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14023 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 14023 INSPECTION DIVISION . JOB INSPECTION RECORD T _ _ PERMIT EXPIRATION 1P JOB ADDRESS ai�B� ail� /�� UNIT# LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR G ��p IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION _ C7 ? _ ANCE OR 180 DAYS.FROM C LAST CALLED INSPECTION. LIFER PREGUNITE14 PERMIT VALIDATION - Pub S , POURAO CONCRETE UNTIL ABOVE,;H'AS^BEE SIGNED p ! UNDERGROUND /SLAB PLUMBING ELECTRICAL NCE DATE MECHANICAL PLc, MECR. �1 0' 0' ❑., DQNOT;POU,R FLOOR UNTIL.ABOVE'HAS BEEN SIGNED BuaDINc PERMIT WOOD FLOOR - INFORMATION VALUATION SIFT, PLUMBING 6 MECHANICAL y ELECTRICAL - - PERMIT To - .., FRAMING C L- IN ULATION '-Z , STORIES TYPE CONSTR. III_ - ✓�P OCC.GROUP RES.UNITS ...- LACE NOS BFLOOR UNTIL ABOVE HAS BEEN SIGNED :. ROOF $O.FT,FLOOR AflEA TOTAL ACREAGE j DIAPHRAGMreDlrvc USE RES IND CON PR Olnxr UAP.P,LY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED Agrl 0 ROUGH —?, P 6l(J 9 ASSESSORS`PAo�CE(L NCO', PLUMBING - GAS TEST TRACT NO. PARCEL NO. rV_ - � - MECHANICAL ACC.DATE ACC,FILE NO. ELECTRICALFINALS "<DATE*,, .. INSP. , FRAMING �+t, y(� _ ;-7,5& SAN # �/ INSULATION - - ZONING ENG.SITE No. PLUMBING GAS FIRE SPRINK EENE MECHANICAL - v I] NF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED,, HEATING ' FLOOD ZONE-LATH-INTERIOR p_Z�-ys/ ELECTRICAL,LATH-EXTERIOR ' _y� FIRE DEPT. v " SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR - llJUg' BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC _ PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS.B-EEN SIGNED occUPANCY SEISMIC FEE i OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR, MICROFILM_ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC "$" Lu ONE WORKING DAY BEFORE REQ UIRED INSPECTION. PLUMBING GZ PLEASE GIVE JOB ADDRESS WHEN PHONING. � —'SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX' 1. PLEASE READ REVERSE SIDE BEFORETOTAL ;u CALLING FOR FINAL INSPECTION. OFFICE COPY /J PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER EDILOING APPLICA ON & PERMIT 14023 ADORESS�o ^^T�J�.P.RD LANE, LOT 1 BUILDING-ELE�TkIC L-PLUMBING-MECHANICAL OWNER ♦"l J. ".A PLAN CHECK VALIDATION GERARD DEVELOPMENT pTYi #�`'e ELECTRIC PERMIT FEE PHONE ♦ CONTRACTOR'S . - NAME �Z. UTLETS-SWITCHES-RECEP 10.00/1.00 a e-a .S�H� uc�1� IGHTING FIXTURES 10.00/1.00 `.' f-ONTRACTOR'S AOOREss 1 1 F�ItST .ST. 0&APPLIANCES 4,00Ali &M-Mil, PHO PANELS 10.00 Q DATE OF APPLICATION AO RRL-aRCI',. LIC..NO.CHITECT GREG W. BENTON, PANELS (OVER 200 AMP) 20.60 PLAN CHECK FEE P.C.NO. + ENGINEER , C13629 SIGNS TRANS. 3.00 ARCH.ORENG5513 MONIiEREY AVE. SPECIALCIRCUIT 5,00 PERMIT VALIDATION ADDRESS LOS GATOS,' CA. ZIP 9503 D TEMP.METER OR POLE INS. 20.00 APPLICANT; 141 FIRST ST. , LOS ALT MOTORS SEE FEE SCH. P /f ADDRESS CA. 94022 - SERVICE CHANGE 20.00 p w D o LICENSED CONTRACTORS DECLARATION N `2., �%1�'J�/p E < u u I hereby affirm that I am licensed under provisions of Chapter 9 • ISSUANCE DATE zG w (commencing with Section 7000)of Division 3 of the Business and ggg LD��a ii PLG. MECH.'^ Professions Code,and my license is in full f e z O License Class Lic.Number 9 H . Dthe Contractor BUILDING PERMIT Ic w OWNER-BUIL DECLAR ION INFORMATION oa MISC.- REFER TO ORD X ; w r I hereby affirm Thal I am exempt from the Contractor's License vA W ATION S/FT. r = o dw Law for the following reason.(Sec.7031.5,Busmessand Professions PERMIT ISSUANCE 10.00 l�^ Code:Any city or county which requiresa permit to construct,alter, /G�/!� �s Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC,CONTR. LIC.NO. ELEC. A'G 0 / N ti x/ Ea iL O IC requires the applicant for such permit to file a signed statement that TOTAL -� PERMIT TO % R�` he Is licensed pursuant to the provisions of the Contractor's License / tzt Law.(Chapter 9(commencingwith Section 7000)of Division 3 ofthe G... a: Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ thebaus for the alleged exemption.Any violation ofSection703L$ STORIES TYPE CONSTR. a ; by any applicant for a permit subjects the applicant to a civil penally 00) 5. of not more than five hundred dollars($500)): ALTER-DRAIN&VENT-WATER (EA. 61- ❑ 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 ��3 / Code:The Contract,I'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 50.FT.FLOOR AREA TOTAL ACREAGE 100 himself or through his own employees,provided that such improve. re meats are not intended or offend for sale.If,however,the bwldfi% GAS-EA.SYSTEM-1 6.00 e� 0, improvement is Sold within one year of completion,the owner- builder wner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 t builder will have the burden of proving that he did not build or nn- BUILDING USE prove for, . .00 purpose ofsale.). INDUSTRIAL WASTE INTER30RES IND CON PB Other ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ E3licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 6 V.B. 6.00 ASSESSORSPARCELNO. and Professions Cade:The Contractor's License Law does not apply y to an owner of property who builds or improves thco on,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 Ja 6- C/G.- (� contracts for such projects with a conlrachms)licensed pursuant to / the Contractor's License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 Q - TRACT NO. PARCEL NO. ❑ lam 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. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certiricate of consent to self-insure, ZONING ,r a certificate,f Workers'Compensation Insurance,'or,a certified ENG.SITE NO. copy thereof(Sec.3800,\/ Lab.C'CAJ Policy No. Company (' \ Certified copy l5 hereby /nished. FIRE SPRINK ENERGY T-24❑ Z Z Certified copy isnth the city inspection ivision. MISC.- .REFER TO ORD. D� �/�,�j App S.n ~ m" ' PERMIT ISSUANCE 10.00 D�- oD ZONE A.L.U. LU CI:l IFICATIi OF EXEMPTION FROM WORKERS' FLoV ❑ N❑ N Y ❑ _ COMPENSATIONINSURANCE I PLG.CONTR. LIC.N0. PLG. � a•0 (This Section need not be completed if thrpermit is for one TOTAL Y❑ N❑ V❑ N❑ =) Z hundred dollars I$1000or less.) „ U O I certify that in the performance of the work for which this per. 'OTY. MECHANICAL PERMIT FEE FEE SUMMARY F mil is issued,I shall not employ any person in any manner so as to O become subject to the Workers'Compensation Laws of California. �a1, - ALTER OR ADD TO MECH. 5.00 BUILDING Date Applicant �= N NOTICE TO APPLICANT: If,after making this Certificate Of Ex }.. Z emotion,you should become subject to(be Workers'Compensation APPLIANCE 5.00 PLAN CHECK previsions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00 A CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)=C.RM.) 6.00 SEISMIC FEE 1 hereby affirm that.there is a construction lending agency f, EXHAUST HOOD(WITH DUCT) 5.00 sof the performance of the work for which this per tis issued(Sec. MICROFILM 3097,Civ.C) �AAp�j�g•� HEATING UNIT(TO 100,000 B.T.U.) 8.00 ' Id .Z NamCAOR is=Mb HEATING UNIT(OVER 100,000 B.T.U.19.50 /p t� Lender's Address ELECTRIC .1 4t I certify that l have read this application and state that the abovL VENTILATION FAN (SINGLE) 4.00 informarion is correct. I agree to comply with all city and CoBnIy - PLUMBING fv, ,ordinances and slate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 T ,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 against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 O-' CONST.TAX �'� may in any we cerue ago SI said City 111 consequence ,f the grant,, a MECH.CONT. LIC.NO. MECH. 1:�,_ �d TOTAL t,C�Bt9 TOTAL „Z ignature,f Applicant/Contractor Date OFFICE / OFFICE COPY ' '