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09942 (2) j POST THIS CARD-NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO: ' n INSPECTION•DIVISION 09114 JOB INSPECTION RECORD ' - - PERMIT EXPIRATION JOB ADDRESS UNI LOT PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT 'STARTED WITHIN INSPECTION DATE I INSPECTOR IN TION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM LIFER - ,. , •LASTCALLEDINSPECTION. . l PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB J PLUMBING /F�' / ELECTRICAL I$BU��/A!c A1TE MECHANICAL - - B ELECT. PLG. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING VALUATION $/FT. � ' MECHANICAL ELECTRICAL PER TI FRAMING &m ' INSULATION o ES TYPE CO OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ROOF SO,.FT,FLOOR AREA TOTAL ACREAGE' . DIAPHRAGM - BUILDING USE ES IND CON PB Olne, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ . '❑ ❑ .❑ ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST TRACT NO. PARCELNO. MECHANICAL ACC.DATE ACC,FILE NO. ELECTRICAL p_q ,� FINALS DATE INSP. FRAMING SAN * INSULATION - PLUMBING ��r , ZONING €Nc.slTe No. GAS ` - - MECH AL FIRE SPRINK -Y ,ENERGY LpA COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEAT NG ❑ "❑ ❑ "❑ FLOOD ZONE A.L.U.C. LATH—INTERIOR , - � ELE gICA �a-,30,.. ,I� �' _ LATH—EXTERIOR FIRE •Y❑ "❑ v❑ "❑ SHEETROCK GRADE. FEE SUMMARY SHEAR INTERIOR BUILDING d 'Ibl^ —e SHEAR EXTERIOR TE ORARY APPROVALS BUILDING ;: •�, FIREWALLS ELECTRIC - • PLAN CHECK GAS - FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM I` , ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC � ONE WORKING DAY BEFORE REQUIRED'INSPECTION. PLUMBING o Z PLEASE GIVE JOB ADDRESS.WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE - MECHANICAL ' IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE $ TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLI 'ANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY PERMIT NUMBER BUIL DING PROJECT IDENTI FICATION gppLICATION & PERMIT BUILDING 09942 T REssBUILDING -ELECTRICAL-PLUMBING-MECHANICALS 'SPLAN CHECK VALIDATION E /,�/E (/ /� ( TY. ELECTRIC PERMIT FEE ✓• \e 1I t PHONE aL���O� CONTRACTORS OUTLETS-SWITCHES-RECEP 10,00/1.00 L-r LOA Sr LIC,No. LIGHTING FIXTURES 10.00/1.00 OONTRACTOR' PPLIANCES-RESIDENTIAL 4,00 AOGRE55 // �j PHONE PANELS 10.00 DATE OF APPLICATION OARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER Llc.No. SIGNS TRANS. 3.00 ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 4 20.00 ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 Foo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 PAIWld-, rt WU w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE w ¢a commencing with Section 7000)of Division 3 of the Business and 99BB����pppp�p�T MECH. H y,i Professions C. a my license is in full fort •ct '1 ❑ o 0 w o License C ss Lie.Number - v m H Ow Date Contractor C ¢ Z J f ¢ n D OWNER-BUILDER DECLARATION CIhP NFO MATIONT X 0,� H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD Huy J Law forthe followingreas°n.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 VALUATION SIFT. w� Code:Any city or county which requiresapermit to construct alter, 2 ¢ ¢00 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. / U • `•' O LL requires the applicant for such permit to file a signed statement that TOTAL PERT TO A w m he is licensed pursuant to the provisions of the Contractor's License vs J H 2 Q Law(Chapter 9'txomnumcing with Section 7000)of Division 3 of the 14 D Business and Professions Code)or that he isezempt therefrom and CITY. PLUMBING PERMIT FEE 0c H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant to,a permit subjects the applicant ma civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(8500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS tr their sole compensation,will do the work,and the sucture is not intended or offered for sate (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 docs such work FIXTURES,PER TRAP 5.00 SO,FT,FLOOR AREA TOTALACREAGE • himself Or through his own employees,provided that such improve. meets are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or im. BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PS Other C1 . . 1,as owner of the property,am exclusively contracting with 0 El El 13 11 licensed contractors to construct the project(Sec. 7044,IlusineSa 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 a contractods)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ l am exempt under Sec..,L&P.C.for this WATER HEATER W/VENT 6.00 reason Owner, Late WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPF:NSA'1'ION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of antsent to self-insure, ,or a certificate of Workers'Compensation Insumnee,or u certified ZONING ENG.SITE NO. copy there f e 0 I.C.I. �,s��r o Policy No n any-jfA s, 0 V. Certified copy is hereby furnished. FIRE SPRINK ENERGY T44 F Z Applicant❑ ti0e col it _led with the, city inspection division. MISC.- REFER TO ORD. y r/J'/ N V N rn CERTIFICATE 017 ISSUANCE 10.00 FLOOD ZONE A.L.U.C. F. EXEMPTION FROM WORKERS'W � COMPENSATION INSURANCE PLC.CONTR. LIC.NO. PLG. � Z( This section need not be completed if the permit is for one TOTAL Y F] NE] Y ❑ NQ hundred dollars(E 100)or less.) U O I certify that in the performance of the work for which this per DTV MECHANICAL PERMIT FEE FEE SUMMARY IL F mit is issued,1 shall not employ any person in any manner So as to O w become subject to the Workers'Compensation Laws of California. y Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING O } 0 NOTICE'10 APPLICANT: If,after making this Certh'icnm of Ex- {- 2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwilh comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOJIDOC.FM.) 6.00 SEISMIC FEE S-Zj 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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name H EATI NO UN IT(O V E R 100,000 B.T.U.)9.50 Lenders Address ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 Agokin is correct.1 agree to comply with all city and county PLUMBING �,. ordinances and state laws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.1 6.00 hereby authorize representatives of this city to enter upon the } above-mentioned property for inspection purposes. BOILEA-COMP to.,100,1700 BTU)SEE FEE SCH. MECHANICAL (We) agree to Save, indemnify and keep harmless the City of misc.- REFER TO ORD. LCupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX in any way accrue sRgat t said City in consequence Of the granf�i of this perm 4. // MECH.CONT. LIC.NO. MECH. TOTAL r T w ///1 IVi //fiJ///„�`// )10 /_n i� TOTAL 1 O 1 ML t ore of Appleant/Cont or etc VL_]= YY �� OFFICE COPY