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12593 (2) POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO VIF RMITN A19EB INSPECTION DIVISION " � 12593 y E JOB INSPECTION RECORD`i ", PIS PERMIT EXPIRATION JOB AIDDRESS4— 1�-7-1 IiC)IIP/IC�IC�'�I ��' UNIT# LOT# I PERMIT EXPIRES IF WORK OWNER CONTRACTOR , ' - IS NOT STARTED WITHIN INSPECTIAN;;-S4? "::cDATEi_ INSPECTOR INSP,ECTION'RECORD' :;" 180DAYS OFPERMIT ISSU. FOUNDATION LIFER Co di,;h CG C di'I ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. PREGLINITE PERMIT VALIOAT19N 'P•OUR.NO CONCRETE UNTIL ABOVE HAS;BEEN SIGNED UNDER GROUND /.SLAB PAI PLUMBING ELECTRICAL`; " 2" G 86 ISSUANCE DATE MECHANICAL, - - eLuc. ELECT. vLc. MECH. City of Cu mrt® ❑ �' ❑ DO NOT POUR FLOOR UNTIL•ABOVE HAS BEEN SIGNED — BUILDING PERMIT, . WOOD FLOOR 14 '''`• INFORMATION PLUMBING _ vA L y aiFT. MECHANICAL': . ELECTRICAL•' PERMIT TO FRAMINGE Q' INSULATION _ C -7r 7 0 W117 L� sroRlEs rvvE CONSTR. I teh pug i U OCC,GHOUP RES.UNITS ._• PLACE NO SUBFLOOR UNTIL'ABOVE HAS BEEN SIGNE ROOF SO.FT.FLOOR AHE- TOTAL ACHEACE DIAPHRAGM - a BUILDING USE HES IND CON PB Dille APPLY NO ROOFING UNTIL ABOVEMAS BEEN SIGNED ❑ ❑ ❑ Cl ❑ ROUGH _ ASSESSORS PARCEL NO, PLUMBING G"., TRACT NO. PARCEL NO. MECHANICAL -' - - - -- " I,,,� ACC.DATE ACC.FILE NO. V%FINALS I!''-t. ^+. '.""DATE ? INSP.- INSULATION SAN # PLUMBING ZONING ENG.SITE NO, GAS MECHANICAL FIRE SPRINK ENERGY T 2 COVER NO WORN UNTIL ABOVE HAS BEEN SIGNED i HEATING Y❑ N❑ Y ❑ No , LATH—INTERIOR 1 ELECTRICAL FLOOD ZONE A.L.U.C. LATH—EXTERIOR ❑ NN[3Y ❑ NNE]- _ FIRE DEPT. Y SHEETROCK ? .. GRADE � 'I ' `FEE SUMMARY' SHEAR INTERIOR BUILDING . SHEAR EXTERIORBUILDING - TEMPORARY PPRO ALS FIREWALLS ELECTRIC PLAN CHECK IGAS• FEE NO TAPE OR PLASTER UNTIL'ABOOHAS BEEN SIGNED occuPANcv SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM U ARRANGE FOR INSPECTION BY PHONING 252-4505, �T , ELECTRIC ONE WORKING'DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. . — SEE PERMIT FOR EXPIRATION DATE - MECHANICAL ? 'IMPORTANT! 1 coNsr.TAx PLEASE READ REVERSE SIDE BEFORE '' `s'f„u +t° CALLING FOR FINAL INSPECTION. TOTAL G n rr 75 0E z , TR 0 :01 ot ` �� `�I,'pVR.�L. Irl lr � '� � 'iN � _-_" - F'. I ♦ Mf � -�,- •. O x� SPR .+ -" a ,� -y •,i> 17 W- r 1t `"� t� �y r� _ I � � � a _.a - ..c ' '�"'` ��' ;e'�f R-� � � •�r��yy'4�L� +�' - ^� 'q�. � 1 - .d " PIPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER ODII DING APPLICATION & PERMIT VADORE x, 59 'PJ BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 12593 OWNER'S - 1 PLAN CHECK VALIDATION NAM x OTY. ELECTRIC PERMIT FEE x y`,i PHONE iint"4e CTORs UTLETS-SWITCHES-RECEP 10.00/1.00 ju.,-- ILIGHTING FIXTURES 10.00/1.00 CONTRACTORS oRs PPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE /-9PANELS 10.00 PATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No. SIGNS TRANS. 3.00 ARCH,OR ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS. 20.00 t AMOTORS SEE FEE SCH. ADDDRESSDRESS �] rl `(X'e�.• SERVICE CHANGE 20.00 F o o LICENSED CONTRACTORS DECLARATION <i t I hereby affirm that I am licensed under provisions of Chapter 9 R JQQCSSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and BCITG7 7 ELECT I PLG. MECH. r i Professions Cod a y license is in full force c z o`� - License Class Lic.Numbe Q ob ❑ ❑ 9 w L w Date Contractor V ¢ x s BUILDING PERMIT rc a OWNER-BUILDER DECLARATION a w u INFORMATION I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION $/FT. aru O a Law for the following reason.(Sec.7031.5,Business and Professions _w PERMIT ISSUANCE 10.00 w Code:Any city or county which reyuiresn permit to construct,alter, improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ' 2 ¢< requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w$ he is licensed pursuant to the provisions of the Contractor's License Hii Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the ¢ Business and Professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE ¢ss-D the basis for the alleged exemption.Any violation of$ection 7031.5 STORIES TYPE CONSTR. a3$ by any applicant for a permit subjects the applicant to a civil penalty 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 their sole compensation,will do the work,and the structure is not OCC GROUP RES.UNITS 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 5.60 ,DO SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- i ments are not intended or offered for sale.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 proving that he did not build or im. RES IND, CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE_ INTER. 30.00 ❑ 1,as owner of the property,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(EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C.tar 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 I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0. or a certificate of Workers'Compensation(Insurance,or a certified ropy thereof(Sec.3800,Lab.C.). yY_ wf Policy No. 'Company_, IMHH/e, LGC_I O ❑ 15ed copy lS hereby furnished. FIRE SPRINK ENERGY T-24 Z Z Certified copy is fit It with Ins Ilion division. 0 Applicant +-1 A��/L�/ MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑ rn PERMIT ISSUANCE -� FLOOD ZONE A.L.U.C. LU - CERTIFICATE OF EXEMPTION FROM WORKERS' QJ 1 COMPENSATION INSURANCE, PLG.CONTR. LIC.NO. PLG. tl O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ Z hundred dollars($100)or less.) r U 0 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. 0 to Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } fait NOTICE TO APPLICANT: If,after making this Certificate of Ex- ♦- Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code,you must forthwith comply with FEE C.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 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. HEATING UNIT(TO 100,000 B.T.U.) 8.001MICROFILM 3097,Civ.C.). Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.501 ELECTRIC Lender's Address . I cmtify that 1 ban 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 BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and slate laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEESCH. MECHANICAL 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 CONST.TAX may in any way Scene against said City in consequence of the PERMIT ISSUANCE 10.00 granting of 1 5 p it, MECH.CONT. LIC.N0. MECH. `� TOTAL TOTAL 11 of.�1�5 Slgnaturr-onpTlicaTtlContractor to ' OFFICE COPY