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11539 (2) POST IS CARD NEAR FRONT OF BUILDII• PERMITND .01 �TY OF CUPERTINO 5 39 - INSPECTION DIVISION 115 JOB INSPECTION RECORD „� PERMIT EXPIRATION JOB ADDRESS! //ff UNIT# LOT# PERMIT EXPIRES IF WORK OWNER Q&(' • O RACTOR IS NOT STARTED WITHIN I SPECTION 15ATE I I SPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION _ ANCE OR 180 DAYS FROM LASTCALLED INSPCTION: LIFER _ - - PERMIT VALIDATION PREGUNITE - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ( - UNDERGROUND /SLAB Iry PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL , BLDG. ELECT. PLG. MECH. ❑ ❑ ❑ ❑'v DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - INFORMATION VALUATION S/FT. PLUMBING ' _ I Q MECHANICAL - PEHMIT TO ELECTRICAL' . -- FRAMING STORIES TVPE CONSTR, , INSULATION OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED III SO,FT.FLOOR AREA TOTAL ACREAGE ROOF I DIAPHRAGM ? BUILDING USE HES IND CON PB Olner APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. -ROUGH PLUMBING rRACTNO, PARCEL NO, GAS TEST MECHANICAL - ELECTRICAL �G FINALS DATE INSP. p Acc.DATE AGO FILE No. FRAMING TID SAN # ZONING ENG,SITE NO. I INSULATION PLUMBING - GAS MECHANICAL FIRESPRINK ENERGY 9]G. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y❑ "[—] Y "F] LATH—INTERIOR 'ELECTRICAL FLOOD ZONE A.L.U.C. LATH—EXTERIOR FIRE DEPT. YE] N❑ Y ❑ No SHEETROCK GRADE - FEE SUMMARY SHEAR INTERIOR - BUILDING SHEAR EXTERIOR TEMPORARY APPROVALSBUILDING FIREWALLS.. ELECTRIC i PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. 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 EXPIRATION DATE —, MECHANICAL IMPORTANT! CONST.rnx PLEASE READ REVERSE SIDE BEFORE TOTAL ; CALLING FOR FINAL INSPECTION. / OFFICE COPY ` APPLICANT TO FILL IEWFORMATION WITHIN RED LINES- SE BALL POINT PEN ONLY BUIL DI NG PROJECT I DE FICATION PERMIT NUMBER BUILEHN// APPLICATION & PERMIT . 11539�� A,ORE55, 14 J Q e BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ONNER'S LLQ„`O IT PLAN CHECK VALIDATION NAME -J><'r••k/r Y PAc. PAX. 01TvN11- QTY. ELECTRIC PERMIT FEE l� • , 915 PHONES 2.91(aPi �� 7 "` �d7 CONTRACTOR'S UTLETS-SWITCHES-RECEP 10.0011.00 o2a2-�3 NA / 4 LIc.No.2 `7 ` LIGHTING FIXTURES 10.00/1.00 raerRAcroRs, PPLIA ' NCES-flESIDENTIAL 4.00 ADDRESS PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT/�"fit(�,� 5 ♦ l A+rf l� PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.N♦o, I SIGNS TRANS. 3.00 ADDRESS ARCRORENG. 1/_ /.aV +� SPECIAL CIRCUIT 5.00 PERMIT VALIDATION rY �. 21 EMP.METER OR POLE INS. 20.00pgFJl, APPLICANT'Ss"" lex W ADDRESS DLV�� MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 Doo LICENSED CONTRACTORS DECLARATION V osl!�u <u uI hereby affirm that 1 am licensed under provisions o(Chapter 9 _L(ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and :BLDG." ELECT. PLG. MECH. F i Professions Code,and my license is in full force and effect. o 0= G License Class Lic.Number w�' El 1: 13y H Date Contractor x I BUILDING PERMIT Icw OWNER-BUILDER DECLARATION INFORMATION wDa MISC.- REFER TO ORD ; LL y I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. F U 0 4 Law for the following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE 10.00 Code:Any city orcounty which requires u permit to construct,shut, Q IF ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 0 LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO K 2 he is licensed pursuant to the provisions of the Contractor's License FiQ Law(Chapter 9(commencing with Section 7000)o fDivision 3 ofthe fI-(JZOa �C'LL 4 D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Ie H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. u ; _ by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00 of not more than five hundred dollars($500).: ❑ I,as owner of the property,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 stmctme,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 properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP S.QU S0,FT.FLOOR AREA TOTAL ACREAGE himself or through his awn employees,provided that such improve meats are not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or am- RES IND CON PB Our., prove for purpose of sale.). ' INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 6 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's 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 tine Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,R&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. ,5.00 1 hereby affirm that I have a certificate of ennunt to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.0 Policy No. Company ❑ Cetlil3ed copy is hereby l'umishCd FIRE SPRINK ENERGY T 2 ❑ Cerbfyd i d ion tl ns on division. Z p ApplicunG � . MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑ fY `� CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU 7 COMPENSATION INSURANCE PLG.CONTR. LIC,NO. pLG. CL o (This section need not be completed if the permit is for one TOTAL Y❑, N❑ v❑ N :D Z hundred dollars($100)or less) U O 1 certify that in the performance of the work for which this per FEE SUMMARY LL {- mil is issued,1 shall not employ any person in any manner so as to OTY. MECHANICAL PERMIT FEE U become subject to the Workers'Compensation Laws of California. 0 /� LU Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING �• w NOTICE TO APPLICANT; If,after making this Certificate of Ex. F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MCF.NL) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MIC.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction tending agency for EXHAUST HOOD(WITH DUCT) 5.00 the 3097 Civ.C.) performance MICROFILM of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 6.00 . Lender's Name Lender's Address H EATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 ' information is correct.1 agree to comply with all city and county PLUMBING n ordinances and state laws relating to building constructio , and BOILER-WHIP(3 H.P.Or100,000B.T.U.) 6.00 hereby above-mentioned property for inspection purposes.authorize representatives of this city to enter upon the BOILER-COMP 1Dver 100,0008TU1SEE FEE SCH. MECHANICAL (We) a& to sav init and keep bar ss the City of MISC.- REFER TO ORD. Cu rtino ag inst I' it' s,j s sts a xInm_which PERMIT ISSUANCE 10.00 CONST.TAX 11 uu in ;=way ago aid er .e of the ' gra 1' f is a f. MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Si at r of Appica rncOr Date 0 \ - OFFICE COPY -