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12167 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER . Y CITY OF. CUPERTINO INSPECTION DIVISION' (�1 YT JOB INSPECTION RE ORDS `�•ri . �" j 'A/ .,.�F�( "� ✓ PER MIT EXPIRATION JOBADDRESS 1Q/oZ'3 /�'I �'IOLFc" A UNIT# LOT# -C PERMIT EXPIRES IF WORK OWNER CONTRACTOR e,A-� C✓'(.L �N� IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION - ',.LASTCALLED INSPECTION. LIFER PREGUNITE - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ., ( . UNDERGROUND'/SLAB '! PLUMBING ELECTRICAL ISSUANCE DATE 'MECHANICAL - BLDG. ELECT. I PLG. MECH, ❑ ❑' ❑ ;j❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $IFT. PLUMBING , MECHANICAL - PERMIT TO ELECTRICAL FRAMING INSULATION - l• STo IES TYPE CONSTR. D4 npBrfmD ' - OCC.GHOUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SD,IT,FLOOR AREA TOTAL ACREAGE ROOF C PNRAGM S • i BUILDING USE RES IND CON PB 00 ' ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 1:1 El 1:1ASSESSORS PARCEL NO. ROUGH PLUMBING ' GAS TEST TRACT NO. PARCEL NO. ' . MECHANICAL ACC.DATE . ACC.FILE NO, ELECTRICAL' - - FINALS DATE INSP. - FRAMING SAN # INSULATION PLUMBING ZONING ENG.SITENO. . GAS MECHANICAL I - FIRE SPRINK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ NEI ❑ N❑ LATH-INTERIOR - ELECTRICAL FLOOD ZONE - A.L.0 C. LATH-EXTERIOR - FIRE DEPT. Y❑- N❑ Y❑ N❑ T;.' SHEETROCK - GRADE - FEESUMMARY SHEAR INTERIOR BUILDING " - SHEAR.EXTERIOR _ - TEMPORARY APPROVALS e—DING FIREWALLS ELECTRIC PLAN CHECK GAS ' FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE,FOR INSPECTION SY.PHONING.252-4505, ) ELECTRIC Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION .k PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL Q� IMPORTANT! ' CONST.TAX PLEASE-READ REVERSE SIDE BEFORE . dd 'C TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -.USE BALL POINT PEN ONLY PERMIT NUMBER ' AWiBUILDI Nti'RR'OJECT (DENT cgnQ - APPLICATION & PERMIT mrvc pip - Aooflass � r f"GP1T- , a Me 101• -- BUILDING-ELECTRICAL-PLUMBING.-,MECHANICAL 12167 . Nes ER's t .PLAN CHECK VALIDATION Me DTV. ELECTRIC PERMIT - F CON ALTtlfl `, NAME UTLETS-SWITCHES-,RECEP 10.00/1.00 LIGHTING FIXTURES ' 10.00/1, ' CONTRACTOR'S ADDRESS APP LIANCES-RESI DENT IAL .00 E PANELS 10.00 DATEOF APPLICATION OR PANELS _ PANELS (OVER 200 AMP) 20.00 . PLAN CHECK FEE P.C.NO. ENGINE x SIGNS TRANS. . 3.00 ARCH.OR ENG, t PERMIT VALIDATION AOOfless SPECIAL CIRCUIT 5.00 EMP.METER OR POLE I S. 20.00 'max- per_- .�• APPLICANT'S - MOTORS ADDRESS SEE FEE SCH. ' SERVICE CHANGE - 20.00 ��' ooF LICENSED CONTRACTORS DECLARATION••' Ei pj I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE y et (commencing with Section 7000)of Division 3 of the Business and F m i ProfessionsC 11e�a license is in full fmcBLDG. ELECT. PLO. MECH.i 'o Z m o. License C s Lic.Number a ve J. Date' Contractor a o o OWNER-BUILDER DECLARATION BUILDING PERMIT w guy I hereby affirm that I am exempt from the Contractor's License, MISC - REFER TO ORD n INFORMATION F u o j Law for the following reason.(Sec.7031'.5,Business and Professions pE IT ISSUANCE A7 UATION $/FT. Code:Any city orcounly whichrequires a permit to construct,all - 70.0 •7 G 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC. TR. . LIC.NO. ELEC. rxp r Amu requires the applicant for such permit to file a signed statement that TOTAL UY_ n w he is licensed pursuant to the provisions of the Contractor's License �s PERMIT T!p F 2 r Law(Chapter 9,(Commencing with Section 7000)of Division 3 of the i o Business and Professions.Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT ��L kkk---IIIJJJ to H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. i 3 , by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): .ALTER-DRAIN&VENT-WATER (EA.) 5.00 71 ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.96OCC.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. .00 ' Code:The Contractor's License Law does not apply to an owner of oPerry who builds or improves thereon,and who does such work FIXTURES-PER TRAP. 5.00 SQ.FT.FLOOR AREA TOTAI.ACREAGE ). imself or through his own employees,provided that such improve- - Dls a•p not intended or offered for sale.If,however,the building ` GAS-EA.SYSTEM-1 1 NC.4 OUT S 6.00 improvement is sold within one year of completion,the owner. 6wlder will have the burden of proving that he did not build or im- GAS-EA..SYSTEM-OVER 4 ( .) . • 2.00 BUILDING USE prove for purpose of sale.). RES IND CON PB Other t` INDUSTRIAL,WASTE IN TE 30.00 11 1:1El ❑ 1:1 . ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(See.7044,Business LAWN SPRINKLERS-1 1 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- ER 5(EA.) 1.00 I, contracts for such projects with a contractors)licensed Pursuant to - theContractor'sLicenseLaw. - SEWER-SANITARY- ORM EA.200tt/10.00 TRACT NO. PARCEL NO. ❑ l um exempt under Sec._,BAP.C.for this resson WATER HEATE /VENT 6.00 - Owner Date WATER SYSTLQ 5.00 ACC.DATE Ace.FILE No. WORKERS'COMPENSATION DECLARATION WATERT ATING 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 thereof(Sec.3800,Lab.C.),. - Policy No. Company _ O. •�❑,., Certified copy is hereby furnished zZ g� Certi res file it the , FIRESPRINK ' ENERGY T$4' O. ABphleant - SC.- - REFER TO ORD. r❑ N❑ I v ❑ N❑ cr N CERTIFICATE,OF'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C. 1 W->_ COMPENSATION INSURANCE P .CONTR. LIC.NO. PLG. ' CL O (This section need not be completed if the permit is for one, TOTAL Y❑- N❑ Y ❑ N❑ Z hundred dollars[$100)or less) U O 1 certify that in the performance of the work far which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'Compensateon� (California. a . Date- - . Applicant AJ ALTER OR ADD TO MECH. 5.00 BUILDING >- N NOTICE-TO APPLICANT: If,after making this Certificate of Ex- H 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 U such provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT(TO 10,ODOCF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10DWC.F.M.) 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,Civ.C.L /A HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name VI-A NG UNIT 100,000 B.T.U.)9.50 Lender's Address 'ELECTRIC I certify that I have read this application and state that the aboveVENTILATION FAN (SINGLE) 4;00 information is correct.I agree to comply with all city and county PLUMBING I ,ordinances and state laws relating'to bonding construction, and BOILER-COMPI3 H.P.or 100, U.1 _6.00 hereby authorize representatives of this city to enter upon'the BOILER-COMP Over 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 PERMIT ISSUANCE ' '10.00 CONST.TAX May in any ay cc a against said City in consequence of the grali nl bt pe ti' - MECH.CONT. LIC.NO. TOTAL�� r%� � a. -� 1371 Cl 5 J TOTAL Signature of Applicant on(ractor Date - .. OFFICE COPY -