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9075 ,� POST THIS CARD NEAR FRONT OF BUILDING , PERMI�NUMB F:N s CITY OF CUPERTINO (�(� �, INSPECTION DIVISION 90 C u JOB INSPECTION RECORD G PERMIT EXPIRATION', `• JOB ADDRESS O D �a UNIT# L T# PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSP C ION DATE INSPECTOR INSPTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION -Z2 -1 j tvdT PI(c?pr LASTCALLED INSPECTION. UFER" PREGUNITE 30 S(I. i,� U pL\k PERMIT VALIDATION Q POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED t0 2046 Wi. UNDERGROUND /SLAB I _ SI&I, qvL '� /v/�/ PLUMBING IssEN `L� p 0 W- J db ELECTRICAL V2YW.. .L'f" C/PTTY �J(2 1"N� MECHANICAL \ BLDG. ELECT, PLG. MECH. ete� e4�p tse6 ❑ . 0 ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED /-11-9 6 BUILDING PERMIT INFORMATION WOOD FLOOR _ e &,y-& 26 - VALUATION SIFT. PLUMBING MECHANICAL PERM1IIT TO ELECTRICAL FRAMING DRIES T PECO Tfi. INSULATION OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 44" $O.FI,fLOONnREF iOTAIACREAGE ROOF � DIAPHRAGM z--7- uuILOINc usE ` ery RES IND CON PB -OIM1rF V APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El 11 1:1 El 0 ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT NO. PARCEL NO. , GAS TEST MECHANICAL ACC.DATE ACC.FILE NO, ELECTRICAL FINALS DATE INSP. FRAMING Sh( SAN # I ZONING ENG,SITE NO. INSULATION PLUMBING GAS FIRE SPgINK ENERGY Lp MECHANICAL Y ❑ rvEl Y ❑ N[j COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ELo LATH-INTERIOR ELECTRICAL �� J ZONE aL.u.c. v LATH-EXTERIOR FIRE DEPT. NE] v �] NE] SHEETROCK 2 3,CW 7 GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLSE ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING -�, z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST.TAX IMPORTANT! PLEASE READ.REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. r OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATIONPE IT NUMBER BUILDING J� ��, APPLICATION & PERMIT 9075 AnDRE.S.� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I EH PLAN CHECK VALIDATION "A QTY. ELECTRIC PERMIT FEE GNE 3 CONTRACTORS NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 \ NAME p �7 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. PERMIT VALIDATION ADDRESS SPECIALCIRCUIT 5.00 ZIPEMP.METER OR POLE INS. 20.00h ASNrs MOTORS SEE FEE SCH. I /Ir•�� 1 ADDRESS SERVICE CHANGE 20.00 c t (1 002 LICENSED CON TRACTORS DECLARATION TEMP.POLE - 30.00 Ctl, /O J� < u I hereby affirm that I am licensed under provisions of Chapter 9 014 Ol ISSUANCE DATE (commencing with Section 7000)of Division 3 Of the Business and LOC. ELELT. PLG. MECH. F H z Professions Code,and my license is in full force and effect. ❑ ❑ ❑ Z o - License Class Lia Number, 0 z h w Uu[c Contractor a r f BUILDING PERMIT w< OWNER-BUILDER DECLARATION INFORMATION dose' MISC. REFER TO ORD w 3 u H I hereby affirm that 1 am exempt from the Contractor's License VALUATION $/FT. uOa Law fur the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 / � '/ � - Code:Anycity orcounty which requires a permit to construct,alter, DOB T% ac S,Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.COINER. LIC.NO. ELEC. so 0 LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO n w$ he is licensed pursuant to the provisions of the Contractor's License iiso i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ELe-V4-7aAt- - < Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE It file basis furlhcullcged asciaption.Any violation al'Seelimh7031,5 STORIES TYPE CONSTR. n 3 $ by any applicant for a permit subjects the applicant tun civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than fisc hundred dollars(8500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP PES.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 docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE \ himself or through his own employees,provided that such improve- GAS-EA.SV STEM-11NC.40UTLETS 6.00 melts 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 he did not build or im- -- prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON pit Omer ❑ 1,as owner of lire prq.city,at,,exclusively emoneling 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:'Phe Contractor's License Law docs not apply to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts!or ch projects w' I a contractors)licensed pursuant to the Contract ' ease L' SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam dcr .B.&P C. ' rI WATER HEATER W/VENT 6.00 reason Owner Date _ WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. wORKERS'COMPENS ON LIKARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a cenifcate of consult 10 oelf-insure. ZONING or a certificate of Workers'Compensation Insurance,ora certified ENG.SITE NO. _ copy thereof(Sec.3900,Lab.C.). Policy No. Company 0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z ❑ Certified copy is fled with The city inspection division. MISC.- REFER TO ORD. 0 Applicant Y ❑ N Y ❑ N❑ c y CERTIFICATE 01'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. Lu > COhIPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL 0 (Phis section need not be completed if the permit is for one 1TOTAL Y❑ IN C] v E] IN ::) Z hundred dollars(S 100)or less.) U O I certify that in the perlbrnance of the work I'or which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- 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. ED Dale Applicant BUILDING S� n ALTER OR ADD TO MECH. 5.00 S } W NOTICE TO APPLICANT: It,after making this Certificate of Ex- F.. ? cmption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCT ION LENDING AGI7NCY AIR HANDLING UNIT(OVER 10.000C.F.M.) 6.00 SEISMIC FEE 17 , A 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of tem work I'or which this permit is issued(Sec MICROFILM 3097,Civ.C.). HEATING UNIT ITB 100,000 B.T.U.) 6.00 Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lenders Address I certify that I have read this application and stale Hot tho above VENTILATION FAN (SINGLE) 4.00 information is correct.I agree to comply with all city and county PLUMBING // ER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 ordinances and stale laws relating to building construction, and BOIL hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,0000TUI 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. Cuper'no against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may any way crue against said City in consequence of tine MECH.CONT. LIC.NO. MECH. A 7 O TOTAL TOTAL nature ofApplicant/ tor Date OFFICE COPY