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14035 (2) POST THIS CARD NEAR FRONT OF BUILDING ' CITY OF CUPERTINO PERMIT NUMBERMI �MBE� INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS '�•�S �'��R�6 ��-UNIT# 'LOT# �o PERMIT EXPIRES IF WORK OWNER '�E'\ R �� V CONTRACTOR G q IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION /�' LIFER LASTCALLED INSPECTION. PREGUNITE , PERMIT VALIDATION tf. ' ::POUR NO CONCRETE•IUNTIL ABOVE';HASIBEE, UN DERGROUND /SLAB ' PLUMBING I `� ELECTRICAL ISSUANCE DATE MECHANICAL PLG. MECH. o. o.' ON. DO-NOT POUR'.FLOOR UNTIL ABOVE HAS BEEN'SIGNED BUILDING PERMIT- WOOD FLOOR VALUATION $/FT. PLUMBING ,jj. MECHANICAL ELECTRICAL PERMIT TO f r f FRAMING INSULATION sroRlEs TYPE V sTR. ,3-0 /� OCC. ROUP RES.If NITS PLACE NWSUBFLOOR UNTIL ABOVEHAS BEEN SIGNED ROOF .. SO.'T 11,0019 AREA TOTAL ACREAGE BUILDING USE HE; , IND CON PB OlhHl APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED [I El [:1 El El ASSESSORS PARCEL NO. ROUGH PLUMBING .��.6 _�1,4 GAS TEST �.l`_ TRACT NO, PARCEL NO. MECHANICAL ACC.DATE ACG FILE NO. ELECTRICAL FINALS DATE INSP., FRAMING �Z,- SAN INSULATION ,�- PLUMBING zoNlNc ENR.sIrE No. GAS FIRE SPRINK ENERGY T]G MECHANICAL ":;p COVER NO WORK UNTIL ABOVE HAS BEEN SIGN_EO�i' i; HEATING "� "C] . LATH-INTERIOR ELECTRICAL FLOOD ZONE 'AL C. LATH-EXTERIOR FIRE DEPT. Y Q N[ ,Y o IN SHEETROCK GRADE FEESUMMARY SHEAR-INTERIOR BUILDINGiff S Q BUILDING `•'r SHEAR EXTERIOR TEMPORARY'APPROVALS FIREWALLS - ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL•ABOq%HAS'BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINACISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC . - oo . 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 - ' APPLIGANr`(O FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMITNUMBER BUILDING APPLICATION & PERMIT 14035 ADDRESS Ml BUILDING - ELECTRICAL-PLUMBING-MECHANICAL „�-� "N PLAN CHECK VALIDATION NAME GERARD DEVELOPMENTarr.! ELECTRIC PERMIT FEE _ HONE "I MrflacTofl.s NAME UTLETS-SWITCHES-RECEP 10.00/1.00 ld- ��_w NAME �j�w M� Llc.rvo. LIGHTING FIXTURES 10.00/1.00 34 ^ ADDRES ��) �I ��.1- - 2 APPLIANCES RESIDENTIAL 4.00 CONTRACTOfl'S PHO PANELS 10,00 U GATE OF APPLICATION ORRCHITECT W. BENTON, PANELS (OVER 200 AMP,) 20.00 PLAN CHECK FEEP.C.NO. ENGINEER ARCHITECT LIC.NO. C13629 SIGNS TRANS. 3.00 ARCH.ORENt513 MONTEREY AVE. SPECIALCIRCUIT 5.00 PERMIT VALIDATION ADDRESS LOS GATOS, CA. zip 9503 EMP.METER OR POLE INS. 20.00 APPLICANTS MOTORSSEE FEE SCH b D aooREss - iT1��f43 c¢1 FIRST ST. SERVICE CHANGE 20.00 ' �'y/meq w w o LIFCN9BDAWT1�ORSG&1,ARA)r"22 g 19BV ` //d-f ¢ i w, 1 hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE a u (commencing with Section 7000)of Division 3 of the Business and BLOCy; GLEET. PLG. MECH. H a,i Professions Code,and my license is in full for and ff jeS{. C RI Il� z 0 m - License Class' Lie.Number �l��j!13- 4 m t w Date_ moi; Ce,-Contract a y 2 s - .�.� sem.. BUILDING PERMIT ¢ ¢¢ a OWNER-BUILDER CLARATION INFORMATION I"Ls REFER TO ORD E: ;e w 1 hereby affirm that I am exempt from the Contractor's License MISE.- woa Lawforthe following reason, 7031.5,Business and Professions PERMIT ISSUANCE 70.00 V VALUATION H w Code:Any city or county which requiresa permit to construct.alter, ��/ ¢ ¢<G improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. e'f (i/V e_ iL O LL requires the applicant for such permit to file a signed statement that TOTAL app PERMIT TO wm m he is licensed pursuant to the provisions of the Contractor's License H � > Law(Chapter 9(commencing with Section 7000)of Division 3 of the E i c Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ H o the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE''COO/NSTR. nam by any applicant fora permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 SN of not more than five hundred dollars($500).): ❑ Las owner of the property,or my employees with wagesas 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,AR EA,COND. 5.00 Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work /`9. F IXTUR ES-PER TRAP 5.00 7L4C- SQ FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improvo GAS 6.00 ments are not intended or offered for sale.If,however,the building o29 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM•OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or im- UILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RE IND CON PB Omer ❑ 1,as owner of the properly,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 Contractor's License Law does not apply p to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. / SEWER-SANITARY-STORM EA.200fU10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT. 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORKF-RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofcomcat to self-insure, or a certificate of Workers'Compensation Insurance,or a cerlified ZONING ENG.SITE NO. copy thereof(See.3800,Lab.C.L Policy No. Company O 0 Certified copy is hereby furnished. IF FIRESPRINK ENERGY T24 Z Z X Certified co filed vtiL is city inspection division. O Applicant `.-�`�/ MISC.- REFER TO ORD, Y❑ N❑ Y ❑ No ~ H CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 0 FLOOD ZONE A.L.U.C. LU >_ COMPENSATION INSURANCE PLG.CONTE. LIC,No. PLG, C O (This section need not he completed if the permit is for one TOTAL Y[:] N CC] ❑ N❑ =) Z hundred dollars($100)or less.) U O 1 certify that in the performance of the work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any,person in any nanner so as to Q W become subject to the Workers'Compensation Laws of California. BUILDING (O/.'/ 00 Date Applicant ALTER OR ADD TO MECH. 5.00 G } H NOTICE TO APPLICANT;If,after making this Certificate of Ex ? caption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most 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 10=C.F.M.) 6.00 SEISMIC FEE 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 germy is issue)(Sec. MICROFILM 3097, .am � $ � µ�.� �j.]DLIfL HEATING UNIT(T0 100,000 B.T.U.) B.00 Lender's Name HEATING UNIT(OVER 100,000B.T.U.)9.50 p Lender's Address ELECTRIC IAL 1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 Q information is correct. I agree to comply with all city and county PLUMBING /la - ordinances and state laws relating to building'construction, and BOILER.OOMP13 H.P.or 100,000 B:T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. BOILER-COMP 10VBr 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. p ^_.777 Cupertino against liabilities,judgments, casts and expenses which CONST.TAX 0�� may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 0 --- granting of this miL MECH,CONT. LIC.NO. MECH. TOTAL s�L�- TOTAL �3 ayptrcant/i"arRTgtteT -� ,LDfatOe OFFICE COPY '