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14018 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 14010 INSPECTION DIVISION JOB INSPECTION RECORD ' \"r �J PERMIT EXPIRATION , JOB ADDRESS 10123 NORTH WOLFE ROAD UNIT# LOT# PERMIT EXPIRES IF WORK OWNER WOMENS WORLD CONTRACTOR R.C.. MYERS IS NOT STARTED WITHIN INSPECTIONDATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION �E r POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICALCUQe ISSUANCE DATE MECHANICAL' BLDG. ELECT. - PLG. MECR. E3, ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMITU - WOOD FLOOR INFORMATION PLUMBING VALUATION /FT. MECHANICAL ELECTRICAL PERMIT yU FRAMING Y �- INSULATION STORIES TYPE CONSTR. - OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - , SO.FT.FLOORAREA TOTALACREAGE ' DIAPHRAGM BUILDING USE RES IND CON PB OVner APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ROUGH ASSESS0115 PARCEL NO, PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING SAN # ZONING ENG.SITE NO. INSULATION � � PLUMBING , GAS MECHANICALFIRE SPRINK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ; HEATING ❑ "❑ Y ❑ N[-] LATH-INTERIOR ELECTRICAL FLOOD ZONE aL.u.c. LATH-EXTERIOR FIRE DEPT. v❑ N❑ Yo N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FELECTRIC G FIREWALLS ELECTRIC ECK GAS ! NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY FEE > OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. LM ARRANGE FOR INSPECTION BY PHONING 252-4505, IC H ONE WORKING DAY BEFORE REQUIRED INSPECTION. Gz PLEASE GIVE JOB ADDRESS WHEN PHONING. SEE PERMIT FOREXPIRATION DATE - ICALIMPORTANT! AXPLEASE READ REVERSE SIDE BEFORE AL CALLING FOR FINAL INSPECTION. OFFICE COPY 4L � APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER ADDRESS As r✓G - APPLICATION & PERMIT ''7�2 �� /.�� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 14018 NAMER S UUN" PLAN CHECK VALIDATION • 4 i 9 QTY. ELECTRIC PERMIT FEE O/j'/L'iiOS co FACTOR'S UTLETS-SWITCHES-RECEP 10.00/1.00 N J.eq IP' ,5p //V n L.C.NO. JL/ LIGHTING FIXTURES 10.00/1.00 CONTRACTORS LfX002 A DBEs y �'y PPLIANCES-RESIDENTIAL 4.00 O F AlH / PNONE7 ` Gy3 f PANELS 1D.OB DATE OF APPLICATION ARCHITECTPANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C.NO. OR NGINEER fOAJ6 LIC.NGC° A'L SIGNS TRANS. 3.00 E ADDRESS eec. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. - 20.00 .� 's 7 APPLICANTS O 0Ox 5/G 9 ADDRESS MOTORS SEE FEE SCH. �w rte---- .0 /Y / SERVICE CHANGE 20.00 �V`7 O// �r woo LICENSED CONTRACTORS DECLARATION 1 rt 0 u 'I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE < w (commencing with Section 7000)of Division 3 of the Business and ) BLDG. ELECT. PLG. MECH. H D i Professions Cod and my license is in full force eff c� Z o - License c' / Lic.Number53W ❑111 j ❑ ❑ 9 a Date Contractor P" •'- Q y f j BUILDING PERMIT Ix w u OWNER-BUILDER DECLARATION INFORMATION OT.A MISC.- REFER TO ORD X ; N I hereby affirm that I am exempt from the Contractors License VALUATION SIFT. Huy J Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 /� �- Code:Any city or county which requires permit to construct,alter, Q Q Q Improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC.NO. ELEC. n -p 0 u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w he is licensed pursuant to the provisions of the Contractor's License HiQ Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe '�CrQ-TL� 00L Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE M the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. d$_ by any vpplic.nt fora RSrjt..9ublects.the applicant ma civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than rW hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as IBACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sale compensation,will do the work,and the structure is Rol intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 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 S.QD all FT.FLDufl PREA TOTAL ACREAGE himself or through his own employees,provided that such Improve- mentsare not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-i INC.4 OUTLETS 6.00 . or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or am.. RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE 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 PAROELNO. 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 forsuch projectswith a contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate ofcousent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'CO tion Insurance, r a certified copy thereof(Sec.3800,Lab.0 ` Gp7 Policy No. Company O ❑ Certified ns here rybyy�furnished. FIRESPRINK ENERGY T-24 Z 2 ❑ Cek'tifned a�19A with the city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ Q APPlican ] I '/ Y N v N PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. CERTIFICATE Olz EXEMPTION FROM WORKERS' W COMPENSATION INSURANCE - PLG.CONTR. LIC.NO. PLG. 0' Q (This section need not be completed If the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ D Z hundred dollars IS 100)or less.) U O I certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F- mit is issued.I shall not employ any person in any manner so as to U become subject to the Workers Compensation Laws of California. 0 i Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } N NOTICE TO APPLICANT: If,after making this Certificate of Ex. Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK U such provisions or thvisions of the i s speror m shall be deemed revoked.ou must forthwith comply with AIR HANDLING UNIT(TO IOPOOGF.M.) 4.00 FEE O CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE 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. HEATING UNIT(TO 100,000 B.T.U.) 6.00 MICROFILM 3097,Civ.C.). Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address 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-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city Io enter upon the BOILER-COMP (Ovar 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned roperly for inspection purposes. (We)�a ree to sa e, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino agei ' bilines,judgments, costs and expenses which CONST.TAX may/in an a against said City in consequence of the PERMIT ISSUANCE 10.00 granting lin er it. MECH.CONT. LIC.NO. MECH. ,S �_ - Sir? TOTAL TOTAL Signatureof Applicant/Cont Date OFFICE COPY