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12480POST THIS CARD NEAR FRONT OF BUILDING -CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS U IT# OT# � OWNER CONTRACTOR Pf RMIT NUMBER 12480 PERMIT EXPIRATION PERMIT EXPIgES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU-' ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE I INSPECTOR INS CTION RECORD FOUNDATION LIFER PREGUNITE I /1 D� V I I v, ��L I � 1 I i PERMIT VALIDATION — ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB. PLUMBING ELECTRICAL MECHANICAL BID LEG F 0 T PLG. MECH. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION S/FT. PLUMBING MECHANICAL ELECTRICAL PERM TORIES TV E CONSTR. FRAMING INSULATION OCC GROUP RES, UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE Firs IND CON PB 6o, Q ❑ ❑ El ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. ROUGH PLUMBING " _ GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL - FINALS DATE INSP. ACC.DATE ACC, FILE NO. FRAMING-'J,�—f-7 SAN # INSULATION PLUMBING ZONING ENG. NO. GAS FIRE SPRINK Y NE ENERGY T, 24 E] N[]Y • MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE v "� A.L, u.c. v �] N(_ LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING - SHEAR EXTERIOR Y APPROVALS FIREWALLS ELECT PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCC UPANCY OF BU I LDING IS NOT PERMITTED UNTIL BUILDING FINA I: ISSIGNED BY BUILDING INSPECTOR. I ARRANGE FOR INSPECTION BY PHONING 252.4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0O Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE, CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPV APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT hDENTIF�CATION APPLICATION & PERMIT BUILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER 12480 BUILDING ^ // ADDRESS I a _ OWNER'S "�� NAME L �SN- DTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION j(1 PHONE DATE OF APPLICATION CONTRACTOR'S NAME �/ 4�y1� Rue 1-ermLc. No. l OUTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING F IXTURES 10.00/1.00 ' CONTRACTOR'S ADORE//y%6�^ V PHONE APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 RRCHITECi OR ENGINEER LIC. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH.OR ENG. AD DRESS SPECIALCIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 ZIP n ... l.. APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 p p LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 Of the Business and 11 fees Code, and my license is in (all 4srcC� Licenr Lic. Number � ISSUANCE ATE E LG. MECH. r !•. t ®i � ❑ ❑ Dale_ Contractor- I' UILY RMIT OWNER -BUILDER DECLARATION I hereby affirm that I exempt from the Contractor's License Law for the following reason. (Sec. 70315, Business and Professions Code: e,demyshcountywhiny structurep riort ottnssuanc alter improve, demolish, or repair any structure, prior to its issuance, also to flit a sighed statement Lichatense requires the dp urtua t t such provisions ht is licensed to the provisions of the Contractor's License INFORMATION MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION 9 -7 /3/Q / $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO QTY. PLUMBING PERMIT FEE 9 (comm the Law(ChapterProfessions Codeng ) or Section is 00) exempt therefrom Business and rum and Code) or That he is exempt and � STORIES TYPE CONBTR. IIIc loris for he alleged Sectio alleged exemption. Any violation of Section ar malty subjects lhe0),): nnoacivil penally Subjects by any applicant fora hundred of not more than five hundred Jollurs (SSOOIJ: ALTER -DRAIN -WATER (EA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves Thereon, and who does such work himself or through his own employees. provided that such improve- ( mems are not intended or offered for sale. If, however, the building Or improvement is held within one year of completion, the owner- builder will have the burden of proving that he did not build or im. prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with FIXTURES - PER TRAP 5.00 SO, FT, FLOOR AREA TOTALACREAGE GAS-EA.SYSTEM-11NC.40UTLETS 6.00 GAS - EA. SYSTEM - OVER 4 IEA.) 2.00 BUILDING USE RES IND COONN PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business ..it Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves Ihercon, and who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 IEA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with It cmurectnr(s) licensed pursuant to the Contractor's. License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sea. ,B.&P.C. for this rcusem WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.OATE ACC, FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'COMPI:NSATION DECLARATION 1 hereby affirm that I have a certificate of consent to selhinsure. or y then or S Comp1 rya ion Insurance or a certil ic( copy Ther e'. 3' L .). ZONING ENG. SITE NO. I�,W/G�. Pnlic y FIRE SPRINK Y ❑ N ❑ ENERGY T-24 v ❑ N❑ iIa Certified copy is hereby f rnished. ❑ Certified filed bi0t he ti 'tsp ion division. Applicant_ _ MISC. - flEFER TO ORD. h IPERMIT CERTIFICATE OP EXEMPTION PROM WO KERS' y COMPENSATION INSURANCE (This secli; n�'need not be completed if the permit is for one ISSUANCE 10.00 FLOOD ZONE Y ❑ N❑ A.L.U.C. Y ❑ N❑ PLG.CONTR. LIC. NO. PLG. TOTAL hundred dollars (S 100) or less.) I certify that in the performance of the work for which this per. mit is issued, 1 shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING d'r3 f-0 become subject to the Workers' Compensation Laws of California. Date Applicant - ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: IL after making this Certificate of Ex eruption, you should become subject to the Workers' Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10=C-F.M.) 4.00 FEE AIR HANDLING UNITIOVER 10=C.EM.) 6.00 SEISMIC FEE �-l1 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work ,or which this permit is issued (Sec. MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Name Lender'sAddress I certify that I have read this upplication and state that the ubovC VENTI LATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and PLUMBING BOILER- COMP (3 H.P. Or 100,000 B.T.U.) 6.00 BOILER -COMP (over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives ec this city Io enter upon the above-mentioned property for Inspection purposcr. MISC. - REFER TO ORD. (We) agree to save, indemnify and keep Imnnless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in Consequence of the g this nniL _0 CONST. TAX PERMIT 1$$UANCE 1000 . MECH. CONT. LIC. NO. MECH. TOTAL TOTAL �� Signa a of App (cant/Contras Date UrIi I:g 4UYV