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12088u IIIIIIIII POST THIS CARD NEAR FRONT OF BUILDING. _ CITY OF. CUPERTINO . ' INSPECTION DIVISION JOB INSPECTION RECORD' - JOB ADDRESS• `n�lm p,bTn,m UNIT# LOT# OWNER CONTRACTOR •PFRMIT NUMBER 12088, - • PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- -ANCE OR 180 DAYS FROM - LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION -. UFER+ PR EG UNITE PERMIT.VALIDATION - ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 'UNDERGROUND /SLA , PLUMBING - ELECTRICAL MECHANICAL I �(a - BLOT. ELECT. ❑ PLG. MECH. ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - ' BUILDING PERMIT INFORMATION " WOOD FLOOR VALUATION •6� SIFT. PLUMBING MECHANICAL ELECTRICAL - PERMIT TO y FRAMING INSULATION' STORIES - TYPE CONSTR. - OCD. CHOUP —SO —FT RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN.SIGNED ROOF FLOOR AREA TOTAL ACREAGE DIAPHRAGM - ,• - l BUILDING USE r IND PB Ome, - ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ASSES SO PARCEL NO. . ROUGH _ PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL _/ � FINALS DATE INSP. ACC. DATE ACC. FILE NO FRAMING _ SAN # ZONING ENG. SITE NO. INSULATION PLUMBING . _(-k7 GAS. _. FIRE SPRINK —.Y ❑ NE] ENERGY L2A Y ❑ NE] ' - MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I HEATING _ FLOOD ZONE Y IN A.LU.C. v I] NE] LATH—INTERIOR ELECTRICAL lLvw LATH—EX TERIORf 'r FIRE DEPT. - SHEETROCK % GRADE • r FEE SUMMARY i SHEAR INTERIOR - .- BUILDING -•,gUILOING SHEAR EXTERIOR ' - TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE / ' GAS SEISMIC FEE .J� NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR.... MICRO FILM ARRANGE FOR INSPECTION BY PHONING -252-4505,1 -. Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION: 0.� PLEASE GIVE JOB ADDRESS WHEN PHONING. z • -SEPERMIT FOR EXPIRATION DATE - E ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. 'TOTAL OFFICECOPY ,. Y 1.1 PLICANT TO -FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY' .,. BUI•LDINGPROJECT IDENTIFICATION APPLICATION Hl PERMIT PERMIT NUMBER Bm LDING ,aooREss lel L��y ovF BUILDING - ELECTRICAL- PLUMBING - MECHANICAL 12 0 8 G }U(8 OWNERS PLAN CHECK VALIDATION NAME r/ ,H / PHONE Z S 3D6 OTY, ELECTRIC PERMIT FEE croRs NAME NAME UTLETS-SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 LOC. NO, CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 ADDRESS PANELS 10.00 PHONE DATE OF APPLICATION ARCHITECT OR ENGINEER LIC*NO, PANELS (OVER 200 AMP) 20,00 PLANCHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENG' ADDRESS SPECIALCIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 nP AS ADDRESS • - - MOTORS SEE FEE SCH. SERVICE CHANGE 20.00' - LICENSED CONTRACTORS DECLARATION I hereby al'fi nn that I am licensed under provisions of Chapter 9 .1 1�1 ISSUANCE DATE .. (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect License Class Lic. Number Date Contmclor BLDG. 19s,r ELECT. '[D PLG. MECH. x• El❑ BUILDING PERMIT OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Business and Professions Code: Any city or county which requiresa permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also INFORMATION IMISC. - REFER TO ORD VALUATION .�f Qd"� S/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License TOTAL PERMIT TO OTY. PLUMBING PERMIT FEE Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 1 ALTER -DRAIN & VENT -WATER (EAJ 5.00 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S50D.) ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or Offered for sale (Sec. 7044, Business and Professions BACK F LOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 - Coscl 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 or through his own employees, provided that such improve- ments are not intended'or offered for sale. If, however, the building GAS'-EA.SYSTEM-111NC.4OUTLETS 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- proveforpurposeofsale.). O I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Be,. 7044, Business GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 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 - OV ER 5 (EA.) 1.00 contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. SEWER-SANITAR V -STORM EA. 200fi/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 III lam exempt ..,I" Sec. B.&P.C. for this on Owner Date WATER SYSTEM 5.00 ACL. DATE ACC. FILE N0. WORKERS' COMPENSATION DECLARATION - WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a ceitificate ofconscm to self -insure, or a certificate of Workers' Compensation Insurance, ora certified - ZONING - ENG. SITE NO. copy thereof (See. 3800, Lab.C.). , Policy No. Company ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 ❑ Certified copy is filed with the city inspection .division. Applicant Y ❑ N❑ Y ❑ No MISC.-REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOOZONE A.L.u.C. PLG. CONTR. LIC. No. PLG. TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one v❑ N❑ Y❑ N❑ CITY. MECHANICAL PERMIT FEE - FEE SUMMARY hundred dollars ($100) orlessJ , I certify that in the performance of the work for which this per- mit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California. Date Applicant BUILDING c,/ _fit c3 V� ALTER OR ADD TO MECH. _ 5.00 NOTICE. TO APPLICANT': If, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation provisions of the Lahor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked 'APPLIANCE 5.00 PLAN CHECK FEE ' ' ,�%'> - j�- AIR HANDLING UNIT (TO 10)000C.F.M.) 4,00 AIR HANDLING UNIT (OVER 10MC.F.M.) 6.00 SEISMIC FEE CONSTRUCT ION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097. Civ CA HEATING UNIT (TO 100,000 B.T.U.) 8.00 ' HEATI NG UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Lender's Address I certify tied I have read this application and state that the above information is correct. I agree to comply wr all city and county ordinances and stale, laws relating to building construction, and VENTILATION FAN (SINGLE) - 4.00 PLUMBING BOILER-COMP(3 H.P. Dr 100,000 B.T.U.) 6.00 BOILER -COMP 10ver 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. misc.- REFER TO ORD. CONST. TAX TOTAL 11 i �9� (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the gramin of this pc 6 y/ lU PERMIT ISSUANCE 10.00 MELH. CONT. LIC. NO. MECH. TOTAL ignature o icant/Cmllmdor Date OFFICE COPY