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C 8523 (2) POST THIS CARD NEAR FRONT OF BUILDING Pf RMIT NUMBER CITY OF CUPERTINO INSPECTION DIVISION . P 8523 JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 102 ' a rd on 1ly'� T - LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPE TIO DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. UFER jRSNILIDATION PREGUNITE - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL - E DATE MECHANICAL PLG. .MECH. ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION SIFT, PLUMBING 1 MECHANICAL �(� IG/J►y_��'.Z ELECTRICAL :Iae. FRAMING RI s go INSULATION DOC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF , 77- SO FT.FLOOR AREF TOTAL ACREAGE , ,..-. Ile / DIAPHRAGM RES ' IND CON-BUILDING USE Olnx, :APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ '5;-� ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST ' TRACT NO, PARCEL NO. " � ,� - MECHANICAL ACF DATE ACC.FILE NO. ELECTRICAL ,S-' ��j FINALS DAT INSP. FRAMING ,•J%R3 — SAN # ZONING , ENG.SITE NO, INSULATION PLUMBING ' GAS FIRE SPRINK� -" ENERGY L24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y [:] . N[ Y ❑ N�. - FLooDzoNE A.L.0 c. _ LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. . Y❑ NQ• ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR . BUILDING • — V SHEAR EXTERIOR TEMPORARY APPROVALS BUIL--NG S J• FIREWALLS ELECTRIC PLAN CHECK ' GAS. FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL SUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 0% F ONE WORKING DAY BEFORE REQUIRED INSPECTION. Pmswc O� wPLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL .i •. <� CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY B I DINGPROJECT.IDENTIFICATION PERMIT NUMBERAPPLICATION & PERMIT I $W LpING � {�q��y/ I ADDRESS �" •'�• aas 8523 �Qai1!- �OU BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S o`er - PLAN CHECK IDATION NAtr2 i161Mvv PRo E QTY. E PERMIT FEE I-f 7-38sa NAME CONTRACTORS OUTLETS- WITCHE RECEP 10,00/1.00 NAME �j 64 °4 4�j LIC.No 79S9y7 3 . LIGHTING FIXTURES 10.0011.00 r-orvTRACTona APPLIANCES-RESIDENTIAL 4,00 AISPRESS n/�`��s' �s •�. e-e .+ &., e*VCDVp S.•7 PHON '99,$5 PANELS 10.00 DATE OF APPLICATION ARRCHITECT PANELS (OVER 200 AMP) 20.00 PLANCHECKFEE P.GNO. ENGINEER LIC.NO. SIGNS TRANS. 3.00 ADCH,OR DRESS ENG SPECIAL CIRCUIT 5.00 PERMIT VALI T �^ ZIP EMP.METER OR POLE INS. 20.00 1F/ APPLICANTS c MOTORS SEE FEE SCH. ~Y 1185 ADDctIp�D,feGWiyy7 �jS"�,S7/7 SERVICE'CHANG 20.00 ?1SUA _v w o o `��//(p LICENSED CONTRACTORS DECLARATION TEMP.POLE yv 30.00 �FB��no 4 i w 1 hereby affirm that 1 am licensed under provisiops of Chapter 9 t _ CE GATE (commencing with Section 7000)ofDivision 3 o(1he Bq CT. PL r</'�/j Business and w. BLDG. ELEG. MECH. r m i Professions Code n my liis in in full for a /.Q q6.� ",L - El � 132 o m F - License Lic.Number City of Cupertino IBJA7\ o Z Date Contractor � Y a¢ ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT Ca E a U INFORMATION • w 3 LL I- 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD F u Ca; Law for the following reason.(Sec.1031.5,Business and Professions PERMIT ISSUANCE 411.0 VALUATION $/f T. Code:Any city.,county which reyuirosa permit to construct,alter, `J /py 1 QQ ¢ improve,demolish,O!repair any structure,prior lO its ISSIIanCC,aISO ELEC.CONTR. LIC.N0.' ELE0. p/ riy /01 i _3., Ca u requires the applicant for such permit to file a signed statement that TOTAL DLy •4 La.. he is licensed pursuant m the provisions of the Contractor's License. Law(Chapter 9(commencing with Section 7000)of Division 3 of the io Business and Professions Code)or that be is exempt therefrom and QTV. PLUMBING PERMIT FEE M I-m the basis for the alleged exemption.Any violation of Section 703 LS STORIES 7V Pp pONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN Be (EA.) 5.00 / �'•e?A1C of not more than five hundred dollars($500).): Adn�lo ❑ I,as oen the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will the work,and the structure is not intended or offered,for sale (Sec. 7044, Business 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 F IXTUR ES-PER TRAP 5,00 50.FT.FLOOR AREA TOTAL ACREAGE . .himself or through his own employees.Provided that such improve. hients mself an not intended onemplofor ees,sale.provided that such tile building GAS-EA.SYSTEM-1INC.4OUTLETS 6,00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other ❑ 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. Q El El ID and Professions Code:The Contractors License Law does 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 contractor(s)licensed pursuant to the Coatraclnr's License Law. SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I um exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.I /�.E 4L �N Policy No. Company A o ❑ Certified copy is hereby furnish Z Z/ Certified -o y is tiled wit "nspec)ran dlviSipR FIRESPRINK ENERGY T34 O✓ Applicant ( MISC.- REFER TO ORD. Y[:] N Y ❑ N Er CCN CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD 2oNE A.L.U.C. W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL Z( This section need not be completed if the permit is for one TOTAL V N Y ry� hundred dollars($100)or less) U O 1 certify that In the performance of the work for which this per-_ QTY. MECHANICAL PERMIT FEE FEE SUMMARY Lt. F mit is issued,1 shall not employ any person in any manner so as to O Wbecome subject to the Workers'Compensation Laws of California. y Date Applicant BUILDING ALTER OR ADD TO MECH. 5.00 �- to NOTICE TO 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 rte Labor Code, you must forthwith comply with FEE L.1 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 I0,000C.FM.) 6.00 SEISMIC FEE e77 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 lire performance of the work for which this permit is issued(Sec .MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(O,VER 100,000 B.T.U.)9.50 a6 Lender's Address ELECTRIC I certify that 1 have read this application andstale that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county PLUMBING ordinances and slate laws relating to building construction, and BOILER-COMP(3H.P.Or10o,000B.T.U.) 6.00 01 hereby authorize representatives of this city to enter upon the BOILER-COMP (over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) a to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cup 'n ainat liabilities adgmenls, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ma i ay accrue a at said City in of the gm n of[ y,per MECH.CONT. LIQ NO. MECH. �p4, G9/C .��I/C� TOTAL TOTAL //,3 ?7 Slgvamm oC Apphcan[/Contracmr Dale O OFFICE COPY 1