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11972 POST THIS CARD NEAR FRONT OF BUILDING "f. CITY OF CUPERTINO Rh,ITND ,BER INSPECTION DIVISION 11972 JOB INSPECTION RECORD ' '/ R 54, /as S7 . PERMIT EXPIRATION JOB ADDRESS(U/—Z-3 4/1 WOLFE- UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER E lTE (.JO /ST GA-TG' CONTRACTOR Zs'LD �[ 'G A2 rC- IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS of PERMIT ISSU- FOUNDATION . ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. LIFER . PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB r v PLUMBING � I ELECTRICAL ISSUANCE DATE •BLDG,' ELECT. PLG, MECH. MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION PLUMBING WOOD FLOOR {' " ALUAT ION $/FT. q+ d MECHANICAL - PERMIT TO ELECTRICAL cm � FRAMING STORIES TYPE CONSTR. INSULATION OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED /. ROOF $O.FT.FLOOR AREA TOTAL ACREAGE' .� DIAPHRAGM —BUILDING USE RES IND CON PB Omer APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ ❑ ❑' ASSESSORS PARCEL N.O. ROUGH � PLUMBING ' GAS TEST - TRACT NO. PARCEL NO. MECHANICAL - ACC.DATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY L24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y E]' N F-1 .Y E] N� FLooO zorvE A.L.u.c. LATH-INTERIOR IELECTRICAL LATH-EXTERIOR FIRE DEPT. v YE] r I] N[3 SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING - BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS ' FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ISEISMIC FEE OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM - ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC /0 • F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0� 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 I 1 - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY 1'61J I LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER aDIEDING APPLICATION & PERMIT ADDREaa 11972 �O/ZN //, -_ (, E i BUILDING–ELECTRICAL–PLUMBING–MECHANICAL OWNER'S NAME —J/.J {/j'BSOG IAC—S - PLAN CHECK VALIDATION CITY, ELECTRIC PERMIT FEE 7E sD iS T.cgTc PHON s _ CONTRgCTOR'a NaME fI(1 OUTLETS-SWITCHES-RECEP 10.00/1.00 7A-!C LIC.NO O' z3JSlo LIGHTING FIXTURES 10.00/1.00'–'— ADDRESS 0.00/1.00 "ADDRESS APPLIANCES-RESIDENTIAL 4.00 PHONE LZ11-41OY/ / PANELS 10.00 agCmTECT DATE OF APPLICATION ORENGINEER PANELS (OVER 200 AMP) 20.00 PLANCHECKFEE P.C.NO. uc.No. SIGNS TRANS. 3.00 ARCX.OR ENG. ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION zip TEMP.METER OR POLE INS. 20.00 APPLICANT'S MOTORS / , p AODREss �iCoq_y�/fl SEE FEE SCH. /V/p—�",--(—"�-,vy�"� o¢ i SERVICE CHANGE 2p,pp 9K_� / G� �� o O LICENSED CONTRACTORS DECLARATION Fi W I hereby affirm that 1 am licensed under provisions of Chapter 9 w a n (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE H. D Z Pru es ions Code and my license is in full force and effect. BLDG. I ELECT. PLG. I MECH. i O`2 – Licenu C ass Lic.Number 2 V, IX'Yn ❑ ❑ 0 w E w� Date 7 Cmdmctmr I ♦.i A ¢w OWNER-BUILDER DECLARATION BUILDING PERMIT A 3 u w I hereby affirm that I am exempt from the Contractor's LicenseMISC.— REFER TO OR INFORMATION r u o a Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCEO VALUATION S/FT. S ve Code:Any city or county which requiresa permit toconsDUCt,alter, 0 ¢ ¢ ¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. a i o ¢ requires the applicant for such permit to file a signed statement that / K C/(/ (,�j, X he IS licensed pursuant to the provisions of the Contractor's License j13� TOT PERMIT TO r z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe s4 ao Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT ¢ FEE �Li7 H $ the basis for the alleged exemption.Any violation of Section 7031.5 a 3 by any applicant for a Permit subjects the applicant to a civil penalty STORIES TYPE CONSTR. of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5,00 O 1,as owner of the property,or my employees with wages as DEVICE their sole compensation,will do the work,and the structure is not BACK FLOW PROTECT. D 4.00 OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of Property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 himself or through his own employees,provided that such Improve- SO.FT.FLOOR AREA TOTAL ACREAGE meets are not intended or offered for sale.IL however,the building GAS-EA.SV$TEM-11NC.4OUTLETS 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 ar im• GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 prove for purpose of sale.). It BUILDING USE DUSTRIAL WASTE INTER. 30,00 RES IND CON pit Omar ❑ I,as owner of the property,am exclusively contracting with RE ❑ ❑ 13 ❑ licensed colaructors to construct tile in e project(Sec. 7044,Busess LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 and Professions Code:The Contractor's License Law does not apply ASSESSORS PARCEL No. 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 contrlctcus)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACTNO. PARCE_LN 0 0lam exempt under Sec. ,B.&P.C.for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM' - 5.00 ACC.DATE ACC.FILE NO. wORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00 1 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 thereof(Sec.3800,Lab.C.) Policy No. Company 1 F9 U L 0 ❑ Certified copy is hereby furnished. Z Z M Certifi d cap is filed with t c city inspection division. FIRESPRINK ENERGY T-24 Applicant A6Z7IC( o MISC.- REFER TO ORD, v � IN El v [3 N[] c N CERTIFICATEOP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 W FLOOD ZONE q.LU.C. COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLO, 1 0 (This section need not be completed if the permit is for one TOTAL Y 0 N❑ Y 0 NEI Z hundred dollars IS IOD)or less.) U O I certify that in the performance of the work for which This per- FEE SUMMARY LL U mit is issued,1 shall not employ any person in any manner so as to GTY• MECHANICAL PERMIT FEE 0 W become subject to the Workers'Compensation Laws of California. y} Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING Z Date S TO APPLICANT: If,after making this Certificate of Ex. F _ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK Provisions of tile mforthwith e Labor Code, you trust comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,0MCF.M.) 4.00 FEE 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 the Performance of the work for which this permit is issued(Sec. 3097,Civ.CJMICROFILM . " HEATING UNIT 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG UNIT(OVER 100,Opp B.T.U.)9.50 ELECTRIC _ l8 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, and BOILER•COW(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City ofMISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which may m any way accrue against said City in consequence of the PERMIT ISSUANCE 10,00 CONST.TAX grunti his permit. MECH.CONT. LIC.NO. MECH. Z44-_1_2 — 7 /r BB - TOTAL TOTAL — .3 Signatur f Applicanl/Contractor Date - OFFICE COPY