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12782 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMB ER. CITY -OF CUPERTINO -s - : • INSPECTION-DIVISION 12782 JOB INSPECTION RECORD PERMIT'EXPIRATION ' I JOB ADDRESS d?� rS�S /NJ7 C. UNIT#, ' LOT# PERMIT EXPIRES IF WORK - OWNER / [ 17j G',2-d' CONTRAcroR c.e�t� w iVf T• ISS NOT STARTED WITHIN ' INSPECTION DATE INSPECTOR I SPECTION RECORD ' lBB DAYSOF'PERMIT ISSU- ANCE OR 180 DAYS FRO L-. L - b �. LIFER M FOUNDATION , LAST CALLED INSPECTION. � ' .x-,1-2-�. � S� - PREGUNITE ? -•• /• 1•� PERMIT VALIDATION i ,1 . POUR NO CONCRETE UNTIL ABOVE H�EE SIGNED UNDERGROUND /SLAB _ • PLUMBING ELECTRICAL - "1�� •Is uANCE DATE MECHANIC r DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT - INFORMATION • !WOOD F. 0 R PLUMBING _ VALUATION S/FT. - �-�•, - J 1 MECHANICAL ELECTRICAL „, - .PBRMIr TO ` FRAMING INSULATION - - - STORIES. TYPE CONSTR. _ OCC.GROUP . RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • �' 'ROOF , 50 FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM . BUILDING USE . RES IND - CON PB Oinn ' APPLY NO ROOFING UNTIL ABOVE HAS•BEEN SIGNED © 1 •❑ ❑ :❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING.. TbPOUT - - r f �{ • GAS TEST, •�. - - .. iRACI NO. 'PARCEL NO. MECHANICAL S�-.3�- �'1 -� ELECTRICAL I "F FINALS DATE INSP. ACC.DATE _ACC FILE NO. . FRAMING SAN INSULATION PLUMBING - '- • ZONING - ENG.SITE NO. GAS - MECHANICAL„ , FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN,SIONEO. , HEATING Y❑ "❑ ❑ �❑ ELECTRICAL FLOOOZONE A.L.U.C. LATH-INTERIOR I lO 1 ' - - - LATH-EXTERIOR FIRE DEPT, � •• Y❑ N❑� 'Y.❑ N❑ SHEETROCK° GRADE FEES'UMMARV SHEAR INTERIOR BUILDING SHEAR EXTERIOR' TEMPORARY^APP.ROVALS BUILDING' K,- .FIREWALLS - ELECTRIC PLAN CHECK GAS „FEE. . NO TAPE OR PLASTER UNTIL ABOVE HASjBEEN SIGNED OCCUPANCY is MIC FEE f+ OCCUPANCY OF BUILDING IS NOT P,ERMITTED UNTIL BUILDING FINAL ISSIGNED 8Y BUILDINGINSPECTOR: MICROFILM ARRANGE FORASPECTION BY PHONING 252-4505, . ELECTRIC /11- W -ONE WORKING DAY BEFORE REQUIRED.INSPECTION:.. O� ' PLUMBING ..,Lua Z `PLEASE GIVE JOB ADDRESS WHEN PHONING. SEE-PERMIT FOR EXPIRATION DATE - MECHANICAL• IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE., TOTALr �7y 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 ,LcT 7 �� �, APPLICATION & PERMIT ' ADDRESS - ' - 12782 y GT BUILDING-ELECTRICAL-PLUMBING-MECHANICAL NAM R's PLAN CHECK VALIDATION "AME I QTY. ELECTRIC PERMIT FEE 't GHONE I$L CONTRACTOR'S (o' OUTLETS-SWITCHES-PIECED 10.00/1.00 NAME 1 Z{•t eeA.111 uC.NOR 3,S2 LIGHTING FIXTURES 10.00/1.00 (G CONTRACTOR'aq,� � - - 9 1 ADDRESS, e " . - 1. PPLIANCES-RESIDENTIAL 4.00 C HONES -3 72,2, PANELS 10.00 d ' DATE OF APPLICATION ARCHITECT PANELS (OVER200 AMP) 20.00 .PLAN CHECK FEE nnpAgqgg••PP.�.C.NO. OR j.A SL END ER L.C.NO. SIGNSTRANS. 3.00 ' n. ABC H.OR ENG.1.583 SPECIAL CIRCUIT 5.00 PER^^7 V LIDATION f1 AOORF55 11 J - 1 N/ iDN zI EMP.METER OR POLE INS. 20.00 V J J ADDRESBTS 1, ,'1 MOTORS' SEE FEE SCH. C,?_- i r ' SERVICE CHANGE, 20.00 /!y r 0 woo LICENSED CONTRACTORS DECLARATION S, uU I hereby it]I irm that I am'licensed under provisions of Chapter 9 - _. ISSUANCE DATE 1- (commencing with Section 7000)of Division 3 of the Business and - n ,q Q e. ( s / BLDG. ELECT. PLG. MECH. r w i Professions Code, my license is in.full fo eLe� f c; 1. �r I i-J`� T License Class Lie.Number (� L•- ^ o m r$ DateF� 4¢7_Contractor - _ L`i 'Of CBQB(flll' BUILDING PERMIT ¢ ¢ w OWNER-BUILDER DECLARATION- ' _ - INFORMATION .W1 hereby alt that I am exempt from the Contractor's License MISC.- REFER TO ORD H u g Law for the following reason.(Sec.7031.5,Busmo,sand Professions PERMIT ISSUANCE 10.00 VALUATION o S/FT. Code:Anycily orcounty which requires a permit to construct,alter, 2NO. ¢ improve,demolish,or repair any structure,prior n its issuance,also ELEC.CONTR. LIC. Or to idlihittiI ELEC. ( V w O C requites the applicant for such permit to file a signed statement that TOTAL / PERMIT TO a w m he is licensed pursuant A the provisions of the Contractor's License Fasi Law[Chapter,9(commencing with Section 7000)of Division Softhe a Business and Professions Code)or that lie is exempt therefrom and DTY. "PLUMBING PERMIT FEE W=$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. s ; by any more forfuaundre dollars(he00.):ant toacivil penalty - ALTER-DRAIN -WATER (EA.) 5.00 of not more than flue hundred dollars(5500).1: � ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.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 docs such workFIXTURES-PER TRAP 5.00 ` so.Fr.FLOOR AREA r TOTAL ACREAGE himself or through his own employees,provided that such improve. 24- ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM•1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, [tic owner- GAS=EA.SYSTEM-OVER 4 IEA.1 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.)., RES IND CON PB Omer ❑ I,as owner of the property.am exclusively contrucling with - ❑. r ❑ ❑'' .❑ 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 conlractORS)licensed pursuant ID the Contractor's License Law. f SEWER-SAN ITAfl V•STORM EA.200ft/10.00 Id TRACT NO. PARCEL NO. ❑ tum exempt under Sec.-,BAP.C.for this -1 WATER HEATER W/VENT 6.00 reason - .7 60 Owner UateWATER SYSTEM S.00 ACEDATE qCC.FILE NO. WOR KERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. �n x'15.00 ' I hereby alfno that 1 have a certificate of consent to self-insure, 1`) 1 p •• ZONING' ENG.SITE NO. or a certificate of Workers'Coope is..0 uruncc.ora codified , copy thereof(Sec.3800,Lab.C.).A eW�7 - �q� ;n Policy No. Company S�,$_{=co!702Q.I-'•PA - U Cl Cetlilied copy is hereby furnished. CI I U V FIRE SPRINK ENERGY T-24 Z Z O Certified copy is Bled with the city inspection division. . MISC.- ' • REFER TO ORD- -I Applicant - _ Y ❑ N❑ Y ❑ N[3 ~ y• PERMIT ISSUANCE 10.00116- • d' CI>RTI FICATE OP F:X IiMPTION PROM WORKERS' "FL0002oNE A:L.u.C. OJ 1 •COh1PF-NSAT'ION INSURANCE - PLG.CONTR, - LIC.NO, PLO, 94 , CL Z( This sectio,,need not be completed if the permit is for one TOTAL O I C] N E] Y❑ N❑ hundred dollars 1$100)or less.) U O 1 certify Ola(in the performance of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,I shall not employ any parson in any manner so as to become subject to the Workers'Compensation Laws of Califomia. C) y Dale ApplicantALTER OR ADD TO MECH. 5.00 ' BUILDING } m NOTICE TO APPLICANT: If,after making this Certificate of Ex- F ? emption,you should become subject to the Workers'Compensation APPLIANCE -Tl a+ 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U, such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT ( '(TO 10= F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNff(OVER 10)000C.F.M.) 6.00 SEISMIC FEE I hereby affix ,that there is a construction lending agency Ibr EXHAUST HOOD(WITH DUQT)0 5.00 S` the performance of the work for which this permit is issued(Sec, - - - MICROFILM 3097,Civ.C.). - ! I HEATING UNIT(T [100,000•B.T.U.) 8.00 Lender's Name HEATI NG UN IT( E R 100,000 B.T.U.)0.50 Lender's Address - - ELECTRIC I certify that 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 e p information is correct. I agree to comply with all city and county PLUMBING d� ordimuices and state laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.) 6.00 .. hereby authorize representatives ec This city ea enter upon (he BOILER-COMP(Over 100,000 BTU)SEE FEESCH. MECHANICAL �� ^ x above anenlioned properly for inspection purposes. (We) agree to save, indemnify and keep hanBless the City of MISC.- REFER TO ORD. J ' Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX �) CT? - may in alb,way ecru sins aid City in consequence of the PERMIT ISSUANCE 10.00 groan gal third mi _ MECH.CONT. LIQ NO. MECH TOTAL 953? Signa are of Applicant Cont IDr Date OFFICECOPY • f'