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13017 (2) POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO RM1'TN MRER 7 INSPECTION DIVISION • 301 1 C— JOB INSPECTION RECORD �`' J ✓`// / �"� • PERMIT EXPIRATION JOB ADDRESS UNIT# LOT#' �� D�L //'' O / PERMIT EXPIRES IF,WORK ' OWN ER (}.,,ea - coNrRAcroR /� /�DrtJ [.//7 IS NOT STARTED WITHIN INSPECTION/ DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR.180 DAYS FROM LASTCALLED INSPECTION. UFER PREGUNITE - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ' PLUMBING d ELECTRICAL ISSUANCE DATE MECHANICAL - SLUG. ELECT. PL, . MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING , MECHANICAL ' T ro ELECTRICAL gR I FRAMING . (I INSULATION STORIES YPE CONSTR. ' OCG GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF 50.;i.FLOOF AFEA TOT/L ACflEhGE DIAPHRAGM FAIrl BUILDING USE - RF:S ' IND' CON P9 Otlnn APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED t.AAY n n Iq I P7 0 El 0 .0 ROUGH - _ - ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL No. MECHANICAL . ELECTRICAL ., FINALS DATE INSP. ACCDATE ACC.FILE NO. FRAMING SAN # INSULATION - - PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL- FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING YE] "E] Y [] NE] LATH—INTERIOR ELECTRICAL FLOOD ZONE . A.L.uc. LATH—EXTERIOR - FIRE DEPT. ^ YNE:] Yo No SHEETROCK " " GRADE- -'CI, .;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, occuPANcv SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY_PHONING`252.4505, ELECTRIC' • �� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE"- CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE 'TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY a: APPLICANT TO FILL,IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY f� BUILDING PROJECT I DENTIFICATI ON PERMIT NUMBER BUILDING APPLICATION & PERMIT ADDRESS BUILDING - ELECTRICAL-PLUMBING -MECHANICAL 301 OWNER'a PLAN CHECK VALIDATION • NA //,'r CITY. ELECTRIC PERMIT FEE O W PHONE Nory ERAcroRs UTLETS-SWITCHES-RECEP 10.00/1.00 uc,No,v 9 LIGHTING FIXTURES 10.00/1.00 ADORESSTGRa APPLIANCES-RESIDENTIAL 4.00 PHDNE PANELS10,00 DATE OF APPLICATION ORCNITECT PANELS (OVER 200 AMP) 20.0 PLAN CHECK FEE P.C,NO. ENGINEER , Llc.NO, SIGNS TRANS. 3.00 ARCH.OR ADDRESS ENG. SPECIALCIRCUIT 5.06 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 PAID' NTS ADDRESSS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 MAY 2 019137 o a 2i F o o LICENSED CONTRACTORS DECLARATION /s a i w I hereby affirm that I am licensed under proviswns of Chapter 9 a v (commencing with Section 7000)of Division 3 of the Business and SLOG. ELECT. PLG. MECH. H i Professions Code,�pd my license is in full fore h fie I. ❑ ❑ ❑ ❑ o i`�,0 License Class n-P/.. Lic..Number Dale Contractor f y�� 5 y J rt a w a OWNER-BUILDER DECLARATION BUILDING PERMIT w0 A INFORMATION ; LL y I hereby affirm that i am exempt from the Contractor's License MISC.- REFER TO ORD n 0 j Law for the followingreason.(Sec.7031.5,Businessand Professions VALUATION . H - PERMIT ISSUANCE 10.00 S/Fr. f vas-f Code:Any oily or county which requires apeohil loconstrucl,aheq - a . e 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC, d y M requires the applicant for such permit t0 file a signed statement Ilia( TOTAL O ERMIT T w he is licensed pursuant to the provisions of the Contractor's License ,,,,((((1111 r2Q Law(chapter 9(commencing with Section 7000)of Division 3 ofthe ry./ 4 D Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE 1/ ` M H the basis for the alleged exemption.Any violation of Section 7031.5 y 3 by any applicant for a permit subjects the applicant toacivil penalty STORIESTYPE CONSTR. of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 0 I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 their Sole compensation,will rho the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale(Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,GOND. 5.00 Code:The Contractor's License Law does not apply to IID owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.0D SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided Thal such improve- Inentsarenot intended or offered for sale.0,however,the building GAS-EA.SVSTEM-1 INC. 40UTLETS 6.00 or improvement is sold within one year of completion,the owner. GAS-EA.SVSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving Ihat he did not build or im- BUILDING USE prove for 1.as owner of the.). INDUSTRIAL WASTE INTER. 30.00 RES 'IND CON PB Omar ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ElAGS❑ESSOR0ARC 0 O. ❑ and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or immovus Thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractons)licensed pursuan Ltu - - theContructor'sLicenseLaw. SEWER-SAN ITARV-STORM EA.2001t/10.00 Qe� TRACT NO, PARCEL NO. ❑ 1 am exempt under Sec. ,B.&P.C.for this reason WATER HEATER W/VENT 6.00 Owner Dae WATER SYSTEM 5.00 T ACG DATE ACC.FILE N0, WORKERS'COMPIiNSAT10N DECLARATIONWATER TRE 1 EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'CompensationInsurance, or a certified ZONING ENG.SITE NO. copy N... Company lof(Sec.3S ) Po O 0 Certified copy is hereby furnished. 8/ FIRE SPRINK ENERGYT]4 Z Z KCeriified py is d I e city inspection division. FO Applicant-C`�T--e MISC.- REFER TO ORD. v � NY ❑ NF] CC N CE RTI FICATE OF EXIT M PITON FROM WOR KERS' PERMIT 01,1011140 lg 7ION 10.00 � '1 FLOOZONE A.L.u,C. n- PLG.CONTR. LIC.NO.(This section needneednotecompleted lit t e not is for one TOTAL D U� Y Ej N V [] N 0 Z hundred do]]..IS 100)or Tess.) U O 1 certify that in the performance of the work for which this per- CITY. - MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued, I shall not employ any person in any manner so as to become subject to the Worken'Compensation Laws of California. ED Date' Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } rn NOTICE*10 APPLICANT: If,after making this Certificate of I'.x- F Z enhption,you should become subject to the W,,rkeri Conhpensatoo APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith Comply with U FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER 10=11F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the perl'onnanec 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 Lender's Address HEATING UN IT(OV E R 100,000 B.T.U.)9.50 ELECTRIC . I certify that I have read this application and state That the above VENTILATION FAN ISINGLE) 4.00 information is correct.1 agree to comply with all city and nt couy PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 `t- hereby authorize representatives for .sec this city to Ener upon the BOILER-COMP 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned propertyyfor vesp of this urpo es. (We) agree to save, indemnify and keep harmless the City of MISC.• REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue,against said City in consequence of the PERMIT ISSUANCE 10.00 granting of this permit. MECH.CONT. LIC.NO. MECH. • TOTAL TOTAL Shgnalure of Applicant/Contractor Une OFFICE COPY