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8818 (2)POST THIS CARD NEAR FRONT OF BUILDING C1, OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD . . ►/It JOBADDRES / NIT# LOT - V OWNER CONTRACTO / ,L PFR NIT NUMBER 8818 'PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF.PERMIT ISSU- ANCE OR 180 DAYS FROM, LAST CALL E DA NSPECTION. INSPECTION DATE INSPECTOR I INSPEC ION RECORD FOUNDATION UFER PREGUNITE - PERMIT VALIDATION ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED'(��+n UNDERGROUND/SLAB1 PLUMBING ELECTRICAL MECHANICAL ELECT. PLG. -MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING INFORMATION PERMIT WOOD FLOOR VALUATION $/FT. PLUMBING - . MECHANICAL ELECTRICAL - - / FRAMINGINSULATION "�TIRIECCNSTR. OCC. GROUP RES, UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT, FLOOR AREA TOTAL ACREAGE DIAPHRAGM . ' BUILDING RES IND ❑ ❑ USE PB Omer ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ,ASSESSOR PABCELNO. PLUMBING GAS TEST - TRACT NO. PARCEL NO. MECHANICAL - ELECTRICAL FINALS DATE INSP. ACC.OATE - ACC. FILE NO, FRAMING SAN * INSULATION PLUMBING ZONING ENG. SITE NO. GAS MECHANICAL FIRE SPRINK Y [:]N O ENERGY T-24 Y [:] NE' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH -INTERIOR ELECTRICAL FLOOD 20 NE Y ❑ No A.L.U.C. Y ❑ No LATH -EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING. I t=L --jif7 BUILDING SHEAR EXTERIOR TEMPORARY APPROVAL FIREWALLS ELECTRIC i- PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING:252-4505, F ONE WORKING DAY BEFORE REQUIRED INSPECTION. oPLEASE GIVE JOB ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING. MECHANICAL CONST. TAX IMPORTANTI PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT I DENTIF ION APPLICATION & MIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMITNUMBER 8x18 r BUILDING - aDDEss �0 osJ OWNER'S NAME !• ��(� ('s-»� � PHONE OTY.ELECTRIC PERMIT FEE PLAN CHECK V7TION 3a ('?� 3vAY/ CONTRACTOR S E OUTLETS -SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 &C.OI-Ja-fry, LIC.No.) DATE OF APPLICATION CONTRACTORS DDRESS ADD/R�A,� � n�'a AA.f!�. L I;,fi, Qilt PHDNE 1/6-�Vr,,, PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 OR ENGINEER LIC. NO. PANELS PANELS(OVER 200 AMP) 20,00 PLAN CHECK FEE P.0. NO. SIGNS TRANS. 3.00 ARCHAN ENG. ADDRESS SPECIAL CIRCUIT 5.0 0 PERMIT VALIDATION _ EMP. METER OR POLE INS. 20.00 ZIP 1/(�//V�'E_/�f-~�/•/] D y'n / ALIC ADDDRESDRESSS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 x•�' LICENSED CONTRACTORS DECLARATION TEMP. POLE 30.00 ( • 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code�at� yIy license is in full for N License 15a__J,a_[�_ Lic. Number JeurflASANCE DATE B ELECT. I PLG. MECH. Date �/�Y�Commctor BU 'LDING PERMIT INFORMATION • OWNER.BUILDER DECL RATION 1 hereby affirm Ihm 1 am exempt Ir1.5 the Cess and Pr License Professions Law Code: Any citylorcountywhiSec.uires a permit to p rio it to consuanc aheq Code: e, y mulish county my it any reqstructure, improve, demolish, or repair any structure, prior n its issuance, also requires the applicant for such permit to file a signed Statement that he is licensed pursuant to the provisions of the Contractor's License MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION / / p / D t'f !i (O ELEC. CONTR. LIC. NO. ELEC. TOTALTO Ru L. rt + Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he isexempt therefrom and OTY. 'PLUMBING PERMIT FEE I' � STORIES/ TYPE CONSTR. dobasis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$500).): ALTER -DRAIN -WATER (EA.) 5.00 ❑ I, as owner of Dm property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenotintendedoroffered for sale. l f, however, the building F IXTUR ES - PER TRAP 5.00 SO, FT. FLOOR AREA TOTAL ACREAGE GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within'one year of,completion, the owner. builder will have the burden of p roving that he did not build or no. prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with . -. GAS - EASYSTEM OVER 4 (EA) 2.00 BUIL IN USE RES IND Pa Co., 1:1 El INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (See. 7044, Business 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 • 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 AWE SSO SPA CEL NO. contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. SEWER -SAN V -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-. B &P.C. for this reason WATER HEATER WIVENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE 010. WATER TREATING EQUIP. 5.00 WORK ERS'COMPE:NSATION DECLARATION 1 hereby affirm that I have a certificate of consent In self -insure, or a certificate of Workers' Compensation Insurance, or pa �certified copy thereof (Sec. 3800, Lab.C.). �' N Co ZONING ENG. SITE NO. Policy No. Company l.� a ❑ Certified py6her@by fur' d. ❑ Cert ifiea; a filed wi h e city ns atom division. Applicam 1//"` w �a%�, FIRE gPRINK Y [] NC] ENERGY T-24 Y ❑ N[:] MISC. - REFER TO ORD. CERT FICA'"Ii OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE. (This section need not be completed if the permit is for one Y N� Y ❑ N❑ PLG. CONTR. LIC. NO. PLG, TOTAL hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per. mit is issued, I shall not employ any person in any manner so as to OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 NO'rl Cli TO APPLICANT: If, after making this Certificate of Ex- APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE emption, you should become subject to the Workers'Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION L17NDING AGENCY 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. 3097, Civ.C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender Address HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC 1 certify that I have read this application and state ha, the above VENTILATION FAN (SINGLE) 4,00 information is correct. I agree to comply with all city end county ordinances and state laws relating to building construction, and BOILER•ODMP(3H.P.or100,000B.T.U.) 6.00 PLUMBING BOILER -COMP (Over 100,000 BTU' SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC. • REFER TO ORD. Cupertino against liabilities tdgments, costs and expenses which may in an way accrue Xt said City in Consequence of the granting of is perrdil. \`L/' I ` PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. tAL/,v�//1\ - TOTAL TOTAL - Stgnatur of Applicant/Contractor Data 'OFFICE COPY I