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8382 (2) "POST THIS CARD NEARFRONT OF BUILDING ' PFRMIT NUMOFR CITY. OF CARTINO' INSPECTION DIVISION 8382 JOB INSPECTION RECORD PERMIT EXPIRATION' JOB ADDRESS. ffl 'UN # _LOT# ' PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT'STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECOR 180 DAYS OF PERMIT ISSU-, FOUNDATION ACE OR 180 DAYS FROM LIFER LAST CALLED INSPECTION. 2 ' P,REGUNITE " .E - - PERMIT VALIDATION' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND / SLAB y PLUMBING ' ' w ELECTRICAL' ISSUANCE DATE MECHANICAL a ELECT, PLG. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING ALUAT,ON $)FT, ' - � '- � a , MECHANICAL ELECTRICAL - ERMITTO . FRAMING ' STORI S INSULATIONVPE CDNSTR. - f, OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO,FT FLOOR AREA 'TOTAL ACREAGE ROOF 1� DIAPHRAGM BW.WING USE RES- IND CON. PB GO,., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. , _ I PLUMBING GAS TEST TRACT NO. PARCEL NO, MECHANICAL - ' 'ELECTRICAL FINALS. DATE INSP. ACC.DATE ACC.FILE NO. FRAMING .y SAN # ZONING ENG.SITE N0. INSULATION PLUMBING ' r GAS FIRE SPRINK ENERGY T-24 MECHANICAL' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' V ❑ N❑ Y ❑ N❑ LATH—INTERIOR - ELECTRICAL FLOOD ZONE A.L.U.C. LATH—EXTERIOR FIRE DEPT. : . Y❑ •.N❑ Yo No SHEETROCK - GRADE FEE SUMMARY SHEAR INTERIOR BUILDING ' SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING . FIREWALLS ELECTRIC,— PLAN CHECK ' _ GAS - . . -FEE �' �•,' , NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' 77— SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING:INSPECTOR. MICROFILM uJ ARRANGE FOR INSPECTION BY PHONING.252.4505, ELECTRIC I.- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING: - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL 4 IMPORTANT! CONST:TAX PLEASE READ REVERSE SIDE BEFORE TOTAL i CALLING FOR FINAL INSPECTION'.. j /I OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY . BUILDING PROJECT,IDENTIFICATION I PERMIT NUMBER BUILDING APPLICATION & PERMIT ^ Ao s G BUILDING-ELECTRICAL-PLUMBING.-MECHANICAL owNER'a . CHECK VALIDATION J'M1E I DUY,. ''ELECTRIC PERMIT ` ' FEE tow NA PHONE •1 P NAMERACTORs UTLETS-SWITCHES-RECEP 10.00/1.00 psi LIc.No. LIGHTING FIXTURES 10.00/1.00 rUNTADDDRESS TDR's APPLIANCES-RESIDENTIAL 4.00 OPHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT - - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.NO. SIGNS TRANS. 3.00 ADDRESS END' SPECIAL CIRCUIT -5.00 PERMIT VALIDATION APPLICANT'S ZIP ITEMP.METER OR POLE INS. 20.00 ADDR ss MOTORS SEE FEE SCH.H. QrAA - SERVICE CHANGE 20.00 w0_o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 Q - i I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE commencing with Section 7000)of Division 3 of the Business and m i Professions Cade d m license is in full for�/�Idyf(q�� 0 ELECT. PLG. MECH. oZ ut o License Class Lie.Number_ !O T'7/ El El H m H J Dale Contractor �'�-I--+-_- rt¢ a OWNER-BUILDER DECLARATION BUILDING PERMIT ` o a U INFORMATION Ixa 3: u H 1 hereby affirm thatLI am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION E/FT. F LL O Law for the following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE ' 10.00 P, Code:Any city or county which requires a permit to construct,alter, IS O improve,demolish,or repair any-structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O u requires the applicant for such permit to file a signed statement that TOTAL w m w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO ri> Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe i 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ H $ the basis for the alleged exemption.Any violation of Secfoa703I.5 STORIES TYPE CONSTR, d ; .. by any applicant for u permit subjects the applicant to a civil penalty - ALTER-DRAIN (EA.) 5.00 of not more than five hundred dollars($500).1: ❑ Les owner the property,or my employees with wages as their sole compensatat ion,will do the work,and y e structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS 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' F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE 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. builder will have the burden of proving that he did not build or im- GAS•EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE prove for purpose of sale.). OEM INDCON PB Other ❑ I,as owner of the properly,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ 11licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 600 aEEEEsoRE PARCEL No. and Professions Cod.;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 contraclorts)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. D 'I am exempt under Sec..,B.&P.C.for this reason WATER HEATER W/VENT 6.00 Owner• Dale , WATER SYSTEM 5.00 ACC.DATE ACG FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EOUIP. 5.00 1 hereby affirm that 1'have a certificate ofconsent to self-insure. ora certificate of Workers'Compen.tio Insum cc,or' edified ZONING ENG-SITE NO, copy thereof(Sec.3800,Lab C.) O Policy No. - Company s O Cetifted co rs hereby furnished. , FIRE SPRINK ENERGY T-24 , Z 2 dCertifie y Is Pled the city inspection division, O ApplicanEXEMPTION misc.- p: REFER TO ORD. Y ❑ N❑ Y ❑ N❑ CC to CE WICATE OF E EMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CIL O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ � Z hundred dollars($100)or less) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F- mit is issued,I shall not employ any person in any manner so as to U become subject to the Worker'Compensation Laws of California. D W Date Applicant ALTER.OR ADD TO MECH. 5.00 BUILDING } N NOTICE TO APPLICANT: If,,after making this Certificate of Ex- F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=0C.F.M.) 4.00 - CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE I 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,CP.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC I, I certify Ihat 1 have read this application and stale That the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 herebyauthorize representatives this city l0 enter upon the above- BOILER-COMP(Over 100,000 BTU)BEE 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,to nts, costs and expenses which PERMIT ISSUANCE 10,00 CONST.TAX ma in y accrue ag said City in consequence of the gra is permit. i y CH.CONT. LIC.NO. TETAL TOTAL azure of Applicant/Contractor ate , I OFFICE COPY