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C 9424 (2) POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO R ,IT NUMBER INSPECTION DIVISION ✓ 942(f JOB INSPECTION RECORD iPERMIT EXPIRATION JOB ADDRESS,�D l 3'10 Hawn ✓y *f ye_ UNIT# _LOT CC I PERMIT EXPIRES IF WORK OWNER C"i• �. I Q 1 I CONTRACTOR IS NOT STARTED WITHIN INSPECTION MBEEN INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION � �-�-�aJ4 ANCE OR 180 DAYS FROM UFER ' - I£��-- d I/I� �• LASTCALLED INSPECTION. �-w PERM1 ION PREGUNITE ' AUG .161985 POUR NO CONCRETE UNTIL A � }}rUNDERGROUNCity DI Cupertino PLUMBING ELECTRICAL ISSUANCE RATE LDG. ELECT. PLG. MECH, MECHANICAL ❑ 1 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED / BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING ' MECHANICAL •PERmrr ro ELECTRICAL FRAMING PIFIED EX STO ITS TYPE CONSTR. INSULATION _ 1f OCG 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 OEl en., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 0 \ ASSESSORS PARCEL NO. ROUGH f PLUMBING / 'TRACT NO, l PARCEL NO, GAS TEST MECHANICAL ' ACC,DATE ACC.FILE NO. ELECTRICAL _� � . - , FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO. INSULATION ) Q. PLUMBING GAS FIRE$PHII ENERGY T 24 MECHANICAL Y N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZOA.L.U.C. LATH-INTERIOR ELECTRICAL LATH-EXTERIOR _a?�Y FIRE DEPT. vc] Y No SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING .. BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC - PLAN CHECK- . FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC N F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. / Z - SEE PERMIT FOR EXPIRATION DATE — MECHANICAL CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. /= ' OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER BD,Ln,NG0 APPLICATION & PERMIT Cj 9424 AOVrREss BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 03 O Q s OwNER'S PLAVCHEC VALIDATION NAME //��ra TY. ELECTRIC PERMIT FEE PHONE /'J `' Y CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 0 VJ� AME �0�(/,(/>j uc.No, LIGHTING FIXTURES 10.60/1.00 O �'AOGRESS DR's PPLIANCES-RESIDENTIAL 4.00 CONTRA �/ / PHONE PANELS 10.00 ��ATE O�PlmATION ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO, OR ENGINEER LIC.No. SIGNS TRANS. 3.00 ADDRRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP. METER OR POLE INS. 20.00 pmo" APPLICANT'S MOTORS SEE FEE SCH. AUG 1985 ADDRESS `f(' 16 SERVICE CHANGE 20.00 0 er o LIC17NSED CONTRACTORS DECLARATION TEMP.POLE 30.00 /s{{��/ (�Qf Cr�'jrR�R�,f� a u u I hereby affirm that I am licensed under provisions of Chapter 9 yII�$IrA}.x'EVA 06 w rt w (Commencing with Section 7000)of Division 3 of the Business and BLDG. ELEC PLG. EC . H N i Professions Code,and my license is in full force and effect. ❑ z o m - License Class Lic.Number 9 z - Dalc Contractor a Y f BUILDING PERMIT L Q w OWNER-BUILDER DECLARATION INFORMATION a o A MISC.- REFER TO ORD X ray I hereby affirm 11,31 1 am exempt from the Contractor's License LLoa Co.for tire following reason. 7031.5.Businessand Professions pERMIT ISSUANCE 10.00 p VALUATION S/FT. � - Code:Any city or county which regairesaperend to construct,alter,Or __11 S ¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. -O 0 requires the applicant for such permit to file a signed statement that TOTAL o PERMIT TO u w$ he is licensed pursuant to the provisions of the Contractor's License H z ¢ Law(Chapter 9(commencing with Seeliou 7000)of Division 3 ofthe i O Business and Professions Code)or that he is exempt therefrom and QTY- PLUMBING PERMIT FEE O r the basis I.,the alleged exemption.Any embdion of Section 7031.5 STOMES TYPE CONSTR. u3 § by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(8500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sale compensation,will do the work,and the structure is not intended or offered For sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 5.00 SO.FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve- 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 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im Prove for purpose of sale.)' INDUSTRIAL WASTE INTER. 30.00 IND CON PB Olin ❑ I,as owner of the property,am exclusively contracting will, ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS P RCEL NO. and Professions Code:The Contractor's License Low does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 i iDU contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Co Contracts such License 1-ow. ❑ I am exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00 reason - Owner Dut4 WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00 I hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Compensation I...mars or a citified ZONING ENG.SITE NO. , copy thereof(Sec.3800,Lab.CJ. Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T$4 ZZ El copy is filed with the city inspection division. MISC.- REFER TO ORD. Z Applicant Y ❑ N❑ Y [3N[]F O jr CCR'fIPICva PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W >_ CCONIPHOMPE11XEMPT ION FROM WORKWORKERS'NSATION 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❑ Z) Z hundred dollars($100)or lass.) U 0 1 certify that in the performance of the work for which Ihis per- GTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H- mit is issued,I shall not employ any person in any nlannerso as to U become subject to the Workers'Compensation Laws of California. U n Dam-Applicant ALTER OR ADD TO MECH. 5.00 - BUILDING , >_ so NOTICE TO APPLICANT: If,after making this Certificate of Ex- l F Z enmtion,you should become subject to 111e Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisinns of the Labor Code, you most forthwith comply with FEE U such provisionsor this permit shall be deemed revoked. AIR HANDLING UNIT(TO 101000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEI SMICdFEE 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. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B:T.U.) 8.00 Lender's Name ELECTRIC HEATING N G U N IT(OVER 100,000 B.T.U.)9.50 ss Lender's Addre30 ,� \ I certify that l lmve read this application and state tanhat the abovnte VENTILATION FAN (SINGLE) 4.00 infonnetion is correct. I agree to comply with all city d couy BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby otle.own representatives of this city to eOrer upon the /S W above-mentioned property for inspection purp(ses. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep Imrmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costsand expenses which PERMIT ISSUANCE 1000 , CONST.TAX may in any way accrue against said City in consequence of the . 'anting of wIer I. MECH.CONT. LIC.NO, j MECH. �S TOTAL _6"" TOTAL / �3 Igna o Applicant/Contrac r Date OFFICE COPY