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11578 POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER CITY OF CUPERTINO INSPECTION DIVISION 11578 JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 01--R 3 N G✓O��¢ ./ESO UNIT# `2 J 0'& LOT# rl' r' PERMIT EXPIRES IF WORK � OWNER 0,p 5 .ffyl CONTRACTOR U�j'Q � .IS NOT .STARTED WITHIN D INSPECTION AT INSPECTOR SPECTION RECORD 190 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION.. PREGUNITE - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED !• - UNDERGROUND /SLAB .[ PLUMBING - - - ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT. PLG. MECR. [Dq ❑. El 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILpp-ING PERMIT PLUMBING WOOD FLOOR R ^•JN nnoN� � SKORMATION - - -LuIFT. MECHANICAL ` ELECTRICAL �—PERMIT TOYF� ! FRAMING INSULATION - STORIES TYPE CONSTR. OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - • • SO.Fii FLOOR PREA TOTAL ACREAGE ROOF DIAPHRAGM BUILDING USE A RES IND CON PB Ome• APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL - -'l- FINALS DATE INSP. Acc.DnrE ACC.PILE No. FRAMING SAN # INSULATION PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑ LATH-INTERIOR ELECTRICAL• FLOOD ZONE A.L.U,C. LATH—EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N❑ SHEETROCK GRADE - FEE SUMMARY SHEAR INTERIOR - BUILDING I SHEAR EXTERIOR TEMPORARY APPROVALS - BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM .I ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F-- 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 BUI LD1 NG PROJECT IDENTIFICATION PERMIT NUMBER BUILDING 5 APPLICATION & PERMIT ADDRESS 11578. 2q 0& BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S - PLAN CHECK VALIDATION NAMEI'l� OTV. ELECTRIC PERMIT FEE r49 PHONE CONTRACTOR JOUTLETS-SWITCHES-RECEP 10.00/1.00 GK` Lc.No. LIGHTING FIXTURES 10.00/1.00LVZ /,!!- ACONTRACTORS ADDRESS ' APPLIANCES-RESIDENTIAL 4.00 A OO PHONEAxe PANELS 10.00 DATE OF APPLICATION JARCwiECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK P.C.NO. OR ENGINEER LIC.NO. � SIGNS TRANS. 3.00 Aol� ADDRESS ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION ADDRESS `��• ZIP EMP.METER OR POLE INS. 20.00 APPLICANT a MOTORS SEE FEE SDH. ADDRESS /f a& ISERVICE CHANGE 20.00 u� /y w 00 LICENSED CONT ACTORS DECLARATION U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE w w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H w i Professions Code,'n y license is in Lull for t ❑ ❑ ❑ Z, o m License 1 . Con Number E I- w Dere Contractor 5,�, a Y s BUIL13ING PERMIT ¢ ¢ w¢ OWNER-BUILDER DECLARATION INFORMATION wo ¢ca ; u w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD VAW ATION $/FT. r u 0 a Law for the following reason.(Sec.703 L5,Business and Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires permit to construct,alter, 4 w Y Z CONTR. LIC.NQ ELEC. ¢ <0 improve,demolish,or repair any struclure,prior to its issuance,also a O LLrequires the applicant for such permit to file a signed Sla[emenl that TOTAL PERMIT TO wm he is licensed pursuant to the provisions of the Contractor's License F z i Law(Chapter 9(Commencing with Section 7000)of Division 3 of the a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE ¢=$ 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 handrail dollars($500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCL.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 Com traclor's'License Law does not apply to an owner of property who builds or improves thereon,end who does such work FIXTURES-PER TRAP 5.00 60.FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve- mentsare not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 Or improvement is Sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA.) 2.00 9UILOING USE . builder will have the burden of proving that he did not build or im- RES IND CON PB Other prove for purpose of sale.). I N DUSTS I A L W ASTE INTER. 30.00 ❑ 1,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 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 contractors)licensed pursuant to the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sac.-;B.&P.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 1 have a certificate of consent 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 ❑ Certified copy is hereby furnished. FIRE SPR INK ENERGY T-24 Z ZCerlified. �s Eled th the Dins L�o division. MISC.- _ REFER TO ORD. F0 AP licant-� ��G Y ❑ N❑ Y ❑ N[] L2 PERMIT ISSUANCE 10,00 FLooO zoNE A.L.u.c. LU > CERTIFICATE EXEMPTION FROM WORKERS' 11 IU COMPEE NSATION INSURANCE PLG.CONTR. LIC.NO. PLG, C. O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ 0 Z hundred dollars IS 100)or less) U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY IL E mit is issued,1 shall not employ any person in any manner so as to O W become subject lothe Workers'Compensation Laws of California., BUILDING Date Apolicant ALTER OR ADD TO MECH. 5.00 p } y NOTICE TO APPLICANT: If,after making this Certificate of Ext L.. ? Sorption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE C.) 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=C.EM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 lire performance of the work for which this permit is issued(Sec. MICROFILM 3097, HEATING UNIT(TO 100,000 B.T.U.) 8.00 Leader's Name me HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC (ZO Lender's Address 0 1 certify that 1 have read this application and stale 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, and BOILER-COMP I3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(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 MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any ay accrue a at said City in consequence of the PERMIT ISSUANCE 10.00 granting S s per dt. MECH.CONT. LIC.NO. MECH. �fy I TOTAL TOTAL Signature. Applmant/Contractor are OFFICE COPY