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13669 (2) POST THIS CARD NEAR FRONT OF BUILDING ' CITY OF CUPERTINO PERCNUMSER . 69 INSPECTION DIVISION JOB INSPECTION RECORD fieqo / PERMIT EXPIRATION JOB ADDRESS LJ / '✓r .(J��"��J fid. UNIT# LOT# - PERMIT EXPIRES IF WORK OWNER �/ LS CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD— 180 DAYS OF PERMIT ISSU FOUNDATION ANCE OR 180 DAYS FROM •� �"' LASTCALLED INSPECTION. LIFER PERMIT VALIDATION PREGUNITE pr v �/ VL2 - I 'POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED //-2 '7 UNDERGROUND /SLAB L>' �. " (1..//-7/L/ I' PLUMBING q 7 �- iELECTRICAL y } ISSUANCE DATE ELECT. PLG. I MECH. I MECHANICAL �q��o ❑_ ❑ Ver DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL PERMIT TO ELECTRICAL NLC L FRAMING STORIES" TYPE CONSTR. INSULATION . OCC,GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R .A / /G �� �L (2� /Z� OFT.FLOOR AREA . TOTAL ACREAGE ROOF r RY( DIAPHRAGM hK.'a ,Ln T Z, ow LDIrvG_§E RES IND, CON PS ORII!r APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED g yr/G' Lo L; irS 'ASSESSORSPARCEL NO. ROUGH • PLUMBING " TRACT NO. PARCEL NO. GAS TEST MECHANICAL I' ELECTRICAL FINALS DATE INSP. ACC"DATE ACC FILE NO. FRAMING - SAN # INSULATION PLUMBING ZONING - ENG.SITENO. GAS FIRE SPRINK ENERGY T24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� "❑ LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C. - LATH-EXTERIOR FIRE DEPT. Y El NEI Yo N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING, SHEAR EXTERIOR • TEMPORARY APPROVALS BUILDING, FIREWALLS ELECTRIC - / PLAN CHECK GAS FEE I 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. 4ICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELEcrRlc f "§ o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY ��AWA&TAOMF16LEIIN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY -6UI LDING PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER I;DIL Irv,, `ILIA i N . 13669 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL EH's - PLAN CHECK VALIDATION NAM N/AyM�E/► �• DTV. ELECTRIC PERMIT FEE vHorvE CONTR ��0�, UTLETS-SWITCHES-RECEP 10.0011.00 ' NAME nq/�� Q Lm.N3- �ij�.3 LIGHTING FIXTURES 10.00/1.00 ' '� DONTRACTORs PPLIANCES-RESIDENTIAL 4.00 ADDREss PRO N PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. O � PANELS (OVER 200 A 20.00,� SIGNS TRANS, 3.00 ARCH.OR ENG. $PECIALCIRCUIT 5.00 PERMIT VALIDATION A DRESS n Q zlv EMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADORE}9 A / ,/,L m lam• FDau 01& SERVICE CHANGE 20.00 Yo 1` o o LICENSED CONTRA ORS DECLARATIONva / !( < 0 1 hereby affirm that 1 am licensed under provisions of Chapter 9 8•' ISSUANCE DATE H w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MELH. < A F w i Professions Cod license is in full fort a 1. ❑ ❑ ❑ z o L- License ass_ Lie.Number_ O w H w Date Contractor_ a y E -, BUILDI G PERMIT a w < OWNER-BUILDER DECLARATION INFORMATION O MISC.- REFER TO ORD w A N 1 hereby affirm that I am exempt from the Contractor's License a. o< Law for the following mason.(Sec.703 I.S.Businessand Professions PERMIT ISSUANCE 10.00 VALUATION SIFT. r ye Code:Any cilyorcounly which requires a permit loconslrucl,alter, W a, w Q p Improve,demolish,or repair any StNclore,prior to RS!..mace,also E C.CO TR. LIC.NO. ELEC. O u requires the applicant for such permit to file a signed statement(thatf/3 OTAL 8� PERMIT TO w m he is licensed pursuant to the provisions of the Contractor's License in Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe < Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE M r o the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR. i ;m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(55001): ❑ 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 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 docs not apply to an owner of property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SVSTEM•11NC.40UTLETS 6.00 o'k men[s arc not intended or offered for sale.If.however,the building 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 im- proveforpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON vB Omal ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS 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 culnraeundo licensed pursuant to the Contractor's License Law. SEWER-SANITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-.BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner - Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0, WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certif¢pte of engssent to self-insure, ZONING ENG.SITE NO. or a certificate of Workeri Comppryryr u r tied copy Ihereof(Sec.3800,Lab.C.),(,} 1��K'� N.,-Company..ffff1l O /d Certified copy is hereby funtishcd. FIRE SPR INK ENERGY T]4 Z Z ❑ Certifi�r/joJ��Ss f lit �s}r�idh division. MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑ A PPlicant-4./reueL/-�a� 4f.Ll Fy PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. - CERTIFICATE OF EXEMPTION PROM WORKERS' W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y❑ NC]D (Phis section need not be completed if the permit is for one TOTAL Z hundred dollars(5100)or less) U O 1 certify that in the performance of the work fur which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } N NOTICE TO APPLICANT: If,alter making this Certificate of Ex. F Z 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 C..1 such provisions or this permit shall be deemed revoked.• AIR HANDLING UNIT(TO 10)000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,CIv.C). HEATING UNIT(TO 100,000 B.T.U.) 8.00• /1 _ Lender's Name �L'6Y/LJC HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address O ,\ 1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 PLUMBING information is correct.I agree to comply with all city and county BOILER-CDN1P(3 H.P.or 100,000 B.T.U.) 6.00 ordinances and state Taws relating to building construction and '1-, 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) 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,against said City in consequence of the ling of this permit. i MECH.CONT. LIG NO. MECH. _ TOTAL TOTAL gnature of Applicant/Contractor Date OFFICE COPY .