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11630 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO INSPECTION DIVISION _� I JOB INSPECTION RECORD - ��,�� 91 pG�.�[ • /� PERMIT EXPIRATION JOB ADDRESS �V '// 1\ C IT# LOT# 1 PERMIT EXPIRES IF WORK OWNER CONTRACTO IS NOT STARTED WITHIN INSPECTON DATE I INSPECTOR SPECTION RECORD 180 DAYS OF PERMIT ISSU•„ ANC. OR 180 DAYS FROM FOUNDATION WFER LASTCALLED INSPECTION. PREGUNITE-." PERMIT VALIDATION�Jr(,///� '. • POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL - BLDG, EX I PLG, MECH. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT 4 INFORMATION • WOOD FLOOR vnwnnoN SIFT. PLUMBING p �"J- •1 MECHANICAL ELECTRICAL / PERMIT TO FRAMING INSULATION �_+y _9`10sroRlEs TYPE CCNSTR. oCC,GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT.FLOOR AREA TOTALACREAGE DIAPHRAGMS •• BUILDING USE IND CON PB Onm' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED n u RE C3 El ROUGH 7�L-/'z A b -Z,1f / _ ASSESSORS'PARCEL NO, PLUMBING I fJ r GAS 3 l'. TRACT N0. - PARCEL NO. TEST + MECHANICAL 8 _ ELECTRICAL - .,FINALS DATE INSP. AGC DATE ACG FILE NO, FRAMING SAN # INSULATION PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL AFIRE SPRINK. ENERGY TIG COVER NO WORK UNTIL ABOVE HAS BEEN IGNED HEATING .❑ N❑ ` ❑ N❑ LATH—INTERIOR -12.- ELECTRICAL N� FLOOD ZONE AA.0 C. LATH—EXTERIOR (—Z FIRE DEPT. v❑ N❑: v ❑ NE] SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING - - SHEAR EXTERIOR /• TEMPORARY APPROVAL BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS NO,TAPE OR PLASTEfl UNTIL ABOVE NA$1BEEN`SIGNEUOCCUPANCY SEISMIC FEE OCCUPANCY,;OFBUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM . ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC o .ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION., ' OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY PERMIT NUMBER BU LDI NG PROJECT 1 DENT[FICATI ON OUILDINO".. Q T v, ,f APPLICATION & PERMIT ADORE '; l;• r BUILDING -ELECTRICAL-PLUMBING -MECHANICAL 11630 /,... OWNER'S / - PLAN CHECK VALIOATIOM " I GPL r L't'`��y6 g TY. ELECTRIC PERMIT FEE �� PHONE CONTRACTOR UTLETS-SWITCHES-RECEP 10.0011.00 AME LIC,.O �� '.�� LIGHTING FIXTURES 10.00/1.00 07/ CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 ADD a �e c/ 1 , ��g;Q/ �(;fMONE L/f�• Q /-/ PANELS 10.00 ,X0 DATE OF APPLICATION ARR /`'CHITECT N,lt VCJ g C f/D$flT PANELS (OVER 200 AMP1 20.00O 7`7 LAN CHECK FEE P.C.No. ENGINEER _ / 'LIC. o. SIGNS TRANS. 3.00 ARCH,OR ENG. 5.00 PERMIT VALIDATION AD DRESS SPECIAL CIRCUIT vim+^ y••ai ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT'SMOTO RS SEE FEE SCH. ADDRESS I'I /�� n - LV- fQ KI /1/4r I SERVICE CHANGE 20.00: Woo LICENSED CONTRACTORS DECLARATION r F t" <u w I hereby affirm that I am licensed under provisions of Chapter 9 Vi,,,' 15541AN@E DATEr^ N < u (commencing with Section 7000)of Division 3 of the Business and RL�/ ELECF. PLG. MECH.,, I- h i_ Professions Code, my license is in full fore - L.ro�f I'-S( LfC1=f'/ z 0 ut 0 / License au Lic.Number I[}, 9 Date- Contractor a xBUILDING PERMIT q: sc w OWNER-BUILDER DECLARATION ;INFORMATION AOo_ MISC.- REFER TO ORD W 3:1 r 1 hereby affirm that I am exempt from the Contractor's License VALUATION SIFT. LL 0 -, Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 /U r - Code:Any city or county which requiresa permit to construct,allet, 2 ¢< improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. / O requires the applicant for such permit to file a signed statement that TOTAL 09 PERMIT TO A W 9 m: he is licensed pursuant to the provisions Of the Contractors License - ,� / I- z r`, Law(Chapter9(commencing with Section 7000)of Division Sof the - - V = i o Business and Professions Code)or that he is exempt therefrom and QTY'. ,• PLU1.MBING PERMIT -FEE / �..- se r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.pp n ; ^ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(S500).): {ate•-. - ❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT. DEV ICE 4.00 OCC.eRou ES.UNITS their sols compensation,will do the work,and the structure is not intendedor offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,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 /( FIXTURES-PER TRAP 5.00 74 SEE Fr.FL R AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- r+ (, mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or unprommenl is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 J BUILDING USE builder will have the burden of proving that he did not build or im- IrvD CON vs Umer prove for.purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with Cl 0 El 11 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 , to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts forsuch projects with acontmclods)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 /0 - TRACT No. PARCEL rvo. the Contractor's License Law. ❑"I am exempt under Sec. .BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 S ACC.GATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent toself-insure. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. r copy thereof(Sec.3800,Lab.CJ.'T ^ A Policy No. Company 0 ❑ Certified copy Ishemby furnish FIRE SPRINK ENERGY T-24 \ Z Z 0 Certified opy (s fled .�t a city inspection division. pi Applicant Myp�l(sbly,cY "` QAAAA^ MISC.- REFER TO ORD. Y [] N� Y � N� Fua PERMIT ISSUANCE 10.00 U FLOOD ZONE A.L.U.C. \ CC CERTIFICATE OF EXEMPTION F M WORKERS' LU > COMPENSATION INSURANCE PLG.CONTH. LIC.ND. PLG, �ru( ;' �- O (This section need not be completed if the permit is for one TOTAL Y N Y N 2 hundred dollars 1$100)or less.) - - U O 1 certify that in the performance of the work for which this per- QTv MECHANICAL PERMIT - - FEE - FE,f'SUMMARY - LL t mit is issued,1 shall not employ any person in any manner so as to .. .. • U O w BUILDING /S-r/O become subject to the Workers'Compensation Laws of California. D. Data Applicant ALTER OR ADD TO MECH. 5.00 �r } N NOTICE TO APPLICANT: If,after making this m'Compe of Ex. F. emvisionyou fshould eLbecome Code,you totheWorthen Ccomply with APPLIANCE 5.00 PLAN CHECK provisions of the Lobar Code,yov'dee forthwith comply with U such provisions oL,this permlCshell be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M) 4.00 FEE i CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 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 permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.1 8.00 MICROFILM 3097,CN.CJ. Lender's Name HEAT[NG U N IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address 1 certify that 1 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 ��a ordinaand state laws relating to building construction. and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00 herebynces..'than. representatives of this city to anter upon theN above-mentioned properly for inspection purposes. BOI LER-COMP lover 100.000 BTU)SEE FEE SCM. MECHANICAL .(We),Agaaa•to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,j dgmenls, costs and expenses whichCONST.TAX may in any way accrue ag at mid City in consequence of the PERMIT ISSUANCE 10.00 s) pan(( oft perm' MECH.CONT. LIC.NO. MECH. TOTAL TOTAL ., Si aure of Applicem/Contractor Date INSPECTOR COPY CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO i �4 DATE ZV - �� , 19_L9_ BLDG. PERMIT THE BLDG. LOCATED AT ' OWNED BY /i �/ G %7;> � % � f HAS BEEN ICOMI_ D FOR USE AS f' BUILDING INSPECTOR • •