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C 8197 POST THIS CARD NEAR FRONT OF BUILDING . PF'NMIi NUMOER CITY OF CUPERTINO QQ1 INSPECTION DIVISION GTI 9�j JOB INSPECTION RECORD / ,I /' s, PERMIT EXPIRATION JOB ADDRESS //��,�f� �� UNIT# LOT# PERMIT EXPIRES IF WORK OWNER / CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION /A LASTCALLED INSPECTION. LIFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Ly ¢¢�� ( I, UNDERGROUND /SLAB !: PLUMBING ELECTRICAL /A_e-w v_• 'ISSUANCE DATE LCR, MECHANICA -Ivr ELECT. PLG. ML I 0 49 DO NOT POUR FLOOR.UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/RT. PLUMBING MECHANICAL �•) PERMITT ELECTRICAL FRAMING 'STORIES T_. PE CONSTR. INSULATION OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT.FLOOR AREA TOTALACREAGE ROOF DIAPHRAGM RUILO USE p HES IND CON VB OJw, • -- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO, ROUGH PLUMBING GAS TEST TRACT rv0. rAo RCEL rv , MECHANICAL ELECTRICAL FINALS DATE INSP. Acc.oars Acc.FILE No. FRAMING SAN * ZONING ENG.SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY T.24 ' MECHANICAL Y ❑ N[] Y NE] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH-INTERIOR ELECTRICAL C/- Q -- FLOOD ZONE A.L.u.c. V� N� , V0 N❑ LATH-EXTERIOR FIRE DEPT. ,3/� fflli SHEETROCK GRADE FEE SUMMARY SHEAR.INTERIOR BUILDING SHEAR EXTERIOR - TEMPORARY APPROVALS euILnING FIREWALLSELECTRIC PLAN CHECK J FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED- OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Lti ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O 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 BU LD1 NG PROJECT I DENTI FICATI ON ERM IT NUMBER __7G1vILOINLDIN BUILDING APPLICATION & PERMIT WLZF-c BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 819 1 OWNERS PLAN CHECK VALIDATION m mE�_ LeW_ P� ' (�E OTY. ELECTRIC PERMIT FEE f�.JAJ NL•FLv'4db CONTRACT R'S Oki � ^ OUTLETS-SWITCHES-RECEP 10.00/1.00 ��t LIC.NO. l L LIGHTING FIXTURES 10.00/1.00 CONTRACTOR S. L PPLIANCES-RESIDENTIAL 4.00 'SAt.Utn. PHONqy 6rj� PANELS 10.00 DATE OF APPLICATION PANELS (OVER 200 AMP) 20,00 PLAN CHECKFEE P.C.NO. OR ENGINEE� SIGNS TRANS. 3.00 ARCH.OR G. PERMIT VALIDATION A p..ESB 500 I✓� x� SPECIAL CIRCUIT . EMP.METER OR POLE INS. 20.00 APPucarursMOTORS SEE FEE SCH. '� AooREss SERVICE CHANGE 20.00 �3/�r LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 wo0 <2 c I hereby affirm that 1 am licensed under provisions of Chapter 7 ISSUANCE DATE (commencing wit r Section 7000)of Uivisio ol'the ftL'am s and BLDG. ELECT. PLG. MECH. r w'^ Professions Cod and 'E,se is in full f ce 1 - ❑ ❑ ❑ License��111yyy (�Lic.Number L am r w Uatc . Contmclnr. A , 2 , ` f p f I , BUILDING PERMIT w < OWNER-BUILDER DECLARATION ,INFORMATION REFERTOORD w 3 u y 1 hereby affirm that I am exempt from the Contractor's License MISC.- VALUATION $/FT. E, u o ¢ Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 yip Code:Any cityorcounty which requires a permit to construct.alter, ��. [ �tAax'1'ri8'O Q 2 improve,demolish.or repair any structure,prior to its issuance,also ELED.CONTR. LIC.NO. ELEC. d ¢ requires the applicant fur such permit to file a signed statement that TOTAL PERMITT u w m LL he is licensed pursuant to the provisions of the Contractor's License O�'J� H z r Law(Chapter 9(commencing with Section 7000)of Uivision3 of the � ��21O/1, /\G/yO46 a Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE f i o BE r o the basis for the alleged exemption.Any violation UfSection 703 L5 STORIES TYPE CONSTR. Lu 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($5001.): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their Pule compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONO. 5.00 Code'file Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improvc- menls are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 1 NC.4 OUTLETS 6.00 r improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 build,,will have the burden of proving llua he did not build or tm- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ 1,as owner of the property,um exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contuctor's License Law docs not apply to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL N0. the Contractor',License Law. O I ran exempt under Sec BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a Certificate of consent to self-in sure, ZONING ENG.SITE NO. or a certificate of Workers'Col1rrpppsatkin nsumnce,or a certified 7[ copy Cher f(Sec.3800,Lab.C/1$(� Polic N _ _Company O e it • hereby niched. FIRE,PRINK ENERGY T-2a Z 2 er 1 is fled with Life city inspection division. MISC.- REFER TO ORD. A tum _ Y❑ N❑ Y ❑ N❑ P y CER ICA :OF EXEMPTION PROM WORKIiRS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. Ill > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. d ❑ ('This section need not be completed if the permit is for one TOTAL Y E] N❑ v[:] N❑ Z hundred dollars(S 100)or less.) U O 1 certify that in the performance of the work for which this Per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY IL H aril is issued,1 shall not employ any person in any manner so as to U W become subject to the Workers'Compensation Laws of California. BUILDING ��08 y Date Applicant ALTER OR ADD TO MECH. 5.00 } Be NOTICE TO APPLICANT: If,after making this Certificate of Ex- ♦- ? 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 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE /� 3c 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.3097.Civ.C.f HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name HEATING UNIT[OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 .information n correct. I agree to comely with all oily and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.1 6.00 hereby authorize representatives of this city to colo upon life BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purpous. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. uperlino against liabilities,judgments, costs and expenses which CONST.TAX in any way accrue against said City in c nscy enee of the PERMIT ISSUANCE 10.00 ra is permit. MECH.CONT. LIC.NO. MECH. TOTAL TOTAL a re hcanl/ tractor Date OFFICE COPY