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14177 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 14177 INSPECTION DIVISION JOB.INSPECTION RECORD ' PERMIT EXPIRATION 10440 LANSDALE JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK OWNER DAVID HERBERG CONTRACTOR ALL WEATHER HEATING IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR.180 DAYS FROM UFER LASTCALLED INSPECTION. - - ' PREGUNITE PERMIT VALIDATION � - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED J UNDERGROUND /SLAB i PLUMBING ELECTRICAL ISSUANCE DATE' MECHANICAL 77 '.BLDG. ELECT. 'PLG. MECR. - IS: ❑ ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT - INFORMATION - WOOD FLOOR t vncunnoN s/ET.,. PLUMBING T ! MECHANICAL . PERMIT TO ELECTRICAL w FRAMING 4 STORIES TYPE CONSTR. INSULATION - OCG GROUP RES.UNITS . PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.F T.FLOUR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE HES IN CON PB OR- APPLYAO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ Ell ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING: TRACT NO. ;PARCEL NO, GAS TEST MECHANICAL ACC.DATE ACC.FILE NO, ELECTRICAL FINALS DATE INSP. ' FRAMING - SAN # INSULATION - PLUMBING .ZONING ENG.SITE NO. GAS •FIRE SPRINK ENERGY T 24 MECHANICAL Y ❑ N❑ Y ❑ NEJ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR - ELECTRICAL FLOOD ZONEA.L.UC, LATH—EXTERIOR • FIRE DEPT.' Y❑ NE] Yo N❑ ' SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR T P RARY APPROVALS - FIREWALLS - ELECTRIC PLAN CHECK . GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE.FOR INSPECTION BY PHONING 252-4505; ELECTRIC H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING c 0� PLEASE GIVE JOB'ADDRESS WHEN,PHONING. Z - MECHANICAL �+ — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.TAX 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 IDENTIFICATIONS - PERMIT NUMBER BUILDING APPLICATION & PERMIT ADORE I Lon . i& • 11 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 14177 OWNER'S Cl - PLAN CHECK VALIDATION NAME + QTY. ELECTRIC PERMIT FEE LGI PHONE V�� I coNTRAory's� e �� UTLETS-SWITCHES-RECEP 10.00/1.00 NFME 1111 rr uc.rvo. LIGHTING FIXTURES 10.00/1.00 fONTRACT APPLIANCES-RESIDENTIAL 4.00 ` ADDRESS 2 Ufit I E L13 1[ J PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP1 20.00 PLAN CHECK FEE PL.NO. OR UJ, ENGINEER rvo. SIGNS TRANS., 3,00 noo iss ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 noo ESS MOTORS SEE FEE SCH. �^�G'11. SERVICE CHANGE 20.00 o ¢ i. / za o o LICENSED CONTRACTORS DECLARATION a u w I hereby affirm that I am licensed under provisions of Chapter 9 . 3,,AISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and ¢ U fit ILBLDG:' ELECT. PLG. MECH., H e i Professions Cod d y license is in full forceand Mffect1 ,SIC. J '❑ ❑ ❑ ren Z Z T D License lass P Lic.Number YOC7 LY r Date Contractor BUILDING PERMIT ¢ ¢ w ¢ OWNER-BUILDER DECLARATION INFORMATION a. oaU MISC.- REFER TO ORD w LL H I hereby affirm that I am exempt from the Cons and Pro License VALUATION SIFT. Fu0Q Law for the following reason.(Sec.7031.5,Business Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to Cons'Iruc[,alter, ¢ Q Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. - D ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO a. w m he is licensed pursuant to the provisions of the Contractor's License F z i Law(Chapter 9(commeneing with Section 7000)of Division 3 oflhe M ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT .FEE ¢yam.p the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR. n ;m by any applicant for a permit subjects Ole applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEV ICE 4.00 DCC.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 Orereon,and who does such work FIXTURES-PER TRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsorenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,Ore owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for pc,,,,of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PR Omer ❑ I,as owner of . . the properly,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 nor 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 contmetons)licensed pursuant to SEW ER-SANITAR V-STORM EA:200ft/10.00 the Contactor',License law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,BAP.C.In,this WATER HEATER W/VENT 6.00 reason Owner - Dam WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0, WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 t I hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance-o�r a c tlficd copy thereof(Sec.3800, ptuLab. Policy No. Company�Ay-v�� O }❑� Certified copy is hereby fumified. FIRE SPRINK ENERGY T-24 Z 2 p Certifi opy.is file wit the cii inspuW, division. MISC.- REFER TO ORD. O A plicant a11/iri Y❑ N❑ Y ❑ N❑ CC lA CERTIFICATE OI'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG:CONTH. LIC.NO. PLG. 0. O IT section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ NEI I 2 hundred dollars(5100)or less.) U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mil is issued,1 shall not employ any person in any manner so as to U beconic subject to the Workcrs'Compensation Laws of California. w Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } m NOTICE TO APPLICANT: If,alter making this Cetlificate of lix- F 2 emption,you should become subject to lire 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 10=CF.NL) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.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 1,p 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 ordinances and state laws relating to building construction, and BOILER-COMP(3 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 BTU)SEE FEE SCM. MECHANICAL 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 „� CONST.TAX may in any way accrue against said City in coPERMIT ISSUANCE 10.00 ` consequence of the 1 0k_ gniming of this perm it. CONT. LIC.NO. MECH. TOTAL �u ure oPio4iut."If TOTAL Signature of Applicant/Contract." Uat � r�2lJ OFFICE COPY