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13009 (2) POST THIS CARD NEAR FRONT OF;BUILDING "' , • PERMIT NUMBER CITY OF CUPERTINOd 13009 INSPECTION 'DIVISION JOB INSPECTION RECORD pp //I` 1 PERMIT EXPIRATION JOBADDR ESS /O S-, Y 's K LI-V�` UNIT# 'LOT# �, ' , .14PERMIT EXPIRES IF WORK OWNERrCONTRACI I L (j-I ISNOT STARTED. WITHIN INSPECTION DATE' INSPECTOR INSPECTION RECORD . IUU DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION - _ _ . - CASTCALLED INSPECTION. GFER PERMIT VALIDATION• PREGUNITE, r POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ` UNDERGROUND /SLAB PLUMBING ELECTRICAL, ' ISSU CEDAIE,'. MECHANICAL' ' •. - _ -SLOG ELECT,ELEcr. ..PLc. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION VALU $/F WOOD'FLOOR ' _ „ t �Q : ATION T. `, PLUMBING MECHANICAL p ELECTRICAL 0 PERMIT TO _ FRAMING _ I 3 `` (f\\\ �j,/ 8 r INSULATION . O` STO.RIES TYPe CONsrra. - - OCC,GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED •• ROOF, •. .• r , SO�Fi•FLOOR AREA TOTAL ACREAGE DIAPHRAGM r BUILDING USE . ' y •` HLS NO CON PB OM APPLY NO ROOFING UNTIL ABOVEHAS BEEN SIGNED - - ❑ ❑ C3 ..Cl El ROUGH - - ASSESSORS PARCEL NO, .,. PLUMBING +' - GASTEST•. TRACT NO, PAHCEINO. MECHANICAL' " ,r - - •' - 1ACC,DATF.'" ACE.FI LE NO. ELECTRICAL, ' FINALS DATE INSP. FRAMING . ' SANW - - ZONING. ENG.SITE NO. INSULATION - PLUMBING j - ' 'GAS I r - MECHANICAL•- FIRE SPH INK ENERGY - ,COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING �'_ N❑ ',Y'Q '"� ' LATH-'INTERIOR ELECTRICAL + FLooD zoNE - A.L.uc. LATH-EXTERIOR - 'F RE DEPT. YE]. N� v 0 N❑ SHEETROCK GRADE' r FEESUMMARY SHEAR INTERIOR .. BUILDING,' - SHEAR EXTERIOR < TEMPORARY APPROVALS , BUILDING . FIREWALLS ELECTRIC. �, .. PLAN CHECK, .,. , GAS - FEE EN NO TAPE OR PLASTER UNTIL ABOVE HAS BESIGNED OCCUPANCY, SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL IS SIGNED BY BUILDING INSPECTOR'. MICROFILM ARRANGE'FOR INSPECTION BY PHONING.252-4505, ELECTRIC ��, .!"ONE WORKING ,DAY BEFORE REQUIRED'INSPECTION z P,LEASE,GIVE JOB ADDRESS WHEN PHONING r PLUMBING SEE PERMIT FOR EXPIRATION DATE MECHANICAL • . r CONST.TAX - -AMPORTANT!' ., PLEASE-READ REVERSE SIDE BEFORE _ TOTAL'! CALLING FOR FINAL INSPECTION. •OFFICECOPY - - R _ APPLICANT TO FILL-IN;INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY aU I LDING PROJECT I DENT[FI CATION - PERMIT NUMBER - awLDING . APPLICATION & PERMIT , ADDRESS` a ' A9,3 Q.. �, BUILDING-ELECTRICAL-PLUMBING MECHANICAL 13009 OWNER'5 - PLAN CHECK VALIDATION NAME / NN OTY] ELECTRIC PERMIT FEE I- 4eNE ' NAMECONTRACTOR' OUTLETS-SWITCHES-RECEP 10.00/1.00 y1 NAME. / �A N' IC N '���5 LIGHTING FIXTURES 10.00/1.00 ,�aE yI1'/n/'71 LIC N r.ONTRAcroR's - APPLIANCES-RESIDENTIAL 4.00 - • � �� ,(J G ,711-..'< MID E 55rR V� PANELS '10.00 .PATE OF APPLICATION ARcmTECT I - PANELS (OVER 200 AMP) 20.00 .PLAN CHECK FEE P.C.NO. OR. . ENGINEER LIC,NO, SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 - ZIP' - EMP.METER OR POLE INS. 20.00 APPLICAN rs MOTORS SEE,FEE SCH, SERVICE CHANGE 20.00 (' ' c 00 ,LICENSED CONTRACTORS DECLARATION S/'YO�(� a u u 1 hereby,affirm that 1 am licensed under provisions o'Chapter 9 ISs(�ANCE DATE rt y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. • z H m I'rofessi Gs Code,and my license is a full[If 'card efI ❑ ❑ art ❑ o,,, Licensrr,, a Lic.Number 29 [ o w w' Dater �_Q� Contractor , r BUILDING PERMIT ¢ ¢w a OWNER-BUILDER DIiCLARA'f10N i-• .� -' o INFORMATION wDe. MISC.- ' REFERTOORD ; ¢y. Thereby affirm that I am exempt from the Contractor's License VALUATION $/FT. F a. o J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE r 10.00 m Coder Anycity orcounly which requires a permit to construct;alteq 2 ca ¢ IO improve,demolish,or repair arty structure,prior to its issuance,also ELEC.DONTR. C.NO. ELEC. La C e, -requires the applicant for such permit t0 file a signed statement that TOTAL -. PERMIT TO w9 he is licensed pursuant to the provisions of the Contractor's License - - 4 /f Hzi Law(Chapter 9(commencing with Section 7000)of Divisioo3ofthe L8 lT a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE g'4 0.. „ ¢F $ the basis for the alleged exemption.Any violin ion of Section 7031.$ STORIES TYPE CONSTR. a by any applicant fora permit subjects the applicant ma civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 of not more than five hundred dollars($500).): - - ❑ L'is owner of the property,or my employees wills wages as BACK FLOW PROTECT:DEVICE 4.00 OCC.GROUP- RES.UNITS their sole compensation,will do the work,and the Structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,GOND. 5.00 Code:The Contnmtor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 So.Fr,FLOOR AREA TOTAL ACREAGE himsellor through his own employees,provided that Such Improve r•u, merits are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-I INC.4OUTLETS'6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-O ER 4(EA.) 2.00 builder will have the burden of proving that he did not build or in. BUILDING USE prove for purpose of sale.). INDUSTRIAL TER. 30.00 RES IND .'CON PB Omer ❑ 1,as owner of the property,ani exclusively contracting will - .❑ ❑ ❑ • ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRIN KL R$-1 I C'� .8. •'-6.00 A55ES50Ra PARCEL NO. and Professions Code:The Contractor's License Law does not apply - . to an owner of property,who hliilds or improves thereon,and who ' LAWN SPRINKL ER 5(EA.) 1.00 _ contracts for such projects with a contractons)licensedpursuantto ' tire Contractor's License Law. SEWER-$ANI. -STD Off/10.00 TRACT.NO. PARCEL NO. ❑ I am exempt under,Sec. B.&P.C.for this WATER HEATER 6.00 reason Owner Dalc WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. 'WORKERS'COMPENSn'1ION DECLARATION WATER'TREATING EQUIP. .. 5.00 •` . I hereby affirm that I have a Certificate of coment to sell'-insure. - - ' or a certificate of Workers Compensation Insurance,or a certified - ZONING ENG.-SITE NO. / copy thercof(Sec.3800,Lab.C.). - Policy No. Company- 0 ompany ' Q '❑.Certified copy is hereby furnished• FIRE SPRINK ENERGY T24 Z 2 .❑ Certified cupy'I, fled with tile'cily inspection division. MISC. - REFER TO ORD: -P APPlicant ' ' _ _ - v ❑ N❑ y ❑ N❑ • c CERTIFICATE OF EXEMPT ION FROM WORKERS' PERMIT ISSUANCE 10.00 0 FLOOD ZONE A.L.U.C. LL COMPENSATION INSURANCE PLG.CONTE. - ❑C.NO. PLG. Q.Z , ('rhis section need not be completed if the permit is for one - TOTAL YE] N❑ V.❑ NE] hundred doBm,(S100)orlcss,) 00 1 certify(bar in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL I. mit is issued,I shall not employ any person in any mmnner so as to V become subject octhe Workers'Compensation Laws of California. y Date Applicant - - ALTER OR ADD TO MECH. 5.00 BUILDING " } W NOTICE 'f0 APPLICANT': If,after making this Certificate of Ex- .,Phil . x- .,Phil .you Should become subject to the Wurkere'Compensation APPLIANCE 5.00 PLAN CHECK Provisions or 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 I0)000C.RM.) 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(Sea - - MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U:) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ,ELECTRIC': ' Lender's Address ® I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING S� ordinances and state laws relating to building construction, and 'BOILER-COMP 13 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter•upon the BOILER-COMP (Over 100,000 BTUI$EE FEE$CH. 'MECHANICAL above-mentioned property for inspection purposes. (We) agzee'to Save, indemnify and keep harmless the City of MISC.- 11 , REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX may in . way„accrue against said City in cause cries f the PERMIT ISSUANCE 10.00 grand n w permit , MECH.CONT. LIC.NO. - MECH. S o'tv i TOTAL TOTAL Sign arc of Ap un C tractor I Da[ OFFICE COPY .