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C 8661 (2) POST THISCARD NEAR FRONT OF BUILDING '• P MIT NUMBER - CITY OF CUPERTINO Q a , INSPECTION DIVISION JOB INSPECTION RECORD - / ��� PERMIT EXPIRATION ` JOB ADDRESS uNi7W � L• .PERMIT EXPIRES7F-WORK OWNER CONTRACTOR NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD -18oDAYSOFPERMITISSU- FOUNDATION - ANCE OR 180 DAYS FROM UFER - .. � b' LAST CALLED INSPECTION. PR EGUNITE PERMIT VALIDATION ' � - �. � , POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �. UNDERGROUND /SLAB L PLUMBING ELECTRICAL - Z IssunncB GATE _ MECHANICAL BLocr ELECT. PLG. :MECH. ©`- o 0 0 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - ' ' BUILDING PERMIT WOOD FLOOR ! INFORMATION PLUMBING: VALUATION SIFT. r MECHANICAL lJ ' ELECTRICAL PERMITT FRAMING '� i ' ✓.! INSULATION -- s 00`ln 'T71 TVP CON + OCG GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ' 4 .. ROOF • SO:FT,FLOOR•AREA TOTAL ACREAGE , a DIAPHRAGM .BUILDING USE , IND CON. PB OIE,r - APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ - 1:1 ❑ ROUGH ASSESSORS PARCEL NOSY , ' - PLUMBING GAS TEST TRACT NO. PARCEL NO, - MECHANICAL. j �. ACC.DATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP: FRAMING ' SAN M INSULATION PLUMBING ZONING ENDSITE NO. GAS MECHANICAL FIRE SPRINK 'A ENERGY T.2a - COVER NO WORK UNTIL ABOVE HAS BEEN'SIGNED HEATING ` "E ` "E LATH—INTERIOR ELECTRICAL - .FLOOD ZONE A.L.U.C. LAT+i—EXTERIOR FIRE DEPT. - v❑ NE] Y 0 N❑ SHEETROCK GRADE - _ FU-SUMMARY . SHEAR INTERIOR BUILDING - _ - , SHEAR EXTERIOR - TEMPORARY APPROVALS - BUILDING 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 0� 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' CALLING FOR FINAL INSPECTION. OFFICE COPY ' i I, ._APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY IEUILoBr9 LDI NG PROJECT IDENTIFICATION APPLICATION & PERMIT 1 0„G EMITNUMBER REu � J � GQ' Gq p rENf BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 8661 OWNER'$ PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE PHONE CONTRACTORS ]PAID NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 I-Q 5.11, '-fpm T C.NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S 51985 CONTRACTORS n PPLIANCES-RESIDENTIAL 4.00 M Y 1 r+ C .ssT Rn vHONE3707 HQ PANELS 10.00 r`•kLI APPLICATION TA PLAN CHECK FEE P.C.NO. GR PANELS (OVER Z00 AMP) 20.00 City ofi Caperti o ENGINEER uc.No. SIGNS TRANS. 3.00 I ADDRESS ENG' _ SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 APPLICANT MOTORS SEE FEE SCH. /o-26 /// ADDRESS f 6 xlr r SERA:vc; SERVICE CHANGE 20.00 'woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 a i v I hereby affirm that I am licensed under provisions of Chapter 9r ISSUANCE DATE w ¢ w. (commencing with Section 7000)of Division 3 of the Businessand BL G ELECT. PLG. MECH. F O z Professions .and my license ism full foret d effect ❑ ❑ ❑ Z o `� - Liccnu Clad r -'+��NILiI:.Number 5 9 w r Datc.]J_Y-E.$' Contractor_ --ABs 5....� r - - ¢ >< Tt-�,v,rTE BUILDING PERMIT ¢ ¢ ¢ OWNER-BUILDER DECLA RATI N ¢ a INFORMATION ww . I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD u0 Law for the followingreason.(Sec.7031.5,Bminessamd Professlom VALUATION /FT. H - g PERMIT ISSUANCE 10.00 Code:Anycity Gloomily which requiresa Permit to construct,alter, �i01hO / ar R ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. ll((//�T�� 0 LL requires the applicant for such permit to file a signed statement that TOTAL 6 w m he is licensed pursuant to the provisions of the Contractor'%License PERMIT TO ii' Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ffic f ic, w I- basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CqNSTR. by by any appliearR fora permit subjects the applicant oacivil Penalty ALTER-DRAIN& VENT-WATER IEA.).5.00 of not more than Five hundred dollars(S500).): ❑ 1,as owner of the properly,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 OCC.GROUP RES.UNITS ,their sole compen,ed on,will do the work,and the structure is nut tended or offered for sale (Sec. 7044, Business and Profwions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employm,provided that such improve- - mems are not immured or ofrc,cd for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of Completion,the owner- GAS EASYSTEM OVER 4 (EA.) 200 BUILDING builder will have the burden of proving that h - . - . . NG USE e did not build or im- IND CNG PB Omer Prove for purpose of sale.). Cl 1. WASTE INTER. 30.00 1:1 El 1:1 1:11.as owner of the property,am cxduuively contracting with licensed contractors to construct 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 whoLAWN SPRINKLERS-OVER 5(EA.) 1.00 eontracts fur such projects with a contmctims)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ l am exempt under Sec..,IL&P.C.for this WATER HEATER W/VENT 6.00 rexsrm Owner Dam WATER SYSTEM 5.00 ACGDATE ACC.FILE NO. W'ORKERS'COMPI:NSAI'ION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a¢rtificate of consent to xlf-insure. or a certificate of Workers Compensation Insurance,or a cerlifwd ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.j. Policy No. Company 0 O Certified copy is hereby furnishu4/f FIRE SPRINK ENERGY T-24 Z ZIQ Certified s Til th cit Ilion division. I- p M4'7laant �1ItGf Z MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ CCD CE IPICATE of:EXIiMPT10N FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.uc. LL > COMPENSATION INSURANCE. PLG.CONTE. sec.NO. PLC. 1 O (This section need not be completed if the pcmih is for one TOTAL Y❑ N❑ Y❑ N ::) Z hundred dollars IS 1001 or Ief,) U O 1 cerlify that in the performance of the work for 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 Q w become subject to the Workers Compensation Laws of California. Q. Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } so NOTICE TO APPLICANT: If,after making this Certificate of Ex- I'- Z emplion,you should become Subject to theWorkcrs'Compensation APPLIANCE 5.00 PLAN CHECK U Er visions provision,of tthishe Labor Code, you must forthwith comply with FEE suchpermit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M_) 4.00 CONSTRUCTION LIiNDING AGENCY AIR HANDLING UNIT(OVER 10X0C.EM) 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.L HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lenders Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 Lenders Address - ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is erorreet.I agree to comply with alt city and county BOILER-CORY(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws elating to budding 'onslrudion, anJ jemby aulhoritt representatives of this city to enter upon the 0'ME (Over 100,00D BTUI SEE FEE SCH. MECHANICAL bovamentioned property for inspection pm,m. , (We) agree to sure, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against Gabihtics,judgmcnh, cnsis and expenses which CONST.TAX may in any way accrue against said Cit consequence of the PERMIT ISSUANCE 10.00 grant ingo pe �- I MECH,CONT. LIQ NO. MET TOTAL TOTAL / !� e ppliclnt oniractor Date OFFICE COPY ,