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9045 (3) POST THIS CARD NEAR FRONT OF BUILDING j PERMIT NUMBER CITY OE .CUPERTINO INSPECTION DIVISION �((Lf 1� �( 9'0.45 ' / {/JO/1B)nI/Nr.1�SPPECTION*RECO RD JOB ADDRESS ['/EDD /�' '•�• 1�� Z� �/��' UNIT# LOT# ,PERMIT EXPIRATION _ " PERMIT EXPIRES IF WORK OWNER 15obYX40 CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF"PERMIT ISSU- FOUNDATION rz& 7 SIL ANCE OR 180 DAYS FROM 6 UFER LAST CALLED INSPECTION. + L" O IL . PERMIT VALIDATIO e.e� PREGUNI7E '' a�, —J�=f/. Ct POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 'UNDERGROUND.,/SLAB PLUMBING ELECTRICAL ISSUANCE DA MECR,f BLDG. ELEC?. PLG. MECHANICAL ,}I 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - UILDING PERMIT INFORMATION I 'WOOD FLOOR - VALUATION $IFT. . ;�. PLUMBING MECHANICAL PERMIT To ELECTRICAL 9 ci FRAMING ' •r INSULATION - r RIES- P CON' R.� % OCC"GROUP RES.UNITS. „ I PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' • " SO.FT.FLOOR AREA TOTAL ACREAGE ROOF O DIAPHRAGM -• BUILDING USE t RESIND h(1N PB Olner ❑ ❑ ❑ ❑` ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDASS E SSOR S.PAPC E L N O. ROUGH PLUMBING n - TRACT NO. PARCEL No GAS TEST MECHANICAL ACC.DATE IACC.FILE-NO. ELECTRICAL ?— FINALS DATE INSP. FRAMING SAN # ' . INSULATION PLUMBING ZONING ENG SITE NO. _ GAS FIRESPRINK ENERGY T@A MECHANICAL v ❑ No Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L.UC. LATH—INTERIOR ELECTRICAL _ LATH—EXTERIOR' FIRE DEPTt _ _ 'v❑ .N❑ 'v I] N❑ SHEETROCK GRADE ° FEE SUMMARY SHEAR INTERIOR - ' BUILDING —' BUILDING. SHEAR EXTERIOR T MPORARY APPROVALS IF FIREWALLS - ELECTRIC - - ' PLAN CHECK ' GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ' ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING , o PLEASE GIVE JOB ADDRESS WHEN PHONING. Z + MECHANICAL - SEE PERMIT FOR EXPIRATION DATE CONST.TAX' IMPORTANT! PLEASE READ REVERSESIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY - ' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LD1 NO PROJECT I DENTI FICATIPERMIT rvumBER � � umILDINc O \APPLICATION & PERMIT gOORE55 9045 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL INER's - - PLAN CHECK VALIDATION • i "' TN OTY. ELECTRIC PERMIT FEE CONTRgCTORS AME UTLETS-SWITCHES-RECEP 10.00/1.00 UCC No. LIGHTING FIXTURES 10.00/1.00 / ONTO ACTOR's APPLIANCES-RESIDENTIAL 4.00 A !Vx/ O PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER - U,No, SIGNS TRANS. 3.00 ARCH.OR ADDRESS ENG SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 _) APPLICANTS MOTORS SEE FEE SCH. ADDRESS DDRESS I ISERVICE CHANGE 20.00 n w o O LICENSED CONTRACTORS DECLARATION TEMP,POLE 30.00 G u U 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE H a N mmencing with Section 7000)of Division 3 of the Business and D E� ET p`p Q1 ❑ H N20 Professions Code,and my license is in full force and effect. 1( _j Z 0w G License Class Lic.Number H w H J Datc Contmetm a rf BUILDING PERMIT tc w u OWNER-BUILDER DECLARATION INFORMATION oMISC.- REFER TO ORD w A. ; m 1 hereby affirm that I am exempt from the Contractor's License VALUATION S/FT. F u O a Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 10.00 f �> F Code:Any city Dreamily which requires a permit to construct,alter, /Q�� S R Q O improve,demolish,or mpairany structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. D ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMI TO wm w he is licensed pursuant to the provisions of the Contractor's License Fi > Law,(Chapter 9(eommencingwith Section 7000)of Division 3 of the g 4 Bus ed exemNon.Anness and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE M Ir$ the basis for the aIle g p' y violation of Section 7031.5 STORIES TYPED TR.' ar 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(E500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES. NITS their sole compensation,will do the work,and the structure is not intended or offered for sale ISec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and whodoes such work FIXTURES-PER TRAP 5.00 So.FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such im(!nrve- mentsarenotintended or offered for sale.If,however,the hwlding GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM•OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or im- BUR IN USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00. RES IND PB Other ❑ I,as owner of the property,am exclusively contracting with ❑ 1:1 ❑ ❑ licensed mmiaclors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 AWES57 PARCEL NO. and Professions Code:The Contractor's License Law does not apply 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 contractor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL No. Iam a funder Sec. ,B.&P.C,for this WATER HEATER W/VENT 6.00 reaso Owner M,19ADat WATER SYSTEM 5.00 ACC.GATE ACC.FILE NO, WORKHRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofe.nsent to self-insure, ZONING ENG.SITE NO. or a certificate of Worker's Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z ❑ Certified copy is tiled with the city inspection division. MISC.- REFER TO ORD. y [DN❑ v E] N[] Applicant p: ua PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. LU CERTIFICATE COMPE SAX I EXEMPTION FROM WORKERS' W need not he completed INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y❑ N❑ Z hundred dollars need not he completed if the permit is for one TOTAL hundred fy that in the pe less) LL O 1 certify that f the performance of person work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY W 1- mit is issued,I shall not employ any person in any manner so as to U become subject m the Workers'Compensation Lows of California. U y Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } m NOTICE TO APPLICANT': If,after making this Certificate of Ex- F 2 eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE '7 .3` I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 tire 309 per iorCance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lenders Address Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's 1 certify that 1 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 ordinotices and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 100.000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (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 age. st said City in consequence of the gra ng of this permit MECH.CONT. LIC.NO. MECH. I. S-9-8�n T°T"` TOTAL �`sd Signature of Applicant/ ontractor Date OFFICE COPY