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9146 (2) POST THIS CARD NEAR FRONT OF BUILDING + PEHMIT NUMREH ' CITY OF CUPERTINO (�q 6 - INSPECTION DIVISION' +76fifD " JOB INSPECTION RECORD' ' '' k� PERMIT EXPIRATION 7v 03 �i�inL�'eG l-tt. 7?? JOB ADDRESS / I/ �F' UNIT,*--LOT# _ - .PERMIT EXPIRES If WORK OWNER a. CONTRACTOR IS. NOT STARTED WITHIN INSPECTION DATE INSPECTOR I INSPECTION RECORD '180 DAYS OF PERMIT ISSU- FOUNDATION _ AWE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION r - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING j(r;•! ,; ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT. PLG. MEC H. Y El El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING VALUATION $/FT. (/ y MECHANICAL -. .I 14U ELECTRICAL - I ,P IVTT. 1 FRAMING 1 -(gIVF\ J INSULATION STORIES TYPE CON TR. OCC.GROUP RES UNITS l -: ,�h• PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED �: 1 SO.FT.fLODR AREA TOTAL ACREAGE ROOF DIAPHRAGM �I,.1; >- It - RES ' IND BUILDING USE USEPB Om., 1a 'y�r APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED Q El El .Ej A SSESSORS PARCEL NO. ROUGH PLUMBING - .IA '+ . ' •,' GAS TEST - TRACTNO. PARCEL.NO­ - MECHANICAL O S ^ ELECTRICAL /p- ��J FINALS DATE INSP. ACC.DATE ACC FILE NO., FRAMING a SAN # ZONING ENG.SITE NO. ' INSULATION AN - GAS MECHANICAL ' FIRE SPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y [] N� Y E] N� LATH-INTERIOR ELECTRICAL - FLOOD ZONE A.L.uc. LATH-EXTERIOR FIRE DEPT. vo NE) Y No SHEETROCK p_ GRADE FEE SUMMARY SHEAR INTERIOR fBUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK ' GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE OCCUPANCY•OF BUILDIN G IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM d "ARRANGE FOR.INSPECTION BY PHONING 252.4505, ;, 3, ELECTRIC P� `ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING J O " ,PLEASE GIVE JOB ADDRESS WHEN PHONING: Z MECHANICAL CONST.TAX - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! -, 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 - ,- BUILDING PROJECT IDENTIFICATION - PERMITNUMBER BUILDING _ APPLICATION & PERMIT j 9146 �,j !/UNE Tg {� EE ��/G' BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S ' I I/1 ,,IA�'alyl �` PLAN CHECK VALIDATION " NA j4AAAcJ ©/V/2WI/' HONEO 7�7Q1 �,���` DTV. ELECTRIC PERMIT FEE o PHONE V {_ NOMERnc.oRs UTLETS-SWITCHES•RECEP 4&9071.00 S ��q+°I' LIC.No. Al LIGHTING FIXTURES •1890/1,00 CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE PANELS 10.00 DATE OF APPLICATION ARRCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER uc.NO. ISIGNS TRANS. - 3.00 ARCH Ess ENG' SPECIAL CIRCUIT S.QQ PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT'S ADDRESS tMOTORS SEPA [SCH. SERVICE CHANGE 20.00 / /o 186 w o o LICENSED CONTRACTORS DECLARATION TEMP,POLE 1JUL 150.00 ¢u P 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE N <i (commencing with Section 7000)of Division 3 of the Business and Y, 89. ELECT. PLG. MECH. F i Professions Code,and my license is in full force and effect. Of OD6' ❑ ❑ ❑ o W i License Class Lie.Number Date Contractor BUILDING PERMIT ¢ o a O OWNER-BUILDER DECLARATION INFO T J QV W ; H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD ut OK $/FT. uo¢ Lawrreason. town Professions � following PERMIT ISSUANCE _ „rte Code:Any demolish, county which structurep riort ots issuance,also a 2 Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. W191 law L� , requires the applicant for such permit to file a signed statement that TOTAL pZ�' PERMIT e w m m he is licensed pursuant to the provisions of the Contractor's License v. z > Law(Chapter 9(Commencing with Section 7000)ofDivision 3 of the f 4 o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE ic r R the basis for the alleged exemption.Any violation of Section 7031.5 STO IES TYPE CONS R. )L; _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).1: ❑ I,as owner of the property,or my employees with wages us 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 dues not apply to an owner of J properly who builds or improves thereon,and who does such work / F IXTURES-PER TRAP -FtBO SG.FT.FLOOR AREA TOTAL ACREAGE -. himself or through his own employees,provided that such improve- �D ments are not intended or offered for sale.If,however.the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA2.00 builder will have the burden of proving that he did not build or im- BUILDING USE plot purpose ofsaleJ.-. INDUSTRIALWASTE INTER. 3000 HE IND CON PB Omer 1,as owner of the property,am exclusively contracting with 0 ❑ D. 1:1licer a nsed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractors License Law docs not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER1PAJD 1.00 contracts for such projects with a cOntractor(s)licensed pursualrt t0 SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. RAC N0, PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C.for thin WATER HEATER WIVE reason I Owner Date / WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WORKERS'C MPENSATION DECLARATION WATER TREATING EDU Pof CUpeffi% I hereby affirm that I have a certificate ofe osent m reIf-Brc, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,o a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T24 Z Z ❑ Certified copy is filed with the city inspection division.. MISC- REFER TO ORD.F O Applicant Y N V N PERMIT ISSUANCE Cr � CER'1'IPICOMOINSWONf INSURANION CE WORKERS' PI.G.CONTR. LIC.NO. PLG t�nO FLOOD ZONE A.L.U.C. 0. 0 (p ❑his section need not be completed if the permit is for one TOTAL /a Y NE] V NC3 hundred dollars($100)or less) U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not employ any person in any manner so as to 0 w become subject to(IIe Workers'Compensation Laws of California. I O t y Datc Applicant. BUILDING `/fL } N NOTICE TO APPLICANT: If,after making this Certificate of fix- ALTER OR ADD TO MECH. 5.00 f" Z emption,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 10MC.F.M.) 4.00 CONSTRUCTION LENDING AG17NCY AIR HANDLING UNITIOVER 10000C.F.M.) 6.00 SEISMIC FEE 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 NamAddy HEATI NG UN IT 100,000 B.T.U.)9.50 00 Lender's Address ELECTRIC +- I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 • information n errata.I agree in comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING Q � ordinances end slate laws relating to building lconstruction,nd co and hereby authorize representatives for ins ec this city es enter the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purports. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and oxpenms which PERMIT ISSUANCE 10.00 CONST.TAX may in y ay a Be again. said City in consequence of the 'on,in is per r' ECM.CONT. LIC.N0. MECH. _ TOTAL TOTAL /39 -- Sign re o Ina Contractor Data OFFICE COPY