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13562 l ;ti POST THIS CARD NEAR FRONT OF BUILDING RM1fITNUM1,BEH CITY OF CUPERTINO INSPECTION DIVISION 13562 . • JOB INSPECTION RECORD PERMIT.EXPI RATION JOBADDRESS 11000 WOLFE ROAD UNIT# LOT#• HEWLETT PACKARD PERMIT EXPIRES IF WORK OWNER CONTRACTOR - IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- y ANCE OR 180 DAYS FROMT FOUNDATION LAST CALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED / UNDERGROUND /SLAB Alf- 1 . k. PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT, PLG, MECH. , ❑ ❑ 1 ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION SIFT. PLUMBING `�� MECHANICAL PERMIT To ELECTRICAL FRAMING - �- STORIES TYPE CONSTR. r INSULATION 000.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED $O,FT,fLOOR AREA TOTAL ACREAGE • ROOF DIAPHRAGM BUILDING USE HES IND CON Pd Dllu'r 11 El El El El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT NO. PARCEL NO. GAS TEST MECHANICAL ACC.GATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO, INSULATION PLUMBING GAS MECHANICAL FIRE SPRINK ENERGY T 24 YC] N� Y C) rv� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.u.c. LATH—EXTERIOR FIRE DEPT. Y❑ N� Y ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING - FIREWALLSELECTRIC i i PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING: - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANTI CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPV - J APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .A - PERMITNUMBE x -BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT �` ADDRESS C 13562 ADDRESS IvGv � 1C BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S' T PLAN CHECK VALIDATION NAME 4/, - w M 11 Ir OTY. ELECTRIC PERMIT FEE • C W lC ^ „ HDNE -f "TMJ V CONTRACTOR OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME 5� LIC.No, LIGHTING FIXTURES 10.00/1.00 �� CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE 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. 3.00 ARCH.OR ENG. S,Qo PERMIT VALIDATION A EGRESS SPECIAL CIRCUIT ZIP EMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. t l2 ADDRESS SERVICE CHANGE 20.00 , �JQ.11 w o O LICENSED CONTRACTORS DECLARATION •"• cr v U 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE y (emon,cneing with Section 7000)of Division 3 Of the Business and BLD ELECT. PLG. MECH. H D i Professions Code•and my license is in full force and effect. El ElEDz Ole- License Class Lie.Number. Qy Dale CmgmCI.r tc BUILDING PERMIT IS OWNER-BUILDER DECLARATION REFER TO ORD INFORMATION w3 u in 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- VALUATION $/FT. Hu0J Law for the followingreasoa(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 V+ Code:Any city or county which requires a permit to construct,alter, ic p Q Improve,demolish,Or repair any structure,prior to Its Issuance,also ELEC.CONTR. LIC.NO. ELEC. / - D , 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 Z i Law(Chapter 9(emomencingwith Section 70000of Division 3 ofthe a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. n; � by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 of not more than five hundred dollars(55000.): LlI,as owner of the property,or my employees with wages as ggCK 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 docs not apply to an owner of properly 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 that such improve- mentsl are not intended or offered for sale.If,however,the building 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 be did not build or un- RES IND CON PB Omer prove.for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,ton exclusively contracting with El ❑ El 13licensed 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 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 contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT N0. PARCEL NO. the Contractor's License Law. ❑ I am exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00 xOwner - � f - WATER SYSTEM 5.00 ACC,DATE ACC.FILE NO. WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certifmale of consent to self-insure, ZONING ENG.SITE NO. or a Certificate of Workers'Compensation Insurance,or a certified copy thereof(See.3800,Lab.C.). Policy No. Conspany O ❑ Certified Copy Is hereby furnished. RE SPRINK ENERGY T 2A Z Z ❑ Certified copy is filed with the city inspection division. Misc.- REFER TO ORD. Y ❑ N❑ Y ❑ No y Applicant FPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c. lr - CERTIFICATF.OF EXEMPTION FROM WORKERS' LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ V ❑ N OTAL ❑ 1 (This section need not be completed if the permit is for one T D Z hundred dollars(SI00)or less.) U O 1 certify that in the performance of the work for which this per CITY. MECHANICAL PERMIT FEE FEE SUMMARY ljL I- mit is issued,I shall not employ any person in any manner so as to � L) become subject to the Workers''Compensation Laws of California. BUILDING .f�p Date Applicant ALTER OR ADD TO MECH. 5.00 } W NOTICE *10 APPLICANT: If,after making this Certificate of Ex- I'- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.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 dor 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 Lenders Address . 1 certify Ihat I have read this application and stale 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 (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keephurrnless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 granting of this permit. MECH.CONT. LIC.NO. MECH. R19 TOTAL TOTAL 7/b xSigifflurty of Apphcant/Contractor Date OFFICE COPY