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9334 POST THIS CARD NEAR FRONT OF BUILDING ' CITY OF CUPERTINO 9 PERMIT NUMBER INSPECTION DIVISION JOB INSPECTION RECORD /'�,4� PERMIT EXPIRATION JOB ADDRESS I�DOO 1/1/!/l� �K' UNIT# LOT P ,PERMIT EXPIRES IF WORK OWNER GCS" CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR IfftPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM 0 LAST CALLED INSPECTION. UFER PERMIT VALIDATION PREGUNITE - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING �y��al ELECTRICAL ISSUA CE DATE MECHANICAL BLDG. ELECT, PLG. MECH. ❑. -❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR " VALUATION SIFT. PLUMBING MECHANICAL PERMIT TO ELECTRICAL FRAMING r/vl ' STO IES TYPE CONSTR. INSULATION OC_CG ROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF 5O FT,FLOOR AREA TOTAL ACREAGE I 7 DIAPHRAGM euaomc USE RES IND CON PB O,h,, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 0 ❑ El ASSESSORS PARCEL NO. ROUGH PLUMBING )- N ' TRACT O. PARCEL NO. GAS TEST MECHANICAL ELECTRICAL FINALS DATE INSP. ACC.­DATE ACC.FILE NO, FRAMING SAN # ZONING ENG,SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY 724 MECHANICAL Yo NE] V ❑ N[] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD zoNe aL.u.c. LATH-INTERIOR ELECTRICAL LATH-EXTERIOR FIRE DEPT, vo NE] V 0 NEI SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! coNsr.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION.- OFFICE COPY -71 ;_.. APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY UILDI NG PROJECT IDENTIFICATION PERMIT NUMBER APPLICATION & PERMIT 9334 WDI � BUILDING-ELECTRICAL-PLUMBING -MECHANICAL OWNER'$ PLAN CHECK VALIDATION Y "AMC E ole n f Zs�23 8 OTY.. ELECTRIC PERMIT FEE /Y C PHONE CONTRACTORSL NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 7yi�O.J LIC.NO, LIGHTING FIXTURES 10.00/1.00 co A R's ADDRESS PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc.No. SIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PAERMIT.VALIDATION ZIP TEMP. METER OR POLE INS. 20.00 ADORE Sa ( MOTORS SEE FEE SCH. {V APPLICA SERVICE CHANGE 20.00 fl Dao LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 City a .u I hereby affirm that 1 am licensed under provisions of Chapter') ISSUANCE DATE H Gm (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F wn z Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑ ao o u, - License Class Lie.Number 0 r D Dam Contractor a y f BUILDING PERMIT ¢ ¢ w a OWNER-BUILDER DECLARATIONIN FORMATION woA " MISC.- REFER TO OR ; N I hereby affirm that I am exempt from the Contractor's License LL o 4 Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION SIFT. � - Code:Any city or county which requires a permit loconslrueL otter, .h..,` K Q o inhprove,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. I�ei lS ELEG. DLL requires the applicant for such permit to IIIe a signed statement that TOTAL PERMIT u w m he is licensed pursuant m the provisions of the Contractor's License � Z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �.��CaQ,(OA� ✓/ z o Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE ¢ H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a ; - by any applicant for a permit subjects the applicant too civil penally ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 UNITS- their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNIiS intended or offered for sale (Sec. 7044, Businesi 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 SO.FT.FLOOR AREA TOTAL ACREAGE himselfor through his own employees,provided that such improve- cuts menot intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 or impmvenient is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- ov 'I'orpumouofmic.). INDUSTRIAL WASTE INTER. . 30.00 RES IND CON PB Omar 1,as owner of the property,am exclusively contracting with ❑ El 1:1 11 ❑ I''Cmsed 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 Low does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA-) 1.00 Lon fo such projects wit con Nuciorl s)IittnsCA pursuant to the Contra is License Law. SEWER-SANITARY EA.200ft/10.00 TRACT NO, PARCEL NO. ❑ la xemPlu ler SCC. .B.&P.C.for this WATER HEATER W/VENT 6.00 anon Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. UA DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have.certificate of con sent to cell-insure. ZONING or a Certificate of Workers Compensation Insurance,or a Certified ENG.SITE NO. C py thereof(Sec.3800 Lab.C.1. 0licy'Nd. Company O ❑ e rlified copy a hereby furnished. FIRE SHRINK ENERGY T-24 Z Z O ertified copy is filed with the city inspection division. MISC.- REFER TO ORD. O Appli ant Y ❑ N❑ Y ❑ N❑ � y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.O. > COMPENSATION INSURANCIi PLG.CONTR. LIC.NO, PLG. CL o (This action need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑ 0 Z hundred dollars($100)or less.) U O 1 certify that in the performance of the work for which this per, CITY MECHANICAL PERMIT FEE FEE SUMMARY U_ F mit is issued,I slmll not employ any person in any manner so as to .� U become subject m to Workers'Compensation laws of California. y Date Applicant ALTER OR ADD TO MECH. 5.00 (y BUILDING Q`-S } m NOTICE TO APPLICANT: If,a0er making this Certificate of F.- F. ? emplion,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=CF.M.) 4.00 CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby Arno that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of❑e work for which this permit is issued(Sec. HEATING UNIT ITO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.). Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address 1 certify that I have read this application andstate that the above uVENTILATION FAN (SINGLE) 4.00 -� information is correct.1 agree to comply with all city and conty BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING it ordinances and state laws relating to building construction, and hereby authorise representatives of this city to cher upon the BOILER COMP (Over 100,000 BTUI SEE FEE SCN. MECHANICAL ,�- (� above-mentioned property for inspection purposes. (We) a rre to save, indemnify and keep harmless the City of MISC,- REFER TO ORD- , Cupertin gains[ habilit'. judgments, canis and expenses which CONST.TAX may in y way accrue aim said City in consequence of the PERMIT ISSUANCE 10.00 gmntin this in MECH.CONT. LIC.NO, MECH. V PZZ-8S TOTAL �lO 0-t' TOTAL v S re of Applicant/ nlractor Date (/V OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATI ON PERMIT NUMBER BUILDING APPLICATION & PERMIT ADOREss Q BUILDING - ELECTRICAL-PLUMBING-MECHANICAL9334 Owry 5 H PLAN CHECK VALIDATION NAME ZS � CITY. ELECTRIC PERMIT FEE •� Ile Je PHONElis-81 NAME EUTLETS-SWITCHES-RECEP 10.00/1.00 LIC.NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR S APPLIANCES-RESIDENTIAL 4.00 •,� ADDRESS ti PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.NO, SIGNS TRANS. 3.00 ADDRESS Ervc' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 AMOTORS SEE FEE SCH. ADDDRESSDRESS SERVICECHANGE 20.00 Oil: pp ,02 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 a u u I hereby affirm that I am licensed tinder provisions of Chapter 9 ISSUANCE DATE z a (commencing with Section 70001 0(Division 3 Of Business and a BLDG. ELECT. PLG. MECH. H m z Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑ z o w - License Class Lie.Number Date Contractor a r E o BUILDING PERMIT a B,at 4u O OWNER-BUILDfiR DECLARATION INFORMATION wg LL w 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION F u. O ¢ Caw for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 S/FT. y0J Code Any city or county which requires a permit 1.construct. lie,, EE Be a improve,Aanulish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO, ELEG E m u requires the applicant for such permit to file B signed statement that TOTAL - PERMIT TO w he is licensed pursuant to the provisions of the Contractors License H As i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ $ the basis for the alleged exemption.Any violation Of ScEtion703I.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(S500)J: ❑ I,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 lifework,and the st Dietary,is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREAICOND. 5.00 Code:Tile 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 r 5.00 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,Provided that such'in prove- mentsare not intended oroffered for saleIf,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- provefor purpose oI &a )' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB omen N I,as owner of the property,am exclusively contracting with El . El El 1:1 1:1e li used contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5V.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 eontmctSforsuchproje-tswith c Due'-toosl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. 'the Contra ID's License Law. ❑ Is, xemptunder Sec. ,B.&P,C.fortlu, WATER HEATER W/VENT. 6.00 axon 0wner [)ale WATER SYSTEM 5.00 ACC.DATE ACF FILE NO. WOR'ERS'COMPENSAI[ON DECLARATION WATER TREATING EQUIP. 5.00 I ereby affirm that I have a certificate of consent to set Ginsure. ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copythereof(Sec.3800,Lab.C.). Vuticy No. Company U 13 Certified copy is hereby furnished. FIRE SPRINK ENERGY T 2 Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. 2 Applicbnt V❑ N❑ I V ❑- IN[D �•� x CI'RI'IPICA'LF OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 PLOOo ZONE A.L.U.C. LL,? COh11?ENSATION INSURANCE PLG,CONTR. LIC.NO. 'ED 13 - (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ NO hundred dollars IS 100)or less.) 0,0 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY x LL F mit is issued,I shall not employ:uiy Person in;my manner so as m U W become subject to(lie Worker Compens'at ion Laws of California. BUILDING O_ Date Applicant -2 ALTER OR ADD TO MECH. 5.00 tl� } US NOTICE '10 APPLICANT: If,after making this Certificate of Ex- F Z emption,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 10MCF.M,) 4.00 CONSTRUCr10N LENDING AGENCY AIR HANDLING UNIT B3VER 10=C.EM.) 6.00 SEISMIC FEE �q I hereby afl'inm that Flerc is a construction lending agency (or EXHAUST HOOD(WITH DUCT) 5.00 the perfor aMICROFILM nee of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(O VER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address 1 certify that I gave read this application and state that the above VENTILATION FAN (SINGLE) 4.00 I information is coram. 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 5 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)BEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep hornless the City of MISC.- s REFER TO ORD. Cupertino gmnst liabilities,.judgments, costs and expenses which CONST.TAX 1 may in way Secure Sins 'laid City-in consequence of the PERMIT ISSUANCE 10.00 (r�i gmntin this p nif. MECH.CONT. \ LIC.NO. MECH. I TOTAL166 mac. TOTAL 'Sig a re o A p icon t for Du[e �.O Va, INSPECTOR COPY t - t ,