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12862 (2) POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER CITY OF CUPERTINO 12862 INSPECTION DIVISION • JOB INSPECTION RECORD PERMIT EXPIRATION I Oo CIO JOB ADDRESS IN # PERMIT EXPIRES IF WORK OWNER CONTRACTo IS NOT STARTED WITHIN IN PECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM UFER ' LAST CALLED INSPECTION. PREGUNITE PERMIT VALIDAT,ON - , POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND' /SLAB t PLUMBING / ,'•Y 7 ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT, PLG. MECH. El El ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION $IFT. MECHANICAL ' T ELECTRICAL PERMIT - FRAMING /\ INSULATION STORIES TYPE CONS R. OCC.GROUP RES.UNITS _ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF 50.FT.FLOOR AREA TOTALACREAGE DIAPHRAGM BUILDING USE RES IND CON PB Do— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ E] ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING ' GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL - FINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING SAN a INSULATION PLUMBING ZONING ENG,SITE NO. MECHANIC L FIRESPR INK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SI HEATING Y ❑ "❑ ❑ "❑ LATH-INTERIOR - ?J� �� ELECTRI AL ELOOOZONE A.L.U.C. LATH-EXTERIOR FIRED PT. Y❑ N❑ Y ❑ N❑ SHEETRDCK �1j -rj-$ PRA UE - FEE SUMMARY SHEAR INTERIOR - BUILDING 3 —y SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING u,�• FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JUCCUPANCY SEISMIC FEE o J OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC • H 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 CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 12862 ADDIF,/s/ / i- ILDING-ELECTRICAL-PLUMBING-MECHANICAL NAMERa ay PLAN CHECK VALIDATION � ]n QTY. ELECTRIC PERMIT FEE • ONE Z57/41/ CONTRACTORS �- NAmE L OUTLETS-SWITCHES-RECEP 10.00/1.00 �y /"14 IC.N0.�6 Q LIGHTING FIXTURES 10.00/1.00 corvrRACTons PPLIANCES-RESIDENTIAL 4.00 ADOREss HON / PANELS 16.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,06 PLAN CHECK FEE P.C.NO. LIC.NO. SIGNS TRANS. 3.00 ADDRESS ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT MOTORS n � ADDRESS SEE FEE SCH. A, ` /R/ SERVICE CHANGE 20.00 fU �r rv/ woo LICENSED CONTRACTORS DECLARATION J ,( 1(1(1 /y��, <u u I hereby affirm that 1 am licensed under provisions of Chapter 9 r}• ISSUUAIIIIJJJ/CE DATE H< vai (commencing with Section 7000)of Division 3 Of the Business and BLDG. EL GT. PLG. MECH. r w z Professions Code..;ITA my license is in lull for f.0 �eL ,^ O ❑ ❑ a z w o Date ss �JLia Number �7 u IIOI eR, H m H w ate / Contractor LJ a Y BUILDING PERMIT ¢ ¢ w OWNER-BUILDER DECLARATION INFORMATION F. ;' I hereby affirm that I am exempt from the Contracmr's License MISC.- REFER TO ORD uOQ Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT. I- - PERMIT ISSUANCE 10.00 O �1 Code:Any city or county which requires permit to construct,alter, /1 / v R ¢ Q p improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTR, LIC.N0. ELEC. ¢ requires life applicant for such permit to file a signed statement that TOTAL n Ism" he is licensed pursuant to the provisions of the Contractor's License PERMIT TO R z a Law(Chapter 9(commencing with Section 7000)0(Division ofthe E.i o Business and Professions Code)or that he is exempt therefrom mad OTY. PLUMBING PERMIT FEE ¢ I- m the basis for the alleged exemption.Any violation of Section 7031.5 a 3 - by any applicant for a permit subjects the applicant to a civil penalty STORIES TYPE CONSTR. of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEV ICE 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 ProfessionsDRAINS-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 IFIXTURES-PER TRAP 5.00 SQ.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees.provided that such improve- memtsxre not intended or offered for sale.If,however,the building IGAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that h - .e did not build or im- BUILDING USE prove 1,aso neeose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IO CON O Other ❑ L as owner of the property,he exclusively. 704,contracting with licensed contractors: construct me project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS FARCE L NO. and Professions Code:The Contractor's License Law does not apply to anowner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with n contrtructor(sl licensed pursuant W the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec,.,BAP.C.for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE N0, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure. or a certificate of Workers' pensation In an��e),au ified ZONING ENG.SITE NO. copy tbzms . 0 /✓i/ Policy NNA,� Q ❑ Certified ' is hereby f�js6C FIRESPRINK ENERGY T 24 Z Z ❑ Certifie .ropy Y e fQ I• c t4-' s g Ivislon. F O Applicant 2�- MISC.- REFER TO ORD. 0 ry Y N tr `� CE RTI F I CATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE - 10.00 FLOOD ZONE A.L.U.C. W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. IL O (This section need not be completed if the permit is for one TOTAL Y❑ N Y ❑ N❑ 0 Z hundred dollars($100)or less.) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY IL 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. C. Date Applicant ALTER OR ADD TO MECH. S,QQ BUILDING ��'� } Co NOTICE TO APPLICANT: If,after making this Certificate of Ex- F- Z enlption,you should become subject to the Workers'Compensation qpp LIANCE 5.00 PLAN CHECK provisions of the Labor Code, yaU,mnSt forthwith comply with FEE U such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PWCF.M-) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 421 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ C.). t HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC . 1 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 t building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of his city to enter upon the BOILER (Over 100,000 BTU)SEE FEE SCH. above-mentioned property for inspe tion purposes. MECHANICAL (We) agree to Save, indemnif Jd keep harmless the City of MISC.- REFER TO ORD. Cupertino agar b"' efts, costs and expenses which - CONST.TAX may in a ccrue ag ' s d City ii o equit of the PERMIT ISSUANCE 10.00 granti this permit MECH.CONT. LIC.NO. MECH. TOTAL TOTAL rignature of Applicant/Contractor Date OFFICE COPY