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13987 (2) I POST THIS CARD NEAR FRONT OF BUILDING f CITY OF CUPERTINO Rn,IT NDMREH .g . INSPECTION DIVISION13987 JOB INSPECTION RECORD PERMIT EXPIRATION oZ Oo3,s ,�G /��tL_.�-�c4 UNIT# LOT# 7 JOB ADDRESS PERMIT EXPIRES IF WORK OWNER 2 7— 6 C20 CONTRACTOR '-0 IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION ECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION - L 'L _ LASTCALLED INSPECTION. UFER PR EGUNTE - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �. y UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT. PLG. MECH. ❑ ❑ ❑ Z DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION s/FT. PLUMBING MECHANICAL ELECTRICAL • PERMIT TO FRAMING STORIES TYPE CONSTR. INSULATION ti � ti I OCC.GROUP RES UNITS 2PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM 1. BUILDING USE RES IND CON PB ONm •APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El El ❑ El ASSESSOR$PARCEL NO. ROUGH , PLUMBING GAS TEST• - r �� -�sp F TRACT NO PARCEL No, MECHANICAL ACC.DATE` ACC.FILE NO. ELECTRICAL _ FINALS DATE INSP. FRAMING Z- SAN # /S4_eZ3.1 zoNlNc ENG,SITE No. INSULATION _ PLUMBING �'j Lf j GAS MECHANICAL FIRE$PRINK ENERGY T2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 4 Y ❑ N❑ Y ❑ N❑ LATH-INTERIOR ELECTRICAL - FLOOD ZONE A.L.U.C. /.1y• ❑ LATH-EXTERIOR FIRE DEPT. YE:] NY N❑ SHEETROCK p GRADE FEE SUMMARY SHEAR INTERIOR BUILDING '7-Y' BUILDING s SHEAR EXTERIOR �{- TEMPORARY APPROVALS i� FIREWALLS JELECTRIC PLAN CHECK GAS FEE'- NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE UCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL 1 - CONST.TAX IMPORTANT! -" PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. y Y OFFICE COPY FINAL GRADE ' RR UT— Ip - .. File No. Date Location :i Subject J ' Notes � ' •� .. ApprovedZ� Date Inspector _q_•j _ r�saC a 1 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER OUILDING APPLICATION & PERMIT ADOREss 13987 ,e - BUILDING -ELECTRICAL-PLUMBING-MECHANICAL _ OWNER'S PLAN CHECK VALIDATION E n DTV. ELECTRIC PERMIT FEE `(J vnonE -19 CONTRACTORS UTLHTETS-SWITCHES-RECEP 10.00/1.00 NaLIC,NO. LIGING FIXTURES 10.0011.00M CONTRACTORS 13 APPLIANCES-RESIDENTIAL 4.00 ADDRESS - 4 PANELS 10.00 Id - DATE OF APPLICATION A H ECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.No. DR ENGINEER sec.No, �( SIGNS TRANS. 3.00 FARCH,OR DDRES$ENG. Oa� SPECIALCIRCUIT 5,00 PERMIT VALIDATION C gip EMP.METER OR POLE INS. 20.00 APPLICANT Sa l4 MOTORS SEE FEE SCH. - (//�u�f.V ADDREss C 1 ( (J CU SERVICE CHANGE 20.00 Woes LICENSED CONTRACTORS DECLARATION ` C u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE D ae (commcmci ng with lmySection 7000)of Division 3 0(3 the - BLDG. ELECT. PLO. MECH. 0 N i Profcssiom C cid my liccnu is in full for z o n - Liu ss Lie.Number O z Date Contractor a s '' LAL BUILDING PERMIT ¢ i a S OWNER-BUILDER DECLARATION INFORMATION X N I hereby affirm that I em exempt from the Contractor's License MISC.- REFER TO ORD P. 0 4 law for the following Reason.(Sce.703 I.S.Businessand Profusions T VALUATION S/FT. _ PERMIT ISSUANCE 10.00 p /� ,! Code:Any city or county which requires a permit to construct,alter, ' 2 ¢ < 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ^J�}-E ca - D M requires the applicant for such permit to file a signed statement that TOTPL / PERMIT TO w$ he is licensed pursuant to the provisions of the Contractor's License F z i Law(Chapter 9(commencingwith Section 7001))of Division 3 ofthe J 4D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ the basis for the alleged exemption.Any violation of Section 703 LS STORIES T $ R d ; by my applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(S500)J: ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 0 .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,EA,CON D. 5.00 - 3 Code The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 Q SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees.provided that such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00 meets are 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 fie did not huild or im- RE IND CON vB Diner prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,em exdmivcly contracting with p ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 1 ASSESISORSPARCELNO. and Professions Code Flue Contractor's License law docs not apply to an owner of properly who huilds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3(0 -3-2 -pip contracts for such projects with a contoolons)licensed pursumt to I SEWER-SANITARY-STORM EA.200ft/10.00 40 TRACT No. PARCEL NO. the Contractor's License Law. ❑ I am exempt under Ser.-,B,&P.C.for this I WATER HEATER W/VENT - 6.00 (Q�� Mason o Owner Date I WATER SYSTEM 5.00 S' ACC.DATE ACC.FILE NO. WORK ERS'COMPENSA'I'[ON DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, ZONING or a certificate of Workers'Co[[mPPpensation Insurance,or a certifred ENG.SITE NO. Po tharenf(Sec. Co pang .11L19 Co Policy o. Company -I Iy Q art itied copy is hereby fumishccL FIRE SPRINK ENERGY T-24 Z Z Certified cy ` filed yith the oily inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ O Applicant-1,/a4 s a V N V N K = CERTIFICATE 017 EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 UFLOOD ZONE A.L.U.L. LU > COMPENSATION INSURANCE PLG.CONTR. LIC.No. DLG. Y❑ NE] V❑ N❑ � Z (This section need not be completed if the permit is for one TOTAL hundred dollars($1 W)or Icss) U O 1 certily that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,I shall not employ any person in any manner so as to ED become subject to the Workers s of California. u Date Applicant_ ALTER OR ADD TO MECH. 5.00 BUILDING S3 } w NOTICE '1'0 APPLICANT. If,after making Ibis Certificate of Ex- F.. ? emption,you should become subject to the Wurkeri Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE V such provisions or this permit that be deemed revoked: AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 t, CONSTRUCTION LENDING AGENCY AIR HANDLING UNTT(OVER 10=C.F.M.) 6.00 SEISMIC FEE / Ts I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 s" the performance oark for wl this permit u issued(Sec. C MICROFILM 3097,Civ.CJ. �1Q H EATING UN IT(TO 100,000 B.T.U.) 8.00 G Lender's Name - HEATING UN IT ER 100,000 B.T.U.)9.50 Lender's Andre ELECTRIC 1 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 ordinances and state laws relating to building construction, and BOILER-ODfeP 13 H.P.or 100,0008.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (OVR 100,000BTU)SEE FEESCH. MECHANICAL above-mentioned properly 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 CONST.TAX LrS7 may in any way e,against said City in consequence of the PERMIT ISSUANCE 10.00 p- j4ACLt of th - mit. 'O MECH.CONT. LIC.NO. NOTAL V" sI a nrenf - TOTAL UP9 gn pp 'ant Contractor Dal OFFICE COPY