAYS FROM ✓t UFERLAST CALLED INSPECTION. ' Z�;� PREGUNITE �� PERMIT VALIDATION - ^ ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB Ot PLUMBING - ELECTRICAL ISSUANCE DATE MECHANICAL BLDG: ELECT, PLG. . MECH. - - E ❑. 00 NOT POUR FLOOR.UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT - INFORMATION WOOD FLOOR PLUMBINGVALUATION $IFT. • - . - , MECHANICAL - U ELECTRICAL PERMITTO FRAMING FL "1 INSULATION STORIES TYPE CONSTR. OCG GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED . ROOF . , , SOFT.FLOOR AREA 'TOTAL ACREAGE . DIAPHRAGM - -BUILDING USE i RES IND CON PB Olney APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El 0 ❑ O ❑ ROUGH ASSESSORS PARCEL NO. ' '� " PLUMBING- - GAS TEST - , TRACT NO. PARCEL NO. _ MECHANICAL 'ACC.DATE ACC,FILE NO, ELECTRICAL FINALS DATE INSP. FRAMING SAN # - INSULATION- PLUMBING 4 + ZONING ENG.SITE No..' G . .. *OCCUPANCY MECHANICAL FIRE SPRINK ENERGYT24 ' �_�� Y COVER NO WORK UNTIL ABOVE HAS BEENING Y ❑, No Y ❑ No ; ' FLOOD ZONE A,L.U.C. LATH-INTERIOR :- - TRICAL.LATH-EXTERIOR DEPT. �' - Y❑ . No Y❑ N❑SHEETROCK - E' - FEE SUMMARY SHEAR INTERIOR,. ING o.�y,SHEAR EXTERIOR' TEMPORARY•APPROVAL - BUILDING„FIREWALLS - RIC 4 PLAN CHECK FEENO TAPE OR PLASTER UNTIL ABOVE HAS BEPANCY 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 z 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 COPY - - . APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTIFI ATI ON PERMIT NUMBER MAI BUILrING APPLICATION & PERMIT O 974 Zo .Ess/ , (� LING- L-PLUMBING-MECHANICAL ELECTRICAL- NA.E ER's PLAN CHECK VALIDATION NAMOTY. ELECTRIC PERMIT FEE O CONTRACTOR PHONE NAME �p UTLETS-SWITCHES-RECEP 10.00/1.00 SU LIC.W lav LIGHTING FIXTURES 10.00/1.00 ,fD ' CONTRACTOR's A OREss Qp}j - PPLIANCES-RESIDENTIAL - 4.00 n F PHONE PANELS - 10.00 DATE OF APPLICATION ORRCHITEc PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER ARCH.OR ENG. LIC.NO. SIGNS TRANS. 3.00 ADDRESS . SPECIAL CIRCUIT 5.00 PERMIT VALIDATION zm EMP.METER OR POLE INS. 20.00 APPLICANTS SEE FEE SCH. ADDRESS � MOTORS N�-V7tC SERVICE CHANGE 20.00 q y(/ woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 1q? l00 a u S 1 hereby affirm that I am licensed under provisions of Chapter 9 Q as a n (commencing with Section 7000)of Division 3 of the Business and `• ,ISSUANCE GATE S. 7 2 Professions Code, d m license Is in full fore an ffeCL BLDG. ELECT. PLG. MECH. zo z H o License Class Lic.Number 0 ❑ ❑ F w J Date_4_a.,p„ Contractor_E � !„1 .y p M ¢ w 4 7 OWNER-BUILDER DECLARATION 67 U'' Y BUILDING PERMIT X i,a- I hereby affirm that I am exempt from the Contractor's License . MISC.- REFER TO ORD' INFORMATION F u O 4 Law for the following reason.(Sec.7031.5,Businessand ProfessionsVALUATION $/FT. w> Code:Anycity orcolmty which requires a permit to construct,alter, PERMIT ISSUANCE Y <1QUQ /ra� aiE eC O improve ,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. u PERMIT TO requires the applicant for such permit to file a signed Statement that TOTAL X m m he is licensed pursuant to the provisions of the Contractor's License - HZQ Law(Chapler9(commencing with Section 7000)of Division 3 ofthe �(_�(�� E 4 D Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE / term the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. i; -. by any applicant fora Permitsubjects $500o.licanttoacivilpenalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars the ap.li ❑ 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 .IS(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 properly who builds or improves(hereon,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. mems are not intended or offered for sale.If,however,the building _ GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner builder will have the burden of proving that he did not build or im- GAS--'EA.SYSTEM-OVER 4 (EA.)' 2,00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Onm ❑ I,as owner of the property,am exclusively contracting with '� licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1'INC 5 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 thereon,and who LAWN SPRINKLERS-OVER 5'(EA.) 1.00 contracts for such projects with a contmetor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec..,B.&P.C.for this on WATER HEATER W/VENT 6.00 Owner Dace 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 of consent to self-insure, or a certificate of Workers'Compensation Insurance;or a certified ZONING ENG.SITE NO. copy ther f(Sec.38 ),Lab.C.). Policy N ompany /�. ❑ CCrti le copy rsherdby(urn- Is I Z Z ❑ Certified o y is Ed with t cii inspection division. FIRE BPRINK ENERGY T-24 24 � O Applicunt MISC.- REFER TO ORD. Y.� N� Y ❑ No D- N CZ IFICAT' F EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE q.L.U.G. W > C PENSATION INSURANCE PLG.CONTR. - LIC.NO. PLG. ` 1 (This section need not be completed if the permit is for one - TOTAL Y❑ NE] v [] N❑ Z hundred dollars($Hon)or IcssJ U O 1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY U. Vmit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. 0 i Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING NOTICE TO APPLICANT: IE aper making this Certificate of his _ emption,you should become subject to the Workers'Compensation APPLIANCE 500 PLAN CHECK Provisions of the Labor Code, you must forthwith comply with .U FEE 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(OVEA 10SWC.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, am Iy - HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name_ Lender's AddressHEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I'certify that I have read this application and state• that the shove VENTILATION FAN,(SING LE) 4.00 information correct I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER H.P.or t00,0008.T.U.) 6.00 hereby authorize representatives of this city to enter ,upon the gOILER-COMP (Over(00,000 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 liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 granting of this per it. MECH.CONT. LIC.NO. MECH. y� TOTAL TOTAL - Sig ere of AD licant/Contractor Date OFFICE COPY .