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12841 (2) POST THIS CARD NEAR FRONT OF BUILDING E. CITY OF CUPERTINO H1 28NUMB 41 --� INSPECTION DIVISION 1 JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS J LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPEdlYbFJ DATE INSPECTOR imSIPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB '' ;( r 7 PLUMBING ✓ ELECTRICAL ISSUANCE DATE' BLDG. ELECT. PLG. MECH. MECHANICAL 1:1 LEI DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WINFORMATION WOOD FLOOR VALUATION $TFT. PLUMBING U ' MECHANICAL PERMIT TO ELECTRICAL FRAMING sroRlEs TYPE CONSTR. INSULATION J OCC.GHOUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED . ROOF SO,FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB Oinn APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO, ROUGH PLUMBING TRACT NO. PARCEL NO. GAS TEST MECHANICAL ACC.DATE ACG FILE NO, ELECTRICAL FINALS DATE INSP. FRAMING —).,"J U SAN # ZONING ENG.SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY L24 ME NIC NCD vEJ N COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED H AT G . . LATH—INTERIOR LEC T IC L FLOOD ZONE ALUC. LATH—EXTERIOR IRE DE . Y❑ No Y ❑ N❑ SHEETROCK. JRADE FEE SUMMARY SHEAR INTERIOR k[60NG —L SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS IELECTRIC PLAN CHECK F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE �) OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC I.- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.TAX 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 .BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT -,�• ADDRESS / IIO2H Iy0RrbS►}OYtlt BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1 284 OWNER'S PLAN CHECK VALIDATION • NAME �0 Rr QTY. ELECTRIC PERMIT FEE G/1roa( 1I PHONE CONTRACTOR k NAME 7 UTLETS-SWITCHES-RECEP 10.00/1.00 / f•'{Zn uNl 12 Ki•n✓SYQ UC.NOLIGHTING FIXTURES 10.00/1.00 ' CONTRACTOR'S '5AH V.11 APPLIANCES-RESIDENTIAL 4.00 ADDRESS "�• 5171,P L j4 1;S�Ne+1 evc PHONE I *f 1� PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. on ENGINEER LIC.No. SIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL CIRCUIT S.QQ PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS. 20.00 ^ Q _ , APPLICANT's MOTORS SEE FEE SCH. /Lla/�`•"•'�"' ADDRESS SERVICE CHANGE 20.00 OF Z 'f m o LICENSED CONTRACTORS DECLARATION / a v u I hereby affirm that 1 am licensed under pruvisimhs of Chapter 9 ISSUANCE DATE I- G w (connuencorg with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. r o z Professions C1�7.y ayqtdh�y license is in full forceyn W I. � ❑ Z o_ - License Cly, pts-J Li,.Number b---��r--•--��'--- ❑ ❑ Q z H,Qfi Doto�Contractor_y, • -' -- - BUILDING PERMIT a a'It ¢ OWNER-BUILDER DECLARATION INFORMATION m o a U MISC.- REFER TO OR wg LL F. 1 hereby affirm that I am exempt front the Contractor's License VALUATION $/FT. .. o¢ Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 (•O EWij, Code:Anycity orcounty which requires a permit to construct,alter, re improve.demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. ELEC. 181 D� to 0O ¢ requires the applicant for such permit to file a signed statement that TOT Q 1 �pMIT TO\ u w m he Is licensed pursuant to the provisions of the Contractor's License J Law(Chapter 9fcommencingwith Section]000)ofDivision 3 ofthe g�' �'• l�f ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT CA Eft ¢ $ the basis for the alleged exemption.Any violation o(5ection 7031.5 Cjl 111 STOO ES TYPE CONSTR. by any applicant for a permit subjects the applicant to a Civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($500).): ❑ I,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 (Sce. 7044, Business and Pogo,lops DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Cods: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 6.00 EO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- randsare nut intended oroffered for sale.ll',however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or improvement is sold within one year of conhpleti m.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- prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB ower ❑ I,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ lice mud 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 dues not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00 contracts for such projects with a contractot s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.2001t110.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO, WORKFRS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00 I hcroby affirm that I have a certificate d cnnsenl to sell'-insure. ZONING ENG.SITE NO. or a cefttificate(it Workers'Compensation Insurance,or a certiticd copy 11DIpL1> Q.Lab.C.). 4 ✓. •�� Pof mpanY 0 e T/'TI I' NCO Q Cerlilicd ropy is hereby furnished. FIRE SPRINK ENERGY T-Ta 3 Certified I y is filed with the city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ Q" Applicant Y N V N W CIiRTIFICAI'E OF EXEAIPTI FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD 20 NE A.L.U.C. LU >_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 1 Cl (This section need not be completed if the permil is for one TOTAL Y❑ N❑ Y❑ N❑ :) Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LLL) mit is issued,I shall not employ any person in any manner so as to W become subject to the Workers'Compensation Laws of California O . Q. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 6 s� } to NOTICE "1'0 APPLICANT: if.alter making this Certificate of Ex- � Z mnption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK pnrvisions of the Labor Code, you must forthwith comply with FEE U such provisions cur 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 Sp 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,CR.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and slate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BO LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes (We) agree to sav indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino ag sl lit h dies,judgments, costs and expenses which CONST.TAX may: ny ay ac a against Said City in consequence of the PERMIT ISSUANCE 10.00 gr' Eng of rspcyh�f' ^ /�� MECH.CONT. LIC.NO. MECH. TOTAL Z/ Ze �'L.�x ,1 TOTAL Signutu o App¢ant/Conlruc r Date Pall J=rIA &A'¢I 7lrKM•C'K Co.,,CW,,OFFICE COPY