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12913 (2) POST THIS #RD NEAR FRONT OF BUILDING PFRM1IITNUMRER CITOF CUPERTINO INSPECTION DIVISION 2913 . JOB INSPECTION RECORD '/c PERMIT EXPIRATION •� JOB ADDR ESS / Ta s�i�Od�GFC/7W/_UNIT4f LOT# PERMIT EXPIRES IF WORK OWNER Og CONTRACTOR S1_6-V,, a IS NOT STARTED WITHIN INSPEC ION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION. ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PREGUNITE d PERMIT VALIOATFNI 2 2e./cT-2--frT POUR NO CONCRETE UNTIL ABOVE HAS BE IGNED PLUMBING UNDERGROUND /SLAB - .P 7 D ELECTRICAL powISSUANCE DATE . MECHANICAL MF11 JL JI LECT. PLG. MECH. F11 T` ❑ ❑ I ❑.. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �UpBIQ DING PERMIT C11!I FORMATION WOOD FLOOR VALUnnoN PLUMBING - - - MECHANICAL ' ELECTRICAL - - PERMIT TO FRAMING INSULATION STORIES TYPE CONSTR, OCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT.FLOOR ANEA TOTAL ACREAGE ROOF DIAPHRAGM BUILDING USE RES IND CON P8 Other APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH PLUMBING GAS TEST 4 TRACT NO. PARCEL NO. MECHANICAL V ELECTRICAL // FINALS DATE INSP, ACC.DATE ACG .FILE NO. FRAMING SAN * INSULATION PLUMBING ZONING ENG,SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY T24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ NE] [:] N[] LATH-INTERIOR ,ELECTRICAL .FLOOD ZONE A.L.U.C. LATH-EXTERIOR FIRE DEPT.- Y❑ No Y ❑ IN SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING c� - SHEAR EXTERIOR - TEMPORARY APPROVAL BUILDING < 4J" + CJ FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE-HAS SIGNED OCCUPANCY SEISMIC FEE 5 OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC - F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O 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. OFFICECOPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USEL POINT PEN ONLY BUI LDI NG PROJECT 1 DENTI FIC�N , PERMIT NUMBER n0ILDING APPLICATION & PE DRESS HEIT 12913 •h AD Rs_ � BUILDING-ELECTRICAL-PLUMBING-MECHANICAL O RS PLAN CHECK VALIDATION NAME CITY. ELECTRIC PERMIT FEE DNE 5" b� NAME CTaR�a �s3 UTLETS-SWITCHES-RECEP 10.00/1.00 _1C.No d- LIGHTING FIXTURES 10.00/1.00 TRA R's ADDRESS APPLIANCES-RESIDENTIAL 4.00 PHON '• � PANELS 10.00 GATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLANCHECK FEE P.C.NO. OR ENGINEER Llc,rvD SIGNS TRANS. 3.00 ADDRESS ENc' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 AR - MOTORS SCH. ,✓ ADDRESS SERVICE CHANGE 20.00 � oo LICENSED CON'T'RACTORS DECLARATION JqR7 MAY a u w 1 hereby affirm that 1 ant licensed under provisions Of Chapter 9 6- ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and OLDQQQ111 ELgCj. MECH. iProfessions Code nd license is in full fart tIt e O z D= License Class Lic.Number 9 H Date - �r -�_Lic.N to mbI a y g - - BUILDING PERMIT ¢ ¢w OWNER-BUILDER DECLARATION INFORMATION W O A I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD pI;; Y P VALUATION $/FT. ¢ Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 .('/ rN J Code:Any city or county which requires a permit to construct,alter, rc ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 3 / m¢ lCgalreS the applicant far SIICh permit t0 file a signed StlllCment That TOTAL �' PERMIT TO a. whe is licensed pursuant to the provisions of the Contractor's License rii La..(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe S'[V�4x.�,4„P��& �0(,,,, a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE a I¢ Cs Ole basis forthcalleged exemption.Anyviolation ofSection7031.5 STORIES TYPE CONSTR. n ;m by any applicant for a permit subjects the applicant to a Civil penalty ALTER-DRAIN&VENT-WATER (EAJ 5.00 //��. of not more than five hundred dollars($500).1: - Q[JN!rB ❑ I,as owner of the property,or my cm ployees with wages as BACK FLOW 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,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 TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-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 im- prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer C1 1,as owner at the property,am exclusively contracting with Cl ❑ ❑ ❑ ❑ licensed contractors tD construct the project(Sec.7044,Business LAWN SPRINKLERS• 1 C 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon.and who LAWN SPRINKLE R 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STOR .200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ l am exempt under Sec. ,B.&P.C.for this WATER HE / E 6.00 on Owner Date WATER SYSTEM5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREA Idino 5.00 I hereby affirm that I have a certificate of consent to self-inure, - ZONING ENG.SITE N0. or a certificate Of Workers'Compensation Insurance,or a c lulled X co py thereof(Sce.3800,Lab.C.)' -s le - J P Q Policy No. Company O ❑ Cerlifiede-pyis hereby furnish FIRE SPRINK ENERGY T 24 Z z A ertifie��Ls,,,. 's IiIcA ilh }moi a I' n division. ApplicCant- L-ra^�� MISC.- REFER TO ORD. Y ❑ N Y N❑ fYN CERTIFICATE 01:EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00/0 FLOOD ZONE A.L.U.C. LU - COMPENSATION INSURANCE PLO.CONTR. LIC.NO. PLG. s.Lo d 0 ('This section need not he completed if the pernsit is for one TOTAL / Y❑ N❑ Y [3 N[3 D Z hundred dollars l$100)or less.) V O 1 Certify that in the performance of the work for which this per, CITY. MECHANICAL PERMIT FEE FEE SUMMARY U_ H 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. O w Dare Applicant - BUILDING } m NOTICE TO APPLICANT: If,after making this Certificate of nix- ALTER OR AD H. 5.00 I.� Z Implicit,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the labor Code, you must forthwith comply with FEE C..) such provisions or this permit shall be deemed revoked. AIR HANDLING IT(T F.M) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLI IT R10,000 C.F.M.16.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOP ( I 5.00 the performance of the work for which this permit is issued(Sec. HEATING U 1 0,000 B.T.U.) B.00 MICROFILM 3097,Civ.CJ. Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC ,3 Lender's Address • I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 , /w information is correct. I agree to comply with all city and county PLUMBING eZA ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 r hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL J ~ above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harniless the City of Misc.- P REFER TO ORD.IS- Cupertino S -' Cupertino against liabilities,judgments, cost and expenses which CONST.TAX may in any way accrue,against said City in consequence of the PERMIT ISSUANCE 10.00 p-' - gratin o Ills permit. MECH.CONT. LIC.NO. MECH. TOTAL �/ TOTAL pt� 'Ott' Sig Lure of Applicant/Contractor a OFFICE COPY