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12263 (2) :. POST THIS CARD'NEAR_ FRONT OF BUILDING PE,RMIT.NUMBER CITY OF CUPERTINO 12263' .• INSPECTION DIVISION - • JOB INSPECTION RECORD rPERMIT EXPIRATION h JOB ADDRESS `� 0 - N T#k LOT# PERMIT EXPIRES IF WORK • OWNER -"CONTRACTOR'- - IS 'NOT STARTED WITHIN - INSPEIdrTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 1BO DAYS FROM LASTCALLED INSPECTION. UFER ' PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED • - �' I � ' UNDERGROUND /SLAB` PLUMBING,.' ELECTRICAL - ISSUANCE'DATE• "BLDG. ELECT. PLG. MECH, MECHANICALS_. . . 00NOTPOUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - r BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING ;.. • - . -U' . MECHANICAL - } PERMII TO ' ELECTRICAL. ' FRAMING IYEE " $T0HI[5 TYPE CONST R. INSULATION • DCC,GROUP RES.UN ITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • • FT.FLOOR AREA TOTAL ACREAGE ROOF DIAPHRAGM BUILDING USE ' NES i IND CON ,PB ,Olnrr, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El ❑ ❑ ❑ O 1:1 ASSESSORS PARCEL NO. • .'ROUGH r r PLUMBING - -TRACT NO. PARCEL NO. GAS TEST' - - - MECHANICAL - ACC.DATE ACG FILE NO. ELECTRICAL -$' FINALS DATE INSP. FRAMINGZ =-ZyS'^ SANu ZONING ENG.SITE NO. - - - INSULATION i —y�. PLUMBING • r I GAS ' • , - FIRE SPRINKENERGY T"]< . MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED - HEATING y ❑ N❑ - y ❑ NE] FLOOD ZONE' : A.L.U.C. LATH-INTERIOR .. ELECTRICAL LATH-EXTERIORFIRE DEPT. YEJ No Y ❑ NE] SHEETROCK 'r GRADE FEE SUMMARY SHEAR INTERIOR BUILDING ' SHEAR EXTERIOR TEMPORARY APPROVALS - BUILDING, FIREWALLS. ELECTRIC - - PLAN CHECK • FEE r - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE - :! OCCUPANCY OF BUI LDI NG'IS NOT PERMITTED UNTI L BUI LDING F INA L IS SIGNED BY,BUI LDING I NSPECTOR. MICROFILM ARRANGE'FOR INSPECTION BY-PHONING 252-4505,, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION.s PLUMBING. O PLEASE GIVE JOB ADDRESS WHEN.PHONING.' Z MECHANICAL , — SEE PERMIT FOR EXPIRATION DATE- IMPORTANT! CONST TAX PLEASE READ REVERSE SIDE BEFORE TOTAL u ,1 CALLING FOR FINAL INSPECTION. -- ,,,• OFFICE COPY ' �' APPLICANTT.O FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY. ? , BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING -+5 9 �ccL�L e. �oSSDaY � APPLICATION & PERMIT 12263 ADDRESS "T.A -1 1 giG1 BUILDING-ELECTRICAL-PLUMBING,-MECHANICAL ly F .PLA N CH ECK VA LI DAT I ON �' ) OI�yC�� OTV. ELECTRIC PERMIT FEE C7TYJ�� _ll�1.W,�PMONE A.V��-IQdO ZcoNTRAc Rs UTLETS-SWITCHES-RECEP 10.00/1.00 ME AGu-U-Q-- LIC.NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S -4.00PPLIANCES-'RESIDENTIAL ADDRESS ' PHONE PANELS 1600 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. �1� ENGINEER /� • ' LIC.No, SIGNS TRANS. 3.00 ARCH.OR ENG. - 5.00 PERMIT VALIDATION ADDRESS - SPECIAL CIRCUIT • _ , ZIP EMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS ry/ SERVICE CHANGE 20.00 0 .Hoo LICI:NSED CONTRACTORS DECLARATION , a is 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE w a ar (commencing with Section 7000)of Division 3 of the Businessand BLDG. ELECT. PLG. MECH. ' H D z Professions Code,and my license is in"full force and effect ❑ ❑ ❑, ❑ z 0 w- License Class Lic.Number. Q yz r Date Contractor `a 4 J BUILDING PERMIT a ¢w OWNER-BUILDER DECLARATION INFORMATION w 3 LL m I herebyaffirm that I am exempt from the Contractor's License MISC.- REFER TO ORD ' p VALUATION $/FT. HUN J Law.for the following reason,(See,7031.5,Businessand ProleVions PERMIT ISSUANCE 10.00 .2 Code'.Any city or county which requires a permit to construct,alter, ac R Q 2 improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIG NO. ELEC. -O¢ requires the applicant for such permit to filo a signed statement that TOTAL - PERMIT TO K $a. he is licensed pursuant to the provisions of the Contractors License Law(Chopler 9(commencing wiOn Section 7000)of0ivision3ofthe W'^'WLUJ a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE I x O at H � the basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES TYPE ,CONSTR. by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars($500).): ❑ 1,as owner of the property,or my employees with wages as BACK F LOW 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:'file Contractor's License Law does not apply to an owner Of properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- himself not intended or ofkrcJ lbr sale.If,howeveq the huiWing GAS-EA.SVSTEM-11NC.40UTLETS 6.00 Or improvement is sold within one year of completion•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 inn- RES IND CON PB Omer prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 [1 1:1 El ❑ O 1,as owner of the property,am exclusively contracting with licensed contractors to construct tine project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORSPARCEL NO. and Professions Coda The Contractor's License Law does not apply _ to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.10 contracts Hr such projects with a mntractonO licensed pursuant to the Con rector's Lice FLaw. I SEWER-SAN ITARY-STO RM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I exempt,` er Sec tl.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner me WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKEgS'COMPENSA'I'ION DECLARA'T'ION „ WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self-insure, - - ZONING ENG.SITE NO. or o certifici le of Workers Compensation Insurance,or u certified copy thercoffSec.3800,Lab.C.). - Policy No. Company O ❑ CerlilieJ copy is hereby furnished. . FIRESPRINK ENERGYT-24 , Z Z 0 Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. Y N❑ y ❑ N❑ Applicant H - PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. CC - CERTIFICATE OE 1!XEMPTION PROM WORKERS' L1J > COMPENSATION INSURANCE PLG.OONTR, LIC.NO.• d O (This section need not be completed if the pernut is lot one TOTAL Y❑ N❑ y ❑ No , Z) Z hundred dollar,IS 100)or Icss.) -L) O 1 certify that in the performance Of the work,fur which this per- OTYMECHANICAL PERMIT FEE FEE SUMMARY LL P mit is issued,I shall not employ any person in any manner so as to Ow become subject m the Workers'Compensation Lawsof Calif ornia' BUILDING p iry`tv Date ApplicantALTER OR ADD TO MECH. 5.00 } vat NOTICE TO APPLICANT: If•after making This Certificate of Ex- - F, Z emnption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK -17'2 provisions of the Labor Code, you must forthwith comply'wi lh FEE `- CJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10=C.F.M.16.00 SEISMIC FEE J� 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 1Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.CJ. Lender's Name - Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC • 1 certify that I have,cad this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct.1 agree to comply with all city and county PLUMBING BOILER-(X)MP(3 H.P.Or 100,000 B.T.U.) 6.00 ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter-upon flue BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (Wep agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX n o any ay, accrue a asmidCit in consequence of the PERMIT ISSUANCE 10.00 g mg of this uL II11/1 (� MECH.CONT. LIC.NO. MECH. S_ - - -1(3C' V 12 3-8 TOTAL ' TOTAL Signature ol'Applmamt/Contmcto, Date OFFICE COPY