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12042 (2) I 1 -' POSTTHIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PFRMIir UYQ�� INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOBADDRESS 10141 HILLCREST ROAD UNIT# LOT# PERMIT EXPIRES IF WORK OWNER ROGER WING CONTRACTOR ATLAS HEATING IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTI N RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION � � ,- { < {r r LASTCALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED PAld UNDERGROUND /SLAB C/ rll PLUMBING A.ti 7 „ qqq11;�•///)! ELECTRICAL ISSUANCE DATE MECHANICAL _ LECT• vLc. MECH. Cr E;B B ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WINFORMATION WOOD FLOOR VALUATION $/FT. ?LUMBING / MECHANICAL 1 ELECTRICAL - 4 FRAMING III INSULATION STORIES TYPE ONSTR. rl DC GROQP —,.RES.UNITS • PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED v- I SQ FT.FIODR AREA TOTAL ACREAGE I ROOF DIAPHRAGM ' eulLomc usE ' RES IND CON PB ONer APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑' ❑ El ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL NO! MECHANICAL ELECTRICAL FINALS DATE INSP. ACC.DATE ACC FILE NOi FRAMING SAN u ZONING ENG,SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY L24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y N Y N� LATH—INTERIOR ELECTRICAL FLOOD ZONE A,u.c. I LATH—EXTERIOR FIRE DEPT, Y N(] Y 0 N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING I FIREWALLS ELECTRIC 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 ISSIGNED BY BUILDING INSPECTOR. MICROFILM I ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ob Lu 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. OrPOCC COPv APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTI FICATION PERMIT NUMBER APPLICATION & PERMIT . 1 ZO4Z ADDRESS/ �/ / /�I/Jl'1CT•///�, (iC•l-(,(/+d/ /��,J BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S - "- // -/�/Q PLAN CHECK VALIDATION "AME/'l�/�rp /TJ/'l//•• / QTY. ELECTRIC PERMIT FEE K UCS• PHONE NAMERAcroR's UTLETS-SWITCHES-RECEP 10.00/1:00 ua rvo. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR �j,J. ��KY�.-en/� a PPLIANCES-RESIDENTIAL 4.00 PHONE ADORES /(L P NE rj-�If ;89-41S7PANELS 10.00 DATE OF APPLICATION RRDHITEcr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0. OO ENGINEER LIC.No. SIGNS TRANS. 3.00 ADDRESS ENG. - SPECIALCIRCUIT 5,00 PERMIT VALIDATION zlr TEMP.METER OR POLE INS. 20.00 ADDRESSTs -. MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION a L,U 1 hereby affirm that I am licensed under provisions of Chapter 9 .ISSUANCE DATE y¢u (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECLi PLG. MECH. F y z Professions Co e,and y license is in full force od f; t ^ O ❑ z 0 License lass Lie.Number < '� 9 N H w Dale Contractor - •f x J� )" `^ ¢ x ¢ a OWNER-BUILDER DECLARATION BUILDING PERMIT a d ° M ISC.- REFER TO ORD INFORMATION w3 u rn 1 hereby affirm that 1 am exempt from the Contractor's License rtVAL TIONI Ino $/FT. HUNJ Law for the following reason.(Sec.7031,5,Businessand Professions PERMIT ISSUANCE 10.00 t-"-- � Code:Any city orcounty which requires a permit to construct,alter, ¢ La ¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. u - ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT To Ax $LL he is licensed pursuant to the provisions of the Contractor's License t z i Law(Chapter 9(commencing with Section 7000)ofDi,ision 3 of the ¢ Business end Professions Code)or that he is exempt therefrom end QTY. PLUMBING PERMIT FEE f i o M r the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYP CONSTR. s;; _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-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 DCC.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 does not apply to an owner Of property who builds or improves thereon,and who does 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-1 8.00 mems 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 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 RES IND CON RB Omar ❑ 1,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.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 MA.) 1.00 contracts for such projects with a contractol(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate ofconsent to selGinsure' ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified _ copy thereo�[[ c. 00, b.C.). Policy NELS any Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 _Z Z �Cerlifie cop i filewit`h�thc�fty inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ O Applicant F v N v N F- y PERMIT ISSUANCE 10.00 PIoo0ZONE A.L.U,C. Lu - CERTIFICATE E EXEMPTION FROM WORKERS' W �_ COMPENSATION INSURANCE PLG.CDNTR. LIC.NO. PLG. 0- O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑ =) Z hundred dollars(S 100)or less.)' - 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,1 shall not employ any person in any manner in as to U become subject to the Workers'Compensation Laws of California. C. Date Applicant ALTER OR ADD TO MECH. -5.00 BUILDING } to NOTICE TO APPLICANT: If,after making this Certificate of Ex- F ? emption,you should become subject to the Workers'Compensation APPLIANCE PA10 5.00 PLAN CHECK Provisions of the Labor Code, you must forthwith comply with FEE CJ such provisions or this permit shall be deemed revoked. AIR HANDLING NIT(TO 10,000C.F.M.) 4.00 c CONSTRUCTION LENDING AGENCY AIR HANDLING 'NI (OVER,104MC`RM.) 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. - IRMICROFILM 3097,CY.C.). HEATING UNITI((T0710010LIAN0U.) 8.00 - Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 1, Lender's Address ? I certify 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 PLUMBING ordinances and state laws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T,U.) 6.00 "q hereby authorize representatives of this city to enter upon the BOILER-COMP love,100,000 BTU)SEE FEE SCH. MECHANICAL V 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. Q Q� CONST.TAX may in any way accrue again t said City in consequence of the gra g of this p rmiL MECH.CONT. LIC.NO. MECH. Q�f {'y`�_p// L[/ TOTALTOTAL Signature of p icant/ r or Date e'•`� '�' Y '" 7 w --� OFFICE COPY a