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14300 POST THIS CARD NEAR FRONT OF BUILDING v ER CITY OF CUPERTINO PER 1T43F00 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 10123 N WOLFE ROAD UNIT# Lor# PERMIT EXPIRES IF WORK OWNER FLOWERS' FOR YOU STORAGEACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM ' FOUNDATION Y QI�'o S�S1c,c„l1- Iu SP••�E4Z� LAST CALLED INSPECTION. UFER O wke..� Co(.}y� .AOY z�5��(Q,a PREGUNITE - vERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �i / d, ✓I^� UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG, ELECT, `PLG. I MO, DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUAnoN PLUMBING MECHANICAL ELECTRICAL PERMIT TO FRAMING f - r•r *STORIES /-TYPE CONSTR. INSULATION OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED- ROOF IGNED ROOF SD,FT.FLOOR AREA TOTAL ACREAGE .• DIAPHRAGM BUILDING USE RES IND CON PB Otlmr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ El ❑ cl ROUGH ASSESSORS PARCEL NO, PLUMBING TRACT NO. PARCEL NO GAS TEST MECHANICAL ELECTRICAL FINALS DATE INSP, ACC.DATE ACC.FILE NO. FRAMING SAN # 20NING ENG.SITE N0. INSULATION PLUMBING GAS _ FIRE SPRINK ENERGY T24 MECHANICAL OIvihi r Y ❑ N❑ Y ❑ N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.u.c. LATH-EXTERIOR FIRE DEPT. a_1_� YC) N� YC NC] SHEETROCK GRADE FEESUMMARY SHEAR INTERIOR BUILDING 116- SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING f FIREWALLS ELECTRIC PLAN CHECK - ' - - - GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. } MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE ti TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY "BUILDING PROJECT I DENTIF[CATION PERMIT NUMBER EDILDING APPLICATION & PERMIT 14 OO AGORW4 + IOIA3 ,Ub 70 / BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S a PLAN CHECK VALIDATION - i NACM'E (NIS) QTY. ELECTRIC PERMIT FEE F/nu4= F ,C, r0ave. PHONE 2/- 30 coNTRAcrons (a UTLETS-SWITCHES-RECEP 10.00/1.00 Q- NAME uc.No. LIGHTING FIXTURES 10.00/1.00 10" roNTRAcroR's PPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No. SIGNS TRANS. 3.00 ADDRRiSS eea SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP - EMP.METER OR POLE INS. 20.00 APPLICANT'S MOTORS SEE FEE SCH. AOORE55 i SERVICE CHANGE 20.00 Foo LICENSED CONTRACTORS UIiCLARATION U U I hereby affno that I am licensed under provisionsof Chapter 9 ISSUANCE DATE ¢ ry (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT.I PLG. MECH. F m z Professions Code,and my license is in full force and effect. ODate- . ❑ z -o License Class Lic.Number Date H m_ J Contractor w s BUILDING PERMIT ¢ aa¢ OWNER-BUILDER DECLARATION INFORMATION woIf MISC.- REFER TO ORD ;u w I hereby affirm that I am exempt from the Contractor s License VALUATION S/FT. u0¢ Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 " w m Code:Any city or county which requires permit to construct,alter, T ¢Q 00 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. SEE.. r 3 � e u requires the applicant for such permit to file a signed statement that TOTAL PERRPET TO A w m he is licensed pursuant to the provisions of the Contractor's License Fri Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE T F o the basis for the alleged exemption.Any violation D(Section 7031.5 STORIES YEE CONSTR. i ;m by any applicant for a permit subjects the applicant Ica civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 of not more than five hundred dollars($500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.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,CONDE 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 so.Pr.FLOOR AREA rornt ACREAGE himself or through his own employees,provided that such improve- mentsarenotintendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.40UTLETS 6.00 . or improvement is sold within one year of completion,lite owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Other v for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 I,as owner of the property,am exclusively contracting with ❑ '❑ ❑ ❑ ❑ tensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.8. 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 contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200f1/10.00 TRACT NO. PARCEL NO. the Contractors License Law. ❑ I amexemplunder Sea ,B.&P.C.for his WATER HEATER W/VENT 6.00 reason Owner Uu[c WATER SYSTEM S.00 ACC.DATE ACC.FILE NO. WORKF: S'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate OI'consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(See.3600,Lab.C.). Policy No. Company 0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is riled with the city inspection division. MISC.- REFER TO ORD. Y N Y N O Applicant ❑ ❑ ❑ ❑ rnPERMIT ISSUANCE 10.00 O FLOODZONE A.L.U.C. CC - CERT[FICATF.OF EXEMPTION FROM WORKERS' Lu Q. O COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. NE]/ ❑ V❑ N❑ (This section need not be completed if the permit is for one TOTAL Y 0 Z hundred dollars($100)orlcss.) 0 O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mil is issued,I shall not employ any person in any manner so as to 0 W become subject to the Workers'CompensalionLaws ofCalifornia. BUILDING SD Dale Applicant ALTER OR ADD TO MECH. 5.00 } y NOTICE TO APPLICANT: If,after making this Certificate of Ex- H ? empiion,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK •'') (, q provisions of the Labor Code, you must forthwith comply with FEE L) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1OPWQF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 101000C.EM.) 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. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address 1 certify that I have read INS 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 slate laws relating to building construction, and BOILER-OOMPI3 H.P.or 100,000 B.T.U.) 6.00 s 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 PERMIT ISSUANCE 10.00 CONST.TAX may in an way accrue against said City in consequence of the granting [ t perm'. MEG..CONT. LIC.NO. MECH. S // 30 41 TOTAL TOTAL Signature of Applic [/Contractor Ual OFFICE COPY