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12741 (2) POST THIS CARD NEAR'FRONT'OF BUILDING / ITNUAR CITY OF CUPERTINO • ` � '" ' INSPECTION DIVISION �� JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS � Uy �� P�CL)OO/),J' GT UNIT# LOT# _ ,/ A PERMIT EXPIRES IF WORK OWNER ., f-/ (,( ,{- /y'f SO C-, - CONTRACTOR v,1_10 c"r,J- - IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR ' INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION _ - ANCE OR 180 DAYS FROM vt _ Ef D 1,l 2 87 LIFER LASTCALLED INSPECTION. -L3r$7 PR EGUNITE PERMIT VALIDATION n c S b-s OUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING 13AID ELECTRICAL ISSUANCE DATE MECHANICAL iUP eLD.Q. •ELF T. PLG. MECH. oit 3 n ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDI Q LANG PERMIT INFORMATION PLUMBING WOOD FLOO VALUATION S/FT, • MECHANICAL Ml ELECTRICAL PERMIT TO • FRAMING INSULATION _ Ta STORIES TYPE CONSTR. OCG GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO,FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM I . BUILDING USE // 9O f7 RES IN. CON PB Otnrl APPLY NO ROOFING UNTIL ABOVE HAS BE -SIGNED B )(.0 El ❑ El ROUGH _ ASSESSORSPARCELNO. PLUMBING GAS TEST I TRACT No. PARCEL NO. MECHANICAL i J ELECTRICAL �-- FINALS DATE INSP. ACC.DATE acc.FILE No. FRAMING -7X- SAN # INSULATION .,L PLUMBING ZONING ENG.SITE NO. GAS ' Y'LI FIRE$PRINK ENERGY MECHANICAL -/7 Y ❑ NEJ Y ❑ No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH-INTERIOR ELECTRICAL FLOOD ZONE AT.UC. LATH-EXTERIOR �U 87 FIRE DEPT. 1 Y❑ Na Y❑ N❑ SHEETROCK ,-008 C GRADE FEE SUMMARY SHEAR INTERIOR • BUILDING SHEAR EXTERIOR -y�- TEMPORARY APPROVALS BUILDING -O FIREWALLSELECTRIC PLAN CHECK GAS FEE ' NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE \ OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY 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 CONST.TAX •�: IMPORTANT! �- PLEASE READ REVERSE SIDE BEFORE TOTAL F CALLING FOR FINAL INSPECTION. OFFICE COPY AnPL j xNT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY L DING PICOJECT IDEN7I FICATION PERMIT NUMBER gUILDINr;BUIAPPLICATION & PERMIT AOOREss r� /'' ljarBUILDING - ELECTRICAL-PLUMBING -MECHANICAL 12741 OwNERF PLAN CHECK VALIDATION NAME Auaa Amo PHONE CITY. ELECTRIC PERMIT FEE NN"AME UTLETS-SWITCHES-RECEP 10.00/1.00 uC.NO. LIGHTING FIXTURES 10.00/1.00 PPLIANCES-RESIDENTIAL 4.00 lVNONE PANELS 10.00 DATE OF APPLICATION PLAN CHECK FEE P.O.NO. oR (��yLE C � n`N/� PANELS (OVER 200 AMP) 20.00 ENGINEEfl L 7 LIC.No. SIGNS TRANS. 3.00 ARCH.OR ENO// �y�d PERMIT VALIDATION ADDRESS Q'S. S C"z SPECIAL CIRCUIT 5.00 LOS zr, EMP.METER OR POLE INS. 20.00 AID APPucArars MOTORS SEE FEE SCH. ,_,�O / e-u, , _ 1 ADDRESS /\ W W.`^-T_� SERVICE CHANGE 20.00 li o o LICENSED CONTRACTORS DECLARATION ' 198 < U I hereby affirm that I am licensed under provisions of Chapter 9 DANCE DATE yam fermate eing with Section 7000)of Division 3 of the Businessand L PLG. MECH. H 0 zProfessions CoJ nd my Isee ase is In full f n e ❑ ❑ ❑ Z02 - License I Lic.Nwnher o m H w Uate Contractor a x s BUILDING PERMIT ¢ ¢ w ¢ OWNER-BUILDER DECLARATION INFORMATION REFER TO ORD K 3 I hereby affirm that 1 am exempt from the Conl inum"s License MISC.- VALUATION 5/FT. I- lcoso Lawlor the following rcasce.(Sec.703 1,5,Businssand Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a Vemtil to construct,alleq �,�/ D�,4 ac x at 0 improve,demolish,or repair any structure,prior s'0 its issuance,also ELEC.CONTR LIC.NO. ELEC. / - o ¢ requires the applicant for such penal(to file a signed statement that TOTAL PERMIT TO whe is licensed pursuant to the provisions of the Contractor's License H z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE re S the basis for the alleged exemption.Any violation of Section 7031.5 STORIES -TYPE CONSTR. a ; by any applicant for a permit subjeelsthe applicant toacivil Penalty of not more than five hundred dollars 1 S500)J: ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ 1,as owner of the property,or in,employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will Jo 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 does not apply to an owner of Property who builds or improves thereon,and who dos such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sac.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 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 powing that he did not build or ire- RFS IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,a property.am of the proren exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construe, the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor i License Law docs 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 contractions)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. -PARCEL NO. ❑ l am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 re7 / ason S Owner Date WATER SYSTEM 5.60 ACC.DATE ACC.FILE NO. WORK ERS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have acertlllcate ofconsent wselfinsure, ZONING or a certificate of Workers'Con lion Insurance, a certified ENG.SITE NO. copy thereof,Sec.3,(Z Lab.C.). a O Policy No. Company Q ❑ Ccrti cd 'opy is hereby a rushed_ FIRE SPRINK ENERGY T 24 Z Z ❑ Certi ed y s tilt t e c inspection division.n. - REFER TO ORD. O Applicant Y ❑ N❑ Y ❑- N❑ cc y CERT ICATE IrEX. PTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.u.c. U.1 COMPEN4S ON INSURANCE PLG.CONTR. LIC.NO. PLG. 4. 0 ('Phis section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ Z hundred dollars IS 100)or less.) 0 O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to OW become subject to the Workers'Compensation laws of Califomu. Lu Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING Sa } 0 NOTICE TO APPLWAN'f: If,after making this Certificate of Es- F-. ? .emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK - provisions of the Lahr Code, you must forthwith comply with FEE such provisions or this permit shall redeemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 t� CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00SEISMIC FEE /C� I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 tire 309performance �CloCt'nce of the work for which this permit u iswed(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name H EATI NG UN IT(OV ER 100,000 B.T.U.)9.50 \ Lender's Address ELECTRIC I cenify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county BOILEA-CONP 13 H.P.or 100,000 B.T.IA) 6.00 PLUMBING underarm and state laws relating to building construction, and 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. agree (o save, indemnify and keep hanmlm the City of MISC.- REFER TO ORD. ao against Bab'I s,Judgments, costs and expenses which CONST.TAX 77 90 any way c Ie galnn said City at conseq en of thePERMIT ISSUANCE 10.00 of Phi perm'. ^ MECH.CONT. LIC.NO. MECH. TOTAL TOTAL O°z'Sep o p icon(/- ntrnml Or D"u1. OFFICE COPY