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11169POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PERMIT NUMBER 11169 INSPECTION DIVISION JOB INSPECTION RECORD y \ - PERMIT EXPIRATION JOB ADDRESS w _ OT# r PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE I INSPECTOR (NSP CTION ECORD FOUNDATION - LIFER PREGUNITE PERMIT VALIDATION / �J '('//! POUR NO CONCRETE UNTIL ABOVE HAS E IGNED UNDERGROUND. B PLUMBING ELECTRICAL - ISSUANCE DATE' ,MECHANICAL BLDG. ELECT. PLG.MECH, DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION STET. f PLUMBING ' MECHANICAL ELECTRICAL vERMIr To FRAMING INSULATION - B ES TYPE,CONSTR: - - OCC. GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO. FT. FLOOR AREA TOTAL ACREAGE DFAPHRAGM BUILDING USE ES IND CON PB Omer ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO ROUGH PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL FINALS DATE INSP. ACCDATE . ACC, FILE NO, FRAMING SAN # INSULATION PLUMBING ZONING ENG. SITE NO. GAS FIRE SPRINK ENERGY T-24 MECHANICAL Y [D N❑ Y ❑ No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL FLOOD ZONE YE] N❑ A.L.U:G, Y N❑ LATH—EXTERIOR FIRE DEPE SHEETROCK GRADE RED X p 11 FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING • f +,�' SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY _ SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, T: I'"! ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING - PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL z -SEE PERMIT FOR EXPIRATION DATE - CONST. TAX IMPORTANT! TOTAL PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY 117 O Z_ z7` PVO-1 CC - LU > ao CU o LL U O w i a A APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER 11169 BUILDING ADDRESS 0I �oskluo PL Y OWNER'S NAME V TsNImnT5L) 1RDNn4 SQ_]� SS5 OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION Ij DATE OF APPLICATION CDNTRACTORE NAME •�c_s3 oiAL PoolT LIC. NO. ]7POSS OUTLETS - SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1,00 ADDRESS OR's CNTRAC I aria CAHde0 AVCPHONE 371 -Soon PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT _ O OR ppp r7 ENGINEER � 11 16661 �+G�MLSQ LIc. Na. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH, ORENG. ADDRESS as sg %,w,AQA_ fie• IIP 9,Jr1.7fI SPECIAL CIRCUIT 5.00 PERMIT VALIDATION 41 TEMP. METER OR POLE INS. 20.00 APPLICANTS ADDRESS � AA 13.S 8 l%��✓L�.P... �' MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000) of Division 3 of the Business and Professions Code, and m license is in full force nd c ec s License Class_ Lie. Number st Date_ Comma.,_ GCS 02. dL - BLDG. I --+I 'Ld••!-'L ELECT. PLG. MECH. " BUILDING PERMIT OWNER -BUILDER DECLARATION affirm that I am exempt from the inessi C10f s License I hor the Law for nycit following count whiSec.7031.5, uireta permit tocnstrmfessions permit to cons uancrool alter, Cope: Any mulish county which reghirUle, prior prl Orn II state statement thatelse improve, the applicantfor alt any strUPermit to file for such Donau m fllu i eConJ actor's i License requires res thedp pursuant he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and INFORMATION MISC.- REFER TO ORD VA WATION a s,�_,,,,��,,`` $/FT. PERMIT ISSUANCE 10.000-1-- ELEC. CONTR, LIC. NO. ELTA (� TOTAL PERMIT TO S ��'� rN C QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exen+plion. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant loo civil penally of not more than five hundred dollars (S500).): ALTER -DRAIN -WATER (EA.) 5.00 ❑ 1, 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 DCC. GROUP RES. harts DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Husiness and Prof ..ions Code The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who docs such work hNnsellor through his own employees, provided that such improve- cntsmenot intended crofferedfar Sale. If, however• the holding FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - I INC.4 OUTLETS 6.00 0.'r improvement is sold within one year of completion, the owner- builder will have the burden of proving that h e did not build or im- prove for purpose ofsaE.). ❑ I, as owner of the property, am exclusively contracting with . .. GAS - EASYSTEM •OVER 4 (EA) 200 BUILDING USE RES IND CON PS Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who contracts for owl, projects with a conlractoRs) licensed pursuant to the Contractor's License Law. SEWER-SANITAR V -STORM EA. 200ft/10.00 TRACT NO, PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C. for Ibis WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC. DATE PCC. FILE N0. WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION I lareby OFrill that I have a eerllf,ow Of c.Went ID SCIf-mone, or a certificate of Workers' Compensation Insurance, or a cerliGeA copy thereof(Sec. 3800, Lab.C.). Policy Nu- Compary ZONING ENG. SITE NO. G6 O O L 3,4 SNE O i,rlilied copy is hereby famished. dCerlifie l�„n., is �jled wi0r•.the city inspection division. Applicant .J ti?Sery_(�CZ1'L �lti FIRE SPRINK Y ❑ IN ENERGY T 24 Y ❑ N❑ MISC. - REFER TO ORD. CERTIFICATE OI' EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 N FLOOD ZONE A.L.u.C. PLG, CONTR. LIC. No.PLG. W TOTAL V COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ N[E] Y ❑ N ❑ QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars (S 100) or less.) I certify that in)he performance of the work for which this per. Hit is issued, I shall not employ any person in any manner so as to BUILDING 9a become subject to the Worker%Compensation Laws of California. Date ApplicantALTER OR ADD TO MECH. 5.00 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 such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=CF.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a c.asvuclion lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued (Sec. 3097, Civ.CJ. MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATI NG UNIT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC 3 Lender's Name Lender's Address ICertify (Int I have read 11115 application and slate that the above Wrrption,is correct. I agree to comply with all city and county +names and state laws relating to building nmstruclion, and VENTILATION FAN (SINGLE) 4.00 PLUMBING a4 -� BOILER -COMP (3 H.P. or100,000B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby aulborwe representatives of this city 1. enter upon the abovememinned property for inspection purposes. MISC. - pry pL REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, Costs and expenses which may in any way accrue against said City in consequence of the PERMIT ISSU CE 10.00 . v gmntingoft sperm C dvfna+h„ is -86 MECH. CONT. LIC. NO. MECH. TOT"` ✓ TOTAL 9Z � Signature Of Applicant/Contractor Date OFFICE COPY