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10871 (2) POSTTHISCARD NEAR FRONT OF BUILDING' 'PERMIT NUMBER CITY OF CUPERTINO 10871 INSPECTION.DIVISION JOB INSPECTION RECORD • I+ PERMIT EXPIRATION JOB ADDR UNIT# _LOT#' PERMIT EXPIRES IF WORK OWNER . CONTRACTOR IS NOT STARTED WITHIN' INSPECTION I DATE INSPECTOR .180 DAYS OF PERMIT ISSU- FOUNDATION (IQ - - —' '^E-OR 180 DAYS'FROM ,[ ' '.-• +, CALLED INSPECTION. UFER '�•VvS 7'�'j�, p •L � L �- T - - PERMIT VALIDATION' PREGUNITE - J —Z• g; 4 15��}t••Ct UK•1-�, BOY1,Ui �U 1 , . ,y..,1 POUR NO CONC ETE UNTIL ABOV HAS B SIGNED 41lb J,V�J1r A cwAw e p J J UNDERGROUND /SLAB PLUMBING ELECTRICAL - "' - - . 'ISSUANCE DATE - MECHANICAL ,. I1- - o✓U C N/ :BLDG ,ELECT. MECH. PLG.. . Ell El 1 0 El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED V1 BUILDING PERMIT WOOD FLOOR' - .. INFORMATION . VALUATION $/FT. PLUMBING MECHANICAL ��. .• f,,,' ELECTRICAL ) F _ T lee�1� f FRAMING TYPE CONSTR. INSULATION I� " — 6 OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED . .. SQ FT.FLOOR hflEA TOTAL ACREAGE ROOF �',,'i¢>_ t DIAPHRAGM'. '�r"'� BUILDING USE RES' IND CON PB 00,e, APPLYAO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO., ROUGH PLUMBING GAS TEST .1 '• TRACT NO. .PARCEL NO, MECHANICAL ACC.DATE ACC,FILE NO_ ELECTRICAL _ FINALS DATE INSP: FRAMING ' _ -2 - SAN ZONING ENG.SITE NO. INSULATION �'y PLUMBING . . GAS MECHANICAL FIRE SPRINK ENERGY TP24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑ LATH—INTERIOR ELECTRICAL FLOOD ZONE A.LU.C. . LATH—EXTERIOR FIRE DEPT. Y❑" N❑ Y N❑ SHEETROCK 2^ - GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS - ELECTRIC - PLAN CHECK - ` - GAS FEE NO TAPE OR PIASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY'OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM AR RANGE'FOR'INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. P 'nnelryc " ' O� PLEASE GIVE'JOB ADDRESS WHEN.PHONING. Z - �- MECHANICAL — SEE PERMIT FOR EXPI RATION'DATE — ' IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. 7'-,%�7 71, OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION I PERMIT NUMBER BUILDING APPLICATION & PERMIT ADORESs l BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 10871 bWNER'SPLAN CHECK VAL PTION "AME 1120Vc/ 90�fS'D DTV. ELECTRIC PERMIT FEE ,(off J rNONE -+Lz NAMECNT"ACTofl UTLETS-SWITCHES-RECEP 10.00/1.00 Q 3�`7u LIC.NO. LIGHTING FIXTURES 10.00/1.00lei CONTRACTORS PPLIANCES-RESIDENTIAL - 4.00 ADDfl555 PRONE PANELS 10.00 DATE OF APPLICATION RGRfTacT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. O OR ENGINEER LIC.NO. SIGNS TRANS, 3.00 nooesss E"G SPECIAL CIRCUIT 5.00 PERMIT VALIDATION 1 ,IP EMP.METER OR POLE INS. 20.00 _ ' 41) ADDRESS 4- ESS ANT S ADDRESS MOTORS SEE FEE SCH. n` /Vr SERVICE CHANGE .00 Woo •LICENSED CONTRACTORS DECLARATION a v u I hereby affirm that I am licensed under provisions of Chapter 9 °.i ISSU. CE DATE (commencing with Section 7000)of Division 3 of the Business anJ BLDG. MECH. F i Professions Code,and my license is in full force and effect ❑ ❑ Z, i R,C License Class Lie.Number Of CVpeDo s L F j Date Contractor L s t: CItY I PERMIT' w a - OWNER-BUILDER DECLARATION INFORMATION wc. ea MIS0.- REFER TO ORD 3:u. I hereby affirm that I am exempt from the Contractor's License Vql to I T. Fwoa Law for the following reason.(Sec.7031.5,Businessland Professions pERM1TISSUANCE 10.00 p 1 of Ca e -' Code:Any city or county which requires a permit to construct,alter, 2 ¢Q FO improve,demolish,or repair any structure,prior to Its issuance,also ELEC.CONT". LIC.NO. ELEC. ti� i - D u requires the applicant for such permit to file a signed statement that TOTAL O PERMIT TO w$w he is licensed pursuant to the provisions of the Contractor's License Fir Law(Chapter 9(commencing will Section 1000)of Division 3 of the f a: c Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE M F the basis for the alleged exemption.Any violation of Section 7031.$ STORIES' TYPE CON R. n ; - by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(1500).): ❑ 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 OCC.GROUP RES.UNITS intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 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. T.F OOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- -EA.SYSTEM-1 INC. OUTLETS 6.00 m i ents are not intended or offered for sale.If,however,the building GAS 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 Pe Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,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 Comractor'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 conlractons)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under ec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner >' Dme7Z WATER SYSTEM 5.00 ' ACC.DATE ACC.FILE NO, WORKERS'COMPENSATION DECLARATIO WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self-insure. ZONING ENG.SITE N0. or a certificate of Workers'Compensation Insurance.or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby famished. FIRE SPRINK ENERGY T 24 Z Z ❑ Certified copy is filed with the city inspection division. - O Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑ F- y 0: CERTI FIC PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. - CERTIFICATE EXEMPTIONNSATION INSURANCE W > COANCIi FROM WORKERS' PLG.CONT". LIC.No. PLG. IL O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑ D Z hundred dollars(1100)or less.) U O 1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL P 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. W Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- ? emption,you should become subject to the Workers'Compensation APPLIANCE .00 - PLAN CHECK provisions of the Labor Code, you must forthwith comply with - FEE V such•provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 4.00 r. CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,01XIC.F.M.)t0d SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DU .00 the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 .T.U.) J MICROFILM 3097,Civ.C.). Lender's Name H EATING UNIT(OVER 100,000 O nELECTRIC t� Lender's AddressI certify that I have read this application and stute that the above VENTILATION FAN (SINGLE) 4.00 inforation is correct. I agree to comply with all city and county PLUMBING Sew rod initiation and state laws relating to building construction, anJ BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino a .at Iia ililtes,judgments, costs and expenses which �-J d CONST.TAX may in a qqty , rue a .at ^rd"61 in consequence of the PERMIT ISSUANCE 10.00 granting is nit. / MECH.CONT. LIC.NO. /r/ L TOTAL /S�' TOTAL ��j O S' a I' ofApplic t/C tactor - a OFFICE COPY