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13911 (2) POST THIS CARD NEAR FRONT OF BUILDING PFRMI,NUMBER CITY OF CUPERTINO 13911 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIR41ON �7I. JOBADDRESS O�S �� f�Gl_l1r�Q—UNIT ',I —LOT# 6 //•yY /�� PERMIT EXPIRES IF WORK - OWNER J�,� t.0 CONTRACTOR c_JQ6 gq ,IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU- FOUNDATION -1 �,-� �� I�, ANCE OR 180 DAYS FROM LIFER y, LAST.CALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 1_ ; UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT. PLG. MECH. ❑ ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION $IFT. � � � MECHANICAL - ELECTRICAL PERMIT TO FRAMING - L� L INS LATION STORIES TYPE CONSTH. �d dSs S OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN 8IGNED ROOF _ SO.FT`FLOOR AREA TOTAL ACREAGE DIAPHRAGM ShelMLA 13-2 Ll-M I USE RES IND CON PB OJmr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 0 ❑ ❑ ROUGH. ASSESSORS PARCEL NO. PLUMBING "1 GAS TEST np �� AC�2�. TRACT NO. PARCEL NO. MECHANICAL — ELECTRICAL FINALS DATE I INSP. ACC.DATEACC.FILE NO. FRAMING S - SAN # ZONING ENG.SITE NO. INSULATION - - PLUMBING '-y W¢�' GAS MECHANICAL L FIRE SPRINK ENERGY TPa COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y N� Y ❑ NE] LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.UC. LATH-EXTERIOR ,� .d FIRE DEPT. Y❑ NO Y NC:] SHEETROCK (D_cl� GRADE FEE SUMMARY SHEAR INTERIOR ,Y.�3_ BUILDING SHEAR ExTERIORTEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC 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 IS SIGNED BY BUILDING INSPECTOR. MICROFILM QARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC �� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX J PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BULLDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER ram ES Lot A LICFL'TION & PERMIT@Doq 13911 noDREss BUILDING -ELECTRICAL-PLUMBING -MECHANICAL S Ln. OWNERS PLAN CHECK VALIDATION 00 NAMEQTY. ELECTRIC PERMIT FEE 47ebr cr Cir PRpNE u 4�0 -14 LJO y CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 �p ME (�:C^i� �'� / •j l_.C.2Y �� LIGHTING FIXTURES 10.00/1.00 0�l corrRAcrons s Gyp PPLIANCES-RESIDENTIAL 4.00 AD RES- 5 __ /�,.y (V_vIN�� Lam{�SypNE -Iq PANELS tO.00 DATE OF APPLICATION OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .C.N . OR ENGINEERS , .N SIGNS TRANS. 3.00 ADDRESS ENG. �� SPECIALCIRCUIT 5.00 PERMIT VALIDATION �'�t ''�er0;Zt- ¢, 7Q EMP.METER OR POLE INS. 20.00 APPLICANT s O! MOTORS SEE FEE SCH. - AOOREss�r n, F.N'1 SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION a v I hereby affirm that 1 em licensed under provisions of Chapter 9 ISSUANCE DATE yz u, (commencing with Section 7000)of Division 3 of the Business and < n BLDG. ELECT. PLG, MECH. 0 N i License CoJyqmJ my license is in full force' ❑ ❑ ❑ ❑ i o.n - License�(7�ss_ Cl Lic.Number`+"Y:.�--'-- m- Data_ 1f6�'� Contractor_ , 1� a Y LL J BUILDING PERMIT Ic 0 n u OWNER-BUILDER DECLARATION INFORMATION w ; w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD F u o j Law for the fallowing reason.(Sec.7031.5,Basin ssand Professions PERM?ISSUANCE 10.00 /D�• VALUATION. S/FT. Code:Any city or county which requiresa permit toronst ruct,alteq a improve,demolish,or repair any structure,poor to its issuance,also ELEC,CONTR. LIC.NO. ELEC. ,6 req WRY the applicant lot such permit to]tie a Signed Statement that TOTAL / O PERMIT TO i u s omhe u licensed pursuant to the provisions of the Contractor's License R TT L F x Law(Chapter 9(cmencing with Section 7000)of Division 3ofthe /PE-✓J a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE $ the basis for the alleged exemption.An g p heapplicnt toaction malty STORIES TYPE CONSTR. a � by any applicant fore pearl subjects the applicant toacivil penalry ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).): ❑ 1,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 imm'uded or offered for to (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:'rhe Contractor's License Law does not apply to as owner of _ property who builds or improves thereon,and who docs such work I F IXTUR ES-PER TRAP 5.00 $ry FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 - ')GL)� or improvement u sold within one year of completion,the owner- GAS EASYSTEM OVER 4 IEA ) 2.00 OWL builder will have the burden of proving that he did not build or int - . - . - BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Oran ❑ I,as owner of the property,am exclusively contracting with I icensaJ contractors m mastruct the project(See. 7044,Business LAWN SPRINKLERS-1 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 30-J-;' -010 contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 O TRACT NO. PARCEL NO. ❑ 1amexempt under Sec. ,BAP.C.forthis WATER HEATERW/VENT 6.00 �67,Z reason Owner Date WATER SYSTEM 5.00 S_ ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent to self-insurt. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thurcoffScc.3800,Lb.Cy L 0. Policy tio. Company_ _ _ Q ❑/C ertifed Copy is hereby fumisl J. FIRE SHRINK ENERGY T 24 Z 2 YT C rtife oQy�Ir�plyll with the city inspection ion division. C. 1' MISC.- REFER TO ORD. � � EI O APPbcanl- Q� Y N V N ~ w PERMIT ISSUANCE 10.00 Q, FLOOD20NE A.L.u.G. LU CIiRT114C(70 OP SAI IO 1'I ON PROM WORKERS' W COMPENSATION INSURANCIi PLG.CONTR. LIC.NO. PLG. �QO Y[] N� Y [] NEJ CL 0 (This section ed not be completed if the permit is far one TOTAL hundmJ dollars(51001 or Ins.l U O 1 certify that in the Performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued.I shall not employ any person in any manner sn as to OW become subject to the Workeri Compensation Laws of California. 0. Dat` Applicant ALTER OR ADD TO MECH. 5.00 BUILDING �3S k m NOTICE TO APPLICANT: If,after making this Certificate of F.x- F ? emplion,you should become subject to the Worked Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shell he deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 1 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER t0,000OF.M.16.00 SEISMIC FEE / 67 1 hereby affirm Das there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 S- the pnrl'ormm f the work for which this permit is issued(Sec. MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 / 6✓ -.1� Lenders Addmss _ ELECTRIC BOO I certify that l have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 G2 ^ ( information is correct.I agree to comply with all city and county PLUMBING � .' ordinances and slate laws relating to building construction, and BOILER-CONF(3 H.P.or 100,000 B.T.U.) 6.00 1 hereby authorme representatives of this city to enter upon the above-mentioned property for inspection purlrosus. BOILER COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (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 may in any way a-crue against said City in consequene of the PERMIT ISSUANCE 10.00 �� OJ n og of th'S par .. MECH.CONT. LIC.NO. MECH. R7 TOTAL TOTAL O Si6netare o App cant Contractor Date OFFICE COPY