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12273 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO • 12273 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRE U IT# LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN ECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUN TISPON ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB / . PLUMBING ' ELECTRICAL ISSUANCE DATE BLDG. ELECT. PLG. MECH. MECHANICAL ID DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDINGPERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING 1 MECHANICAL PERMIT TO ELECTRICAL FRAMING STORIES TYPE CONSTR. INSULATION OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED . 50.FL FLOOR AREA TOTALACREAGE ROOF DIAPHRAGM BUILDING USE ' HES IND CON PR OVwr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED EL ASSESSOR SPARC EL NO. ROUGH PLUMBING LHACT NO, PARCEL NO. GAS TEST MECHANICAL ACC.DATE ACC.FILE NO, ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY T 24 MECHANICAL Y ❑ N� Y ❑ N[-I COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH-INTERIOR ELECTRICAL FLOOD ZONE aL.U,C.. LATH-EXTERIOR FIRE DEPT. v NE] v 0 No SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC FEE CHECK 1 GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC wONE 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 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER APPLICATION & PERMIT ADD.Ess N/0 �g3 NeLFA UILDING-ELECTRICAL-PLUMBING-MECHANICAL 12273 OORE OWNER'S ,tl�'LlJ �� / PLAN CHECK VALIDATION • ME QTY. ELECTRIC PERMIT FEE /,GR PHONsZS"y-zSBb AM cANTRACTORa UTLETS-SWITCHES-RECEP 10.00/1.00 N //�� W uc.No. LIGHTING FIXTURES 10.00/1.00 ADDRESS TORS f-qVA&WAW AllS PPLIANCES-RESIDENTIAL 4.00 L n PHONE `' qA PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.NO. SIGNS TRANS. 3.0 (!L ARCH.OR ENG. S.00 PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT �f�F zIR EMP.METER OR POLE INS. 20.00 Anrs �G2G r// y MOTORS SEE FEE SCH. ADDRESS J� SERVICE CHANGE 20.00 Woo LICENSED CONTRACTORS DECLARATION M t U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH. Z Professions Code, d ray fe se is in full force 3' it IT ❑ ❑ ❑ ❑ a 0. W License Class I.ic.Number T L Date__7 e/ `/C' Cont r w a OWNER-BUILDS DE LA I r� BUILDING PERMIT REFER TO ORD INFORMATION wA H I hereby affirm That 1 am exempt from the Contractor's License MISC.- VALUATION $/FT. u o j Law for the fullowing reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 ty Code:Any city or county which requires a permit to construct,alter, A ¢ K Q 2improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO. ELEC. / W O O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO a w m he is licensed pursuant to the provisions of the Contractor's License F Rea Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe Sty-✓ 4 D Business and Professions Code)or that he is exempt therefrom andOTV. PLUMBING PERMIT FEE I o the basis for the alleged exemption.Any violation cf Seetion 7031.5 STORIES TYPE CONSTR. s- by any applicant subjects applicant loacivil 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,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 SG,FT,FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve. menu are not intended or offered for sale.IL 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 im- RES IND GON PB Other prove for purposeof 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 PARCEL NO. and Professions Code:The Contractor's License Law docs not apply to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such cenprojects Lwithaconvaaorts)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Contractor's License.Law. ❑ lam exempt under Sec..,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Uate WATER SYSTEM 5.00 ACC.DATE ACO.FILE N0. WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate ol'cousent In self-insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(See.3800,Lab.C.). Policy No. Company 0 ❑ Cenilied copy is hereby urnished. FIRE SPRINK ENERGY T-24 Z Z ertifi py rc e n tl city, specnon division. MISC.- REFER TO ORD. A liCanl_ /��iLy[l��, Y❑ N Y [3 NC] K " CERTIFICATE 017 EXEMPTION FROM WORPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W > COMPENSATION INSURANCE PLG.CONTR. ❑c.NO. PLG. CL O (This section need not be completed if the permit is for one TOTAL Y NF] v No ::) Z hundred dollars($100)or less.) - U O 1 terrify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY ,_ I- mit is issued.I shall not employ any person in any manner w as to U become subject to the Workers''Compensation Laws of California. BUILDING 3p v LU Date Applicant ALTER OR ADD TO MECH. 5.00 -�--� } m NOTICE '10 APPLICANT': If,after making this Certificate of Ex. ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK t tl 2 provisions of the Labor Code, you must forthwith Comply with C FEE S U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,CV.0.). Lender's Name J HEATI NG UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC Cie Lender's AJJm ' I Certify that 11 have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP Ove,100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to e, demnify and keep harmless the City at MISC.- REFER TO ORD. Cupertino against i bilit es,judgments, osis and expenus which CONST.TAX may � y way v� sa' yin consequence of the PERMIT ISSUANCE 10.00 gra o Ih'is iY. ^ I n� MECH.LONT. LIC NO. TOTAL TOTAL 77 Signatufeof pplicant/Contractor /Date J/[ OFFICE COPY '