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8449 (2) POST THIS CARD NEAR FRONT OF BUILDING ' PERMIT NUMBER CIT*)F CUPERTINO Q INSPECTION DIVISION UL u ' � �J/OBB�IN�SIPPECTION RECORD- IT E "r�l ! rLMI�✓� Dr - . PERM EXPIR S IF IWN JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK , OWNER CONTRACTOR IS NOT STARTED, WITHIN INSPECTION DATE INSPECTOR INSPEJtTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM i UFER - LASTCALLED INSPECTION. • � . PREGUNITE PERMIT VALIDATION .I PAID POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ��{{I�Y o,1198� UNDERGROUND /SLAB t.!`; ,jr I PLUMBING ELECTRICAL - _ City Ot Cupertino ISSUANCE DATE MECHANICAL - - - - L ELECT. PLG. }MECH, . ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION $/FT. (� _ s' MECHANICAL, ELECTRICAL _ _��' 'PERMITf ' E FRAMING -�� . 'V'�,`�' INSULATION ST IETYPE CONSTR. ' '" I OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SOFT FLOO RAREA TOTALACREAGE DIAPHRAGM BUILDING USE P IND CON PB Olney APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑. ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO PLUMBING —1 — GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL � (,. FINALS - 'DATE INSP. ACC.DATE. ACC.FILE NO. - ' FRAMING . ..� ' SAN # INSULATION PLUMBING ZONING ENG.SITE NO. - , GAS aVAL FIRE SPRINK, .ENERGY.T-i0 ` MECHANICAL ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATINGY.❑ 'N"❑ v ❑ ` N❑ FLOOD ZONE aL.u.c. LATH-INTERIOR ELECTRICAL LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Yo 'i ED SHEETROCK GRADEFEE SUMMARY SHEAR INTERIOR BUILDINGSHEAR EXTERIOR TEMPORARYBUILDING yi✓. FIREWALLS ELECTRIC PLAN CHECK.' t r GAS FEE . • 11 NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ' SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING M-4505, ELECTRIC' o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION'DATE,- MECHANICAL CONST.TAX IMPORTANT! PLEASE READ.REVERSE SIDE BEFORE TOTAL I CALLING FOR FINAL INSPECTION. OFFICE COPY - PL'CANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUfLDI NG PROJECT I DENTI FICAT PERMIT NUMBER 7AO�.RESS OING'. APPLICATION & PEFf g 4 4 9 UBUILDING-ELECTRICAL-PLUMBING-MECHANICALEP,Ry�'a�' n• r PLAN CHECK VALIDATION US K C QTY. ELECTRIC PERMIT FEEr.�� PHONE IAI 1TRACTORS _'9E . OUTLETS-SWITCHES-RECEP 10.00/1.00 MAY Jol-t-u G(a�cL LIC.NO. LIGHTING FIXTURES 10.00/1.00 MA a o f (' CONTRACTOR'S s APPLIANCES- 4.00 �Jo� ADDRESS Cr9l XGU PHONE PANELS' 10.00 •V CT/� �N y PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE .C.NO. fyGWEER SIGNS TRANS. 3.00 -noes G' -� SPECIALCIRCUIT 5.00 PERMIT VALIDATION ( _q" l' ZIP EMP.METER OR POLE INS. 20.00 I �r APPLICANTSCk MOTORS SEE FEE SCH. aooREss S ��Wt13�12D2, co, SERVICE CHANGE 20.00 00 r w o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 Q U u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE y <N (Commencing with Section 7000)of Division 3 of the Business and BL ELECT. PLG. MECH. H N z Professions Code,and my license is in full force and effect. [IEl 11o z H O License Class Lie.Number Date Comrucfor _ ¢ y2 ¢ e ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT 0 o U INFORMATION X ; N 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD w Law forthe followingmason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. ,ny Code:Any city orcounry whicho,quiresaperinit to construct,after, - ¢ � ¢ FO improve, or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC b au O LL requires the applicant for such permit to file a signed statement that TOTAL u w w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO rz > Law(Chapter 9(commencing with Section 7000)ofDivision 3 cfthe E 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE D M H the basis for the alleged exemption.Any violation of Sect ion 7031.5 STORIES TYPE CONSTR. 0 a ; by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as BACK F LOW 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 does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself re through his own employees,provided that such imProve- menlsarenotimhhisornemploees,provided that r.such building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 or improvement Is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER'4 (EA.) 2.00 buil r will hove the burden of proving thin he did not build or im- BUILDING USE o *l'or purpose 0fsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pe Other 1,as owner of the property,am exclusively tonlracting with ❑ ❑ ❑ ❑ ❑ It - ed contractors to construct the project(Sec. 7044, Business LAWN SPRINKLERS-11 INC 5 V.B. 6.00 ASSESSORS PARCEL NO, W Professions Code:The Contractor's License Law docs not apply o 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.200(1/10,00 Ih mmctor's License Law. TRACT NO. PARCEL NO. ❑ m exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Da WATER SYSTEM5.00 ACC.OATE ACC.FILE NO. WORK F.RS'COMPENSA'I ION DECLARATION WATER TREATING EOUIP. 5.00 1 hereby affirm that I have a certificate ofconsent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.CJ. Policy No. Company O ❑ Certified Copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is riled with the city inspection division. MISC.- REFER TO ORD. F 0 Applicant- Y❑ N❑ Y ❑ N❑ iy CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD20NE A.L.U.C. L COMPENSATION INSURANCE PLG.CONTR. LIC.No. PLG, 1 O (This section need not be completed if the permit is for one TOTAL Y❑ N❑J Y❑ N❑ =) Z hundred dollars IS 100)or less.) U O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY- 1L I- mit is issued,I shall not employ any person in any manner so ns t0 O W beconn:subject to the Workers'Compensation Laws of California. n Date ApplicantBUILDING6. } m NOTICE TO APPLICANT: If,after making this Certificate of rix- ALTER OR ADD TO MECH. 5.00 Z em tion,you should become subject to the Workers'Com Lnsation I I- - p. . p' APPLIANCE 5.00 PLAN CHECK Hovmm�s io the Labor Code, you must forthwith comply with FEE f� C„) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 4,00 CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10PWC.F.M.) 6.00 SEISMIC FEE a 5 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 ITO 100,000 B.T.U.) 8.00 Lender's Name H EATI N G U N IT(OVER 100,000 B.T.U.)9.50 Lender's Address - ELECTRIC I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information ordinances correct I agree tcomply with all city and County PLUMBING informaio and stale Taws relating to building construction, and BOILER-COMP(3 H.P.or 100,0008.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP Over 100,000STU1SEE FEESCH. MECHANICAL Q above-mentioned property for Inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the gmn[ing,yf this pentinit. MECH.CONT. LIC.NO. MECH. P4 2.ee4a� _3o_ TOTAL TOTAL Signature of Appluarrycomprictor Date OFFICE COPY - - I