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13261 (2) POST THIS C NEAR FRONT OF BUILDING CITYTF CUPERTINO ;RMIrNl1MREN INSPECTION DIVISION 13261 JOB INSPECTION RECORD M(( 19915 PRICE AVENUE PER@1 LT.E/PIRATION 7. F DRESS UNIT# LOT# PERMIT EXPIRES IF WORK SAM T. LIMA., . CONTRACTOR PERRY KIRBY IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT,ISSU- ATION ANCE OR 180 DAYS FROM A IT.CALL D NUFER �Elop. PREGUNITE E IrC n�77� POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �® �� r�_ , I� UNDERGROUND /SLAB - PLUMBING ELECTRICAL L�1 "1 . INS I A 0 MECHANICAL LtC11 ECH. it- EPARTMEN - - - B City Dti ��pertino 0 1 0 1 r p O DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - INFORMATION VALUATION $/FT. PLUMBING , / 11 MECHANICAL ELECTRICAL PERMIT ro FRAMING N INSULATION $TORIES TYPE CONSTR. OCC.GNOUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' ROOF SQ FT FLOOR AREA TOTAL ACREAGE 1 ..GM BUILDING USE RES IND CON PB OIM1eI APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ 0 ❑ ❑ ROUGH . ASSESSORS PARCEL NO. PLUMBING GAS TEST I TRACT NO. PARCEL NO. MECHANICAL - ELECTRICAL - FINALS DATE INSP. ACC.DATE ACC.FILE N0, FRAMING SAN * ZONING ENG.SITE NO. INSULATION PLUMBING GAS MECHANICAL , FIRE SPRINK ENERGYT24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Yr] No Y ❑ N[:] C U L. . . LATH—INTERIOR � ELECTRICAL FLOOOZONE A. , LATH—EXTERIOR FIRE DEPT. Y❑ IN Y 0 N� SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK ._ GAS FEE / NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 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 �IAPP.LICANT TO FILL IN INFOFSTION WITHIN RED LINES - USE BP . POINT PEN ONLY BUILDING PROJECT I DENTI FICATI PERMIT NUMBER aDILDING /^ APPLICATION & PER ADnREss / ^/ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 13261 owNER'5 PLAN CHECK VALIDATION "<E � y� v `ONE �" OTV ELECTRIC PERMIT FEE e y fir.'✓Zi. PHONE J� NAME ACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 LIC.No. LIGHTING FIXTURES 10,00/1.00 CONTE AONTA TO 'S APPLIANCES-RESIDENTIAL 4.00 S PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER Vim_ LIC.NO. SIGNS TRANS. 3.00 ARCH.OR ADDRESS ENG. SPECIALCIRCUIT 5.00 1- PEAR M(IIT�VfAILIggqDA❑❑❑TION ZIP EMP.METER OR POLE INS. 20.00 Ca 11 D E II 1{� APPLICANT'S �Q MOTORS SEE FEE 0.00 I n LI z IIL tl!' Ill I�� •'�J SERVICE CHANGE 20.00 I vzz(T/ J 1 J woo LICENSEDCONTRACTORS DECLARATION IJ� 1',(/i� iw I hereby affirm that I am licensed under provisions of Chapter 9 15 AN?/,ME (commence with Section 7000)of Division 3 of the Business and AIJT1 Q n B B}pG ❑-L ), DILL 1 H m i Professions Code,and my license is in full force and effect. OLD ")1"_L ` )I x o m License Class Lie.Number- o9 m H w Date Contractor 1 y s ., AI BUILDING PERMIT NI X ¢w at OWNER-BUILDER DECLARATION INFORMATION xAs;e I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD en FILOH 'J1 VALUATION $/FT. a Law for the following reason, 7031.5,Business and Professions PERMIT ISSUANCE 1U.QQ L Code:Any city or county which requires a pennit to construct,alter, SC 2 Q 0 improve,demolish,or repair any structure,prior In its issuance,also ELEC.CONTE, LIC.NO. ELEC. o a, requires the applicant for such permit to file a signed statement that TOTA�Gjat clip PER MIT TO E $ he is licensed pursuant to the provisions of the Contractor's License HiQ I.aw(Chapter 9(commencing with Section 7000)of Division 3 of the E4 D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE M s-$ the basis for the alleged exemption.Any violation ol'Section 7031.5 STORIE6 TYPE CONSTR. iii by any applicant for a permit subjects the applicant loo civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my ennployces with wages as BACK F LOW PROTECT. DEVICE 4,00 OCC. HCUP RES.UNITS their sola compensation,will do the work,and the stmclum is not intended or 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 ropcHy who builds or improves thereon,ant,wlto dne554C1,work FIXTURES-PER TRAP 5.00 $0 FT.FLOOR AREA TOTAL ACREAGE through his own employees,provided that such improve. not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 ptovoment is sold within one year of completion, the Owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have(be burden of proving that he did not build or im' RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 El 1,as owner of the property,am exclusively cont racling with ❑ ❑ ❑ ❑ ❑ 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 for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 ' the Contractors License Law. TRACT NO. PARCEL NO. ❑ lam exe pl under Sec.�,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owne - Dxre WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK FRS'COMPENSATION DI:CLARA'I'I N WATER TREATING EQUIP. 5.00 1 hereby affirm That I have a certificate of consent to self-insure. ZONING ENG.SITE NO. or a certificate of Workers Compensation Insurance,or a cerlifieJ copy thereof(Sec.3800,Lab.C.). Policy No. Company 0 ❑ Certified copy is hereby fundshed. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with (be city inspection division. MISC.- REFER TO ORD. 0 Applicant Y ❑ N❑ Y ❑ N CC w. PERMIT ISSUANCE 10.00 R- CERTIFICATE Ole EXEMPTION 17ROM WORKERS' FLOOD ZONE A.L.U.C. Lu COMPRNSAT'ION INSURANCE PLG.CONTR. LIC.NO. PLG. 1 O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑ Z)Z hundred lollars($100)or less.l U 0 I certify that in the performance of(he work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. 0. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING S. } W NOTICE TO APPLICAN'T': If,after making(his Certificate of Ex- Z emptier,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith 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 10=C.EM.) 6.00 SEISMIC FEE 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(See. MICROFILM' 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC c Ip y that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 Is correct. I agree to comply with all city and county PLUMBING .and state laws relating to building wnstmction, and 801LER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 uthorize representatives of this city R enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino lin o against liabilities,judgments, costs and expenses which y way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX granting fthis fiction, MECH.CONT. LIC.NO. MECH. \ ! \ META, TOTAL Signature of Applaant ontr etnr Date OFFI E COPY