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12212 ' POST THIS CARD NEAR FRONT OF BUILDING . .w.1"• , r PERMIT NUMBER CITY OF CUPERTIN® o INSPECTION DIVISION 12,212 JOB INSPECTION RECORD -- I. PERMIT EXPIRATION JOB ADDRESS 0� 1 ' U IT# LOT# CIO //D,1/ PERMIT EXPIRES IF WORK OWNER W CON ACTOR VV� (/�J IS NOT STARTED WITHIN INSPECTION DATE INSPECTO —INSP ON'RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LIFER LAST CALLED INSPECTION. IK 7 .6'� PREGUNITE PERMIT VALIDATION wAlfe iYD aG 7/i 6/J'7J6a -J POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -.Q3c'7 'F UNDERGROUND /SLAB - 7� wt� - . - (tom cl'E PLUMBING ./yy/LLQ L,tAff v! 14^A � j ELECTRICAL - /J../L r` K (/ ,djjf ISSUANCE DATE MECHANICAL BLDG. ELE PL MECH. Q DO NO POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED /O- d'-'7 BUILDING ERMIT WOOD FLOOR [Ui"t%'�uz?- 2-ST S% INFORMATION VALUATION $/FT. PLUMBING .i.i I �/ae. f � MECHANICAL L-Sfrs'hYlEn rehv..l*C�bLw�� ro ELECTRICAL 1� r L'ur cetwwr xci., PERMIT TO FRAMING .. INSULATION tc11f e + (V If W STORIES TYPE CONSTR. rZZ-6Q SQA �-`L OCG GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -7n5[S Cc ROOF `{X-O O-p,Ne UadQrNSCD SO.FT.FLOOR AR EP TOTAL ACREAGE 'AI DIAPHRAGMS (-if Cr S G0. SC Q: BUILDING USE "ES IND CON PB Other APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO, ROUGH PLUMBING CT TRACT NO, PARCEL NO, GAS TEST `r6 MECHANICAL - - ' ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING SAN 0 INSULATION PLUMBING - zDNING ENG.SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY T.21 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NEINE] LATH-INTERIOR - ELECTRICAL FLOOD ZONE L.UC. LATH-EXTERIOR FIRE DEPT. Y❑ " Yo "[j' SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING Z SHEAR EXTERIOR TEMPORARY APPROVALV BUILDING FIREWALLS - ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY G 'SEISMIC FEE Ad i7I OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM 1 ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Lu F0- ONE WORKING DAY BEFORE REQUIRED INSPECTION. T PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - e; IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE y- TOTAL, CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY a . •' BO LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER BU1°1NGVp"zo H A APPLICATION & PERMIT 12212 ADDRESS (OI[T1..h(,4j•R7(.�E LpL'j)' [{\��� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL NAME" �' NC PLAN CHECK VALIDATION lc PHaN DTV. ELECTRIC PERMIT FEE �S'3a 3 J� croR's NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 j//07V �- NAME y LIC.NO. LIGHTING FIXTURES 10.00/1.00 ADDRESSTOPXAPPLIANCES-RESIDENTIAL ARCHITECT4.00 / PHONE PANELS 10.00 DATE OF APPLICATION , , 1 �� PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR Ll 1 ENGINEER 0©6 LIc.No SIGNS TRANS. 3.00 ARCHON ENG` ��Y1,rIi�P t•, I'lKL PERMIT VALIDATION AooRE`ss �''VV�g TT CY✓ �s�.� SPECIAL CIRCUIT 5.00 ' ( (% W.� ZIP vpr[�y EMP.METER OR POLE INS. 20.00 PI�r� APPLICANT'S AODRESS ,v� MOTORS SEE FEE SCH. n /yy (Ut W4 L.{�„ SERVICE CHANGE 20.00 �LIp '02 oO LICENSED CONTRACTORS D17CLARATION 111�l� �f yr <i w I hereby affirm that I am licensed under provisions of Chapter 9 w< (commencing with Section 7000)of Division 3 of the Business and N E CATE H N i Professions Code,andlmy license is in full force and effect. BLOWY '9450111. tflogm MECH. So,�- License Class_E_Con Number ❑ ❑ aL H w Date Contractor sr y E J E a i OWNER-BUILDER DECLARATION BUILDING PERMIT w ; r I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION F u y J Lnw for the following reason.(Sec.703L5,Business and Professions PERMIT ISSUANCE VALUATION $/FT. 5 "a, Code:Any city or county which requiresa permit toconstruct,alter, 10.00 1 <0O improve,demolish,or repair any structure,prior to Its issuance,also ELEC.CONTE. LIC.NO. /a � ELEC. - DLL requires the applicant for such permit to filo n signed statement that TOTAL PERMIT TO n w m A he is licensed pursuant to the provisions of the Contractor's License ,f P p FZ > Law(Chapter 9(commencingwith Section 7000)ofDivision 3 ofthe FEE E'zUJ6` t o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT a, H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. iii by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).): Q ❑ I,as owner the properly,or my employees with wages as [hBACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES,UNITSeir sole compensation, ion,will do the work,and the structure is not Vintended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 VCode: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 SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided(hat such improve- mentsarenotintendedoroffered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4(Eq.) 2.00 builder will have the burden of proving that he did not build or un- BUILDING USE pr2vjpfor purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer y 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 V and Professions Code:The Contractor's License Law does not apply ASSESSORS PARCEL NO. Iftto an owner,of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 rcontracts for such projects with a contractors)licensed pursuant to r the Contractors License Law. SEWER-SANITARY-STORM EA.200ft110.00 TRACT NO. PARCEL NO. O 1 am exempt under Sec. . B. C.for this s� reason � WATER HEATER W/VENT 6.00 V Owro r I111.1c ., r WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. � WORKfiRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to sel Ginsum. ZONING or a certificate of Workers'Compensation Insurance,or a ef[ified ENG.SITE NO. t reof(Sec.3800,Lob.C).`1� {`�F _ Policy Company_E_ldk C) ❑ Cetlified copy ex hereby union Pd. FIRE SPRINK ENERGY T-24 Z Z ❑ Cerlified copy is filed with the city inspection division. FO Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ No it L4 CERTIFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG 1 a (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ :) Z handrail dollars(5100)or less.) U O I certify that in the performance of the work for which this per, QTY MECHANICAL PERMIT FEE FEE SUMMARY LL U ,nil is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. W Date Applicant BUILDING AQ } DO NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 3. H 2 ennHaon,you should become subject to the Workers'Compensation APPLIANCE 5.00 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 10A00C.F.M.) 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000 C.F.M.) 6.00 SEISMIC FEE &= �O-O� 1 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,CN.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9,50 ELECTRIC 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 stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives ec This city to enter upon the BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) a I, sav in m iify and keep harmless the City of MISC.- REFER TO ORD. Cupertino ainst Iiabl ies„'udgmen s, costs and expenses which CONST.TAX Tay N qny ay accrue Aga st ssi City in consequence (he PERMIT ISSUANCE 10.00 granlingof this ermit' MECH. T. LIC.NO. MECH. TOTAL TOTAL t / OZ 3 a* Signatu App at/ rector to OFFICE COPY