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8299 (2) POST THIS CARD NEAR FRONT OF BUILDING • PERMIT NUMBER CITY OF CUPERTINO y. INSPECTION DIVISION 8299 JO INSPECTIOP RECORD" A • PERMIT EXPIRATION JOB ADD ESS NF .�' LOT# 'PERMIT EXPIRES IF WORK . tats✓t owNER CONTRACTOR - Y, IS NOT;STARTED WITHIN INSPECTION D TE INSPECTOR INSPECTION RECORD 180 DAYS OF'VERMITISSU- I FOUNDATION - •ANCE OR 180 DAYS FROM UFER LAST CALLED INSPECTION. PREGUNITE PERMIT VALIDATION ( - • POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /.SLAB PLUMBING � � 4F,JI ELECTRICAL ISSUANCE OgrE MECHANICAL e EL CT PLC. Mk Ill DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING VALUATION STET ' � - ' MECHANICAL ELECTRICAL - - PERMrt To FRAMING INSULATION ' - s RIES 7NPrMNSTR. - - • OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.FT.FLOOR AOEA TOTAL ACREAGE `- DIAPHRAGM' BUILDING USE RES (NO CON PB Ole., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORSPARCF.LNO. ROUGH' PLUMBING - - GAS TEST, TRACT N0, J PARCEL N0. MECHANICAL .. . ELECTRICAL � FINALS DATE INSP. ACC.DATE.- ' ACC.FILE NO. FRAMING SAN # ZONING ENG.SITE NO. INSULATION, PLUMBING GAS - MECHANICAL FII�SPRINK ENERGY T.Y4 . COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y 0 "El "o LATH—INTERIOR FLOODZONE A.L,U.C. � � ELECTRICAL LATH—EXTERIOR FIRE DEPT. Y❑ NO •° ❑ NI]'• SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING - BUILDING SHEAR EXTERIOR TEMPORARY APP ALS 1 FIREWALLS ELECTRIC . ,PLAN CHECK. - - GAS FEE I NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEI MIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUIL DING FINAL ISSIGNED BY BUILDING INSPECTOR. }MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC :f�•' ONE WORKING DAY BEFORE REQUIRED INSPECTION. yy� \\ PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING r' •J z SEE PERMIT FOR EXPIRATION DATE.- MECHANICAL 1 , IMPORTANT! •CONST.TAX '. PLEASE READ REVERSE SIDE BEFORE ; TOTAL CALLING FOR FINAL INSPECTION. OFFICECOPY - - — •lam � --r.��__-- _`�"_ —_�_ � _ i+li APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER HUILDINGADDRESS APPLICATION & PERMIT ^ ^^ BUILDING- ELECTRICAL-PLUMBING-MECHANICAL PLAN CHECK VALIDATION- ' OTV. ELECTRIC PERMIT FEE N NAOMEAcrORs UTLETS-SWITCHES-RECEP 10.00/1.00 N 7 S 7� uc rvO LIGHTING FIXTURES 10.00/1.00 r,ONgEas s PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10,00 DATE OF APPLICATION ORRCHITECT PANELS I OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.No. SIGNS TRANS. 3.00 oDRES5 ENG' SPECIALCIRCUIT 5.00 PERMIT VALIDATION AZIP EMP.METER OR POLE INS. 20.00 Qd I ADDRESS DDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 . /9:�_ ° ¢ TEMP.POLE 30.00 (V r D o LICENSED CONTRACTORS DECLARATION 1 au U I hereby affirm that I am licensed under provisions of Chapter 9 z w ISSUA CE DATE (commencing with Section 7000)of Division 3 of the Business and BLDG. LECT. PLG. MECH. � n z Professions So I icense i.Ntim l far74LrE ff -/� i ❑ Oz m p icer Lic.Numberrt-_� It )ate Condmemr-'I-'7re" ~ N C11P BUI N P,€ONO . w a OWNER-BUILDFiR DECLARATION erllno J! R A MISC.- REFER TO ORD IR I hereby affirm that I am exempt from the Contractor's License '- F LL O 4 Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE .19'B0 � VALUATION $/FT. as Code:Any city or county which requires a permit to construct,alteq q . a ¢ ¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. �O `- 09004 el y Lino ELEC. w °ec requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO m w he is licensed pursuant to the provisions of the Contractor's License Za Law(Chapter 9(commencing with Section 7000)of Division 3 of the 4 ° Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT, ^'FEE'" t-m the basis for the alleged exemption.Any violation of Section 7031STORIES TYPE CONSTR. .5 (' . by any applicant for a permit subjects the applicant tea civil penalty of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ I,as owner of the properly,or my employees with wages'as BACK FLOW PROTECT. DEVICE 4,00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the strum are 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 nut apply to an owner of property who hroug hOrimpeOVWthes,pr :tad who hat such i such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve mends 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- builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 ILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES NO CON PB Other 131,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 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 cmntractora)licensed pursued to $EWER-SANITAR V• the Contractors License Law. A.200ft/10.00 TRACT NO. PARCEL NO. ❑ 1 am exempt under See.-,R&BC.for this WATER HEATER W N 6.00 reason Owner Date WATER SYSTEM I C`w 5.00 ACC.OATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREAT QUIP 5.00 •, . I hereby affirm that I have a certificate of consent O self-insure, ' o/s//`17 or 1 hereby nate of Workers e.nensutide nsumnee,or a certified ' }n0 ZONING ENG.SITE N0. copy thereof(Sec.3800,Lob.G.� g�s Q Policy No. Company ❑ Certified ropy is hereby furnished. Z Z ❑ Certified Copy is fled with the city Inspection division. FIRESPRINK ENERGY T-24 F O Applicant MISC.- REFER TO ORD. Y ❑• N❑ Y ❑ N❑ jr T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE G FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG, OU C' O (This section need not he completed if the permit is for one TOTAL �� V❑ N❑ V❑ NE]Z hundred dollars IS 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 F mit is issued,I shall not employ any person in anyntannerso as to O W become subject to the Workers'Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5,00 BUILDING } fait NOTICE TO APPLICANT: If,after making this Certificate of fix- I F Z emption,you should become subject to the Workers'CompensationAPPLIANCE 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 10MC.EM.) 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 Name Lender's Address H EATI NG U N IT IOV ER 100,000 :U')' .50 ELECTRIC 1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 QL) information is correct. I agree to comply with all city and county PLUMBING tea` ordinances and state laws relating to building construction, and BOILER-COMP (H-P,Or100,000BT 6. •� ` J hereby authorize representatives of this city to enter upon the BOILER-COMP(Over_000 EE EE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER T } Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE I 10.00 �Q CONST.TAX may in any,way accrue against said City in consequence of the gra of this hem' MECH.CONT. LIC.NO. MECH. 4 3 TOTAL /f�L TOTAL o Signature of Applicant/Contractor Date / _ (; OFFICE COPY