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12367 (2) POST.THIS CARD NEAR FRONT OF BUILDING ALL PEVMrt NUMBER CITY OF CUPERTINO 12367 INSPECTION DIVISION JOB INSPECTION RECOR L/ PERMIT EXPIRATION JOB ADDR SS U l0T# PERMIT EXPIRES IF WORK OWNER ,1 CONTRACTOR IS NOT STARTED WITHIN IN PEC ON TE INSPECTOR /INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDAT ON - ANCE OR 180 DAYS FROM UFER ' LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED <� UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL RL ELE P MECR. i ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING qERMIT INFORMATION PLUMBING WOOD FLOOR VALUATION ' $/FT. MECHANICAL ELECTRICAL - - - PERMIT TO /V FRAMING _ r F 6 INSULATION STORIES TYPE CONSTR. • OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE - RES IND CON PB Olnr• APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO, • PLUMBING GAS TEST TRACT NO: PARCEL NO. MECHANICAL . ELECTRICAL ACC.DATE ACC.FILE NO, 1 FINALS DATE INSP. FRAMING SAN # INSULATIONPLUMBING 4J,-.j��8� ZONING ENG.SITENO - GAS MECHANICAL Y -FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑ LATH-INTERIOR ELECTRICAL ,S FLOODZONE A,L.U,C. LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR _ BUILDING SHEAR EXTERIORTEMPORARY APPROVALS BUILDING FIREWALLS JELECTRIC PLAN CHECK_ GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED 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 IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL V CALLING FOR FINAL INSPECTION. OFFICE COPY J I APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN.ONLY BUIiDI NG PROJECT I DENTI FICATION PERMIT NUMBER pWL ,NG APPLICATION & PERMIT AopREss C L) 1 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 12367 ,tom OWNERS ✓ PLAN CHECK VALIDATION y� NamE OTV. ELECTRIC PERMIT FEE D vHorvE _ N ` UTLETS-SWITCHES-RECEP 10 CONTRACTOR'S .00/1.00 O ti 2V Lt. No. p LIGHTING FIXTURES 10.00/1.00 clie.� CONTRA DRS APPLIANCES RESIDENTIAL 4.00 ADDRESS., �3 / PHONE L PANELS 10.00 DATE OF APPLICATION AARRCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LC.NO. SIGNS TRANS. 3.00 ADDRESS euc. SPECIAL CIRCUIT 55,00 PERMIT VALFErAMW ZIP EMP.METER OR POLE INS. 20.00 „ ADDRESS ASMOTORS SE H. 4 (JrIY%KA(Y{} DREPPLI E55S SERVICE CHANGE 20.00 YW� o¢ i r o o LICENSED CONTRACTORS DECLARATION d <u wI hereby affirm that I am licensed under provisions of Chapter r) ISSUANCE DATE H ¢w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H w z Professions Cod my license is in full for n4ef of � `LG ❑ z out - icense CI s Lic.No nber g w r Date� Contractor M "¢ aOWNER- BUILDING PERMIT to U BUILDER UECLA-ATI N INFORMATION E: g e- N I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD to u o J Law for the following reason.(Sec.703 t.5,Businessand Professions PERMIT ISSUANCE 10.00 u VALUATION g/FT. Code:Any cityor county which requires a permit to construct,alter, ¢ a0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONT-. LIC.NO. ELED. 30 ✓ / Liv i w m¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO he is licensed pursuant to the provisions of the Contractor's License H z r Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe / 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE �� %�(d/.�-L ¢ H$ the basis for the alleged exemption.Any violation of Section 703 t.5 STORIES TYPE CONST-. a3 _ by any aomthafor a permit dollars(he0).):ant toa civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($5001.1: ❑ I,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 ace.CROUP RES.UNITS tended 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 properly who builds or improves hereon,and who does such work FIXTURES-PER TRAP 5.00 � 50.FT.FLOOR ARE. TOTAL ACREAGE himself or through his own employees.provided that such improve- ments are not intended oroffered for sole.IC however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OV .) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 0.00 RES IND CON PB Omer ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec. 7044,BusinessLAWN SPRINKLER 5 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.) .00 contracts for such projects with a contruc Wns)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-S .00 TRACT NO. PARCEL NO. ❑ lam exempt under See ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Daze WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORK IiRS'COMPINSA'1'ION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to sel Ginsure. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.CJ. Policy N.. C RR,e my O ❑ Certified copy is hereby Ilnnished. RE SPRINK ENERGY T 24 Z 2 ❑ Certified copy is filed with the city ins licence division. F- O mAPPlicant MISC.- REFER TO ORD. Y ❑ NC] Y ❑ N[] CFRTIIICAFE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 Q FLOODZONE A.L.UC. LU > COMPENSATION INSURANCE: PLG.CONTH. LIC.No. PLG - CL O (Phis section need not be completed if the permit is for one TOTAL Y❑ N Y ED 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 shell not employ I person in any manner so as to U W hemi mb'e I t the Workers'( mpensmion ws o' 'alilornia. Date Applin`°nt ALTER OR ADD TO MECH. 5.00 BUILDING Q C}u } to NOTI 1 LICMN If,a to m a Eng t us Cer I ate of Ex- F- Z emption,you should become subject the Worker..,'Compensmion APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you ust forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCUON LENDING AGENCY AIR HANDLING UNIT(OVER IQOW C.F.M.) 6.00 SEISMIC FEE SSI7 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. 3077,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify III at 1 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.COMP(3 H.P.or 100.000 B.T.U.) 6.00 hereby authorise representatives of this city to enter upon [he BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above hereby mentioned property tativinspection this 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 i a way accrue.against said City in consequence of the PERMIT ISSUANCE 10.00 granti go this permit MECH.CONE LIG NO. MECH. TOTAL TOTAL ZJ fognatilre orA,PVdftt1ConITmIor OFFICE COPY