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11226 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 11226 INSPECTION DIVISION JOB INSPECTION RECORD T HERMIT EXPIRATION JOB ADDR ESS /L�� "r�:5"lre Dr • 'UNIT# LOT# PERMIT EkPIRES IF WORK OWNER LJ e. VIV+-Se^ CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM LIFER LAST CALLED INSPECTION.# PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL - ISSUANCE DATE MECHANICAL BLDG, ELECT. PLG. NECK XD ' El El ® . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION 'WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL PERMIT To ELECTRICAL FRAMING I..-k''II�1 /f�ck STORIES TYPE CONSTR. INSULATION OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED �\ ROOF 50.FT.FLOORAREA TOTAL ACREAGE D AP RA GM BU I LLIING USE RES IN CON PB 011- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ASSESSORS PARCEL NO ROUGH PELECTRICAL , 7-,1- •a �. 2=7— TRACT NO. PARCEL NO. f ACC.OATE ACC,FILE NO. - — FINALS DATE INSP. SANZONING ENG.SITE NO. PLUMBING GAS MECHANICAL FIRE SPRINK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y El NEI Y El NE] LATH—INTERIORELECTRICAL FL000 zoNE A.L.U.C. LATH—EXTERIOR FIRE DEPT. Y 0 NEI Y ❑ N❑ SHEETROCK GRADE FEESUMMARY SHEAR INTERIOR - BUILDING SHEAR EXTERIOR TEM A R L BUILDING I FIREWALLS ELECTRIC PLAN CHECK 'y GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, +' ELECTRIC Fu'. ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING .: PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — . MECHANICAL IMPORTANT! CONST.TAX ) PLEASE READ REVERSE SIDE BEFORE , TOTAL / CALLING FOR FINAL INSPECTION. OFFICE COPV OFFICE CITY OF CUPERTINO COPY GAS SERVICE NOTICE y 9A E ( I @ To y/ I You are hereby authorized to connect the GAS service for, m ` Owner or Tenant / '' W4• [A > At ® l� k�� / New Service No. of Meters Reconnects N / i No. of Add. Meters Move Service Move M ter��--/ PLUMBING INSPECTOR �� " .APD .APPLICANT TO FILL IN INFORMATION WITHIN RELINES - USE BALL POINT PEN ONLY • y'� BU I LDING PROJECT IDENTIFICATION PERMITNUMBER B aO1NG APPLICATION & PERMIT AonR a S3 YOA�- )+11•L At. 11226 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL pWNER's / PLAN CHECK VALIDATION IAME ��//� � Nils OTV. ELECTRIC PERMIT FEE M/,DALE /Gi ' "�PHONF y96-6y`I NAMERacroRs UTLEL -SWITCHES-RECEP 10.00/1.00 LC.No. LIGHTING FIXTURES 10.00/1.00 CCONTRACTORS ADDRESS - PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION OgcHrtacT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.No. SIGNS TRANS. 3.00 nooHESS ENC' SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 PAI APPLICANT'S MOTORS SEE FEE SCH. ADDRESS M-nl/ y1� JI' wn� ,�f� oti. VN T'3 3 9 III SERVICE CHANGE 20.00 O 1966 w00 LICENSED CONTRACTORS DECLARATION C�`-M a it u I hereby affirm that I and licensed under provisions of Chapter 9 ly YYs (commencing with Section 7000)of Division 3 of the Business and B G. ELECT. MECH. rm i Professions Code,and my license is in full force and effect. ❑ ❑ ❑ z 0L - License Class Lie.Number Q L H Cw Dale Contractor ¢ x s BUILDING PERMIT ¢ ¢ ¢ ¢ OWNBR.BUILDER DECLARA'T'ION INFORMATION 0 ve MISC.- REFER TO ORD g LL w I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. F LL O < Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 Code:Anychy orcounty which requires a permit construct.alter, rt ¢¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. y - ¢ requires the applicant for such permit to File a signed statement that TOTAL PERMIT TO w$ he is licensed pursuant to the provisions of the Contractor's License py. i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe at Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE M r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIESTYPE CONSTR. e � � by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500)): X 1,as owner of the properly,or my employees with wages as BACK 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,AR EA,CON D. 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 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. Rents are not intended or offered for sale.l f,however,the building GAS-EA.SYSTEM•11NC.4 OUTLETS 6.00 or improvement is Sold within one year of completion,the owner- GAS EASYSTEM OVER 4 (EA) 200 BUILDING USE builder will have the burden of proving that h - . - . , e did not build or am. RES IND CON PB Other 1,aso prove of sale.), INDUSTRIAL WASTE INTER. 30.00 ❑ 1:1 11 13❑ wnernee of the properly,am exclusively contracting with licensed as ocontractors to construct the pricer 1La 7094,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and n owner of Code:The hontrhmsro License Law does not apply co tr wirer of h projects who builds tr improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 tine Co is for such License ecL wish a contractor(s)license)pursuant ro the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. ❑ lam exempt under Sec.-,EL&RC.for this WATER HEATER W/VENT 6.00 ranson Owner Da Ir o WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0, WORKERS'COMPF.NSA7'ION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a grtifted ZONING ENG.SITE NO. copy the rcof(Seu.3800,Lab.C). Policy No. Company O ❑ Certified copy is hereby fumlahed. FIRE SPRINK ENERGY T-24 Z 2 O Certified copy is fled with the city inspection division. MISC.- REFER TO ORD. O Applicant V C] NE] I V E] No Hy PERMIT ISSUANCE 10.00 FLooO zoNE A.L.U.C. � CF.R'fIFICCOMONSATIOTINS FROMWORKIi RS' CL COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N Y❑ N� LD Z hundred section need not be complete) if tire permit is for one TOTAL hundred dollars IS 100)or less.) U O -I certify that in the performance of the work for which this per DTV. MECHANICAL PERMIT FEE FEE SUMMARY IL 1- mit is issued,I shall not employ any person in any manner so as to / O W become subject to the Workers'Compensation Laws of California. n Date Applicant BUILDING >_ N NOTICE TO APPLICANT': If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.0017- 0 � Z emption,you should become subject to the Workem''Compens'ation APPLIANCE - 5.00 PLAN CHECK n provisions of the Labor Code, you must forthwith comply with FEE J C.) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4,00 CONSTRUCTION LGNDING AGENCY AIR HANDLING UNIT(OVER I0)000C.F.M.) 6.00 SEISMIC FEE S 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. MICROFILM 3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC . I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 J*. LTfornation is correct.I agree to comply with all city and county PLUMBING 11 I� ,�rmtonces and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 ••ereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. gO1LER•COMP (Oiler 100,000 B7U)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the gralltlnp Ofts peph LL. MECH.CONT. LIG NO. MECH. W J G(�-4 CrPy� /0�u J 8t TOTAL TOTAL ✓h Signature of Applicant/Contractor Dale OFFICE COPY