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C 8644 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY ,01 CUPERTINO '864 INSPECTION DIVISION' JOB INSPECTION RECORD,. y� f!2 y�'',/ j/.I�/e PERMIT EXPIRATION JOB ADDRESS_!/1 �• rJIfN fel /I Ylj• UNI L0T4f � • • PERMIT EXPIRES IF WORK owrvER CONTRA. OR IS NOT STARTED"WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM UFER LAST CALLED INSPECTION. PREGUNITE - PERMR VALIDATION - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ,1 SUA € PLUMBING ELECTRICAL - i - NCE AT ^ MECHANICAL': a ELEcr.. MECH. ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT. WOOD FLOOR - +, INFORMATION ' PLUMBING :�;7_g vALuanoN 9/FT, MECHANICAL ELECTRICAL - FERMI FRAMING - - INSULATION - STORIES •. YEE ONSTR: E OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO,FT,FLOOR AREA TOTAL ACREAGE DIAPHRAGM' ELI LDING USE RES IND :CON- PB Olher APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ' ❑ ❑ •❑ ROUGH ASSESSORS PARCELNO., / e PLUMBING GAS TEST TRACT NO. =.PARCEL NO.. {t MECHANICAL r ELECTRICAL FINALS DATE INSP. ncc.DArE Acc.EILE No.. FRAMING . - SAN * , • . . I INSULATION PLUMBING ZONING ' ENG.SITE No: GAS MECHANICAL FIRE SPRINK' ' ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING r❑ N❑ ' 'Y ❑ No LATH—INTERIOR ELECTRICAL - FLCODZONE A.L.U.C. ' LATH—EXTERIOR -l7 FIREDEPT.. Y❑ N❑ 'Y N SHEETROCK _ GRADE FEE SUMMARY SHEAR INTERIOR . BUILDING SHEAREXrERIOR' TEMPORARY'APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK, GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE ' UCCUPANCVOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDINGINSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z ' PLEASE GIVE JOB ADDRESS WHEN PHONING.' — SEE PERMIT FOR EXPIRATIOWDATE — MECHANICAL IMPORTANT.!; covsT.rnx .. PLEASE READ REVERSE SIDE BEFORE TOTAL "'CALLING FOR FINAL INSPECTION. OFFICE COPY - .rjO APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER Y RDILDIOORESjjpp��NG APPLICATION & PERMIT g ('� • C11144 &r BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER' "Z NAME s 8644 PLAN CHECK VALIDATION OTA. ELECTRIC PERMIT FEE +�C3 Aa ��/{/�/y jt. PHONE I 'l / �O CONTRgCTOR'S .A NAMA /'��./� UTLETS-SWITCHES-RECEP 10.00/1.00 JV m LQ7vzne.uc.No, ' LIGHTING FIXTURES 10.00/1.00 I:ONTRACTOR'S _7c, ADORE PPLIANCES-RESIDENTIAL 4.00 ' ggcercecr °NE �S� PANELS 10.00 OR DATE OF APPLICATION ENGINEER PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ARCH.OR ENG, LIC.NO, SIGNS TRANS. 3.00 ADDRESS SPECIAL CIRCUIT 5.00 FERMIT VALIDATION EMP.METER OR POLE INS. 20.00 APPLICANT'S ADDRESS MOTORS SEE FEE SCH. -6 - SERVICE CHANGE 20.00 F z 0 J ! O o LICENSED CONTRACTORS DECLARATION TEMP.POLE < i w I hereby affirm that I am licensed under provisions of Chapter 9 UJ n (commencing with Section 7000)of Division 3 of the Business and ISS ANCE DATE F.N i Professions Code d y license is in full f I BLOC. ELECT. PLG. MECH. z o,.r- License C'ss ❑ ❑ O m -p Lia Number - i J Dale ^ Contract p ¢w OWNER-BUILDER DEC R 1 BUILDING PERMIT W ;'m 1 hereby affirm that 1 am exempt from the Contractors License MISC.- REFER TO ORD I F RI�4 TION F LL o g Law for the following reason(Sec.7031.5,Business and Professions PERMIT ISSUANCE Y U I S/FT. Fwy Code:Any city or county whichrequiresa permit to construct,alter, 10.00 X a G p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO, CLL requires the applicant for such permit to file a signed statement,that ELEC. n w 0 he is licensed pursuant to the provisions of the Contractors License TOTAL ERM( Hz > Law(Chapter 9(commencingwith Section 7000)ofDivision3 ofthe f a o Business anJ Professions Code)or that he is exempt therefrom and CITY. , PLUMBING PERMIT FEE AtiT�l G� �/ nE$ the basis for the allege)exemption.Any violation o(Sedion 7031.5 M1y any applicant for a permit subjects the applicant loo civil penalty ALTER-DRAIN -WATER (EA.15.00 STORIES TYPE CONSTR. olnol more than five hundred dollars($5001.1: ' O I,as owner of the property,or my employees with wages as BACK FPROTECT.DEVICE LOW PR their sole compensation,will do the work,and[he structure is not 4.00 OCC.GROUP RES.UNITS intended or offered for sale(Sec. 7044, Business and Professions Code:The Contractor i License Law does not apply to an owner of DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ' Property who builds or improves(hereon,and who docs such Vwork V FIXTURES-PER TRAP 5.00 hlmal•If Ur[Irro11gI1 Ilia OWn Bmpinyees,prOVlded that sneh ImpNSO,FT.FLOOfl AREP TOTAL ACREAGE mems are not intended or offered for sale.If,however,the buJd mg GAS-EA.SVSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year oI completion,the owner- builder will have the burden of proving that he did not build or am. GAS-EA.SYSTEM-OVER 4(EA.) 2.00 prove for purpose of sale.). BUILDING USE ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer r licensed contractors to construct the project(Sec. 7044,Business ❑ ❑ ❑ ❑ ❑ and Professions Code:The Commctor's License Lawdmxrctapply LAA NSPRINKLERS- 11NC5 V.B. 8.00 ASSESSOgS PARCEL NO, to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a conlractorls)licensal pursuant to - the Contractor's Lictow l-t e, SEW ER-SANITARVSTORM EA.200ft/10.00 ❑ lamexemplunder Sea ,B.&P.C.for this TRACTNO. FARCELNO. reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKS that I h PENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that i have a certificate In consent to self-insure, or a certificate a.Workers'Compensation Insurance,or a certified ZONING copy their IS c�.38 ,Lab.C.l ENG.SITE N0. Policy , DNaYxc�Yo t 0 Certified c ad 0 A*cam c In;pe is (. FIRESPRINK ENERGY T-24 MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ = T C17RTIFICAI'I:OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 U COMPENSATION INSURANCE. --FOOD ZONE A.L.u.c. Q. O PLG.CONTR. LIC.NO.(This section need not be completed if the permit is for one PLG. Z hu - TOTAL v❑ N❑ v ❑ ryN[3V 0 hundred dollms($100)or less,) 1 certify that in the performance of the work for which this per. LL F mit is issued CITY.I shall not employ any person in any manner V,as toMECHANICAL PERMIT FEE FEE SUMMARY O W becOme subject to he Workers'Compensation Laws of California. Due C. Applicant W NOT 5 } to NOTICE TO APPLICANT: If00 BUILDING ,alter making this Certificate of Ex- ALTER OR ADD TO MECH. x� F 2 emption,you should become subject to the Workers'Compensation APPLIANCE Provisions of the Labor Code, you must forthwith comply with 5.00 PLAN CHECK U such provisions or this Permit shall be deemed revoked AIR HANDLING UNIT(TO 10=1C.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1000C.EM.).6.00 SEISMIC FEE �/ I hereby affirm that (here is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 N the performance of(he work for which this permit is issued(Sec. 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lnnder's Name Lender's Address H EATI NG U N IT IOVER 100,000 B.T.U.19.50 ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 �l information is correct. I agree to coraPIY with all city and county ordinances and State laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP(Over 10O,poo BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- Cupertino against Ilabili' ,juJgments, costs and expenses which REFER TO ORD. may in 'nit midCityin consequence of the PERMIT ISSUANCE 10.00 CONST.TAX n � MECH.CONT. LIC.NO. M ig ore canTOTAL 1. 111.1nor Date TOTAL OFFICE COPY