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13850 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER s' CITY OF CUPERTINO INSPECTION DIVISION, 13850 JOB INSPECTION RECORD PERMIT EXPIRATION . �i10435 TANTAU• B-6 JOB ADDRESS UNIT# LOT# pERMIL EXPIRES IF WORK OWNER ' TANDEM COMPUTER CONTRACTOR . RUDOLPH .AND SLETTEN IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ?NCE OR 180 DAYS FROM LASTCA_ LLED INSPECTION. UFER PREGUNITE - PERMrt;VAUDATnON POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING - - � L) 'f ELECTRICAL 'ISSUANCE DATE MECHANICAL - 9LOG. ELECT. PLG. MECH. 0. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT WOOD FLOOR INFORMATION - VALUATION SIFT. I _ PLUMBING % MECHANICAL - _ PERMIT TO ELECTRICAL FRAMING .INSULATION. STORIES TYPE cONSTnsTR. OCC.GROUP RES.UNIT$ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED .- ROOF - - AREA TOTAL ACREAGE DIAPHRAGM .11w I BUILDING USE RES9ND CON PR Other APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - 0 ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST ` TRACT NO PARCEL NO.. MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL - - FINALS DATE INSP. _ FRAMING SAN * ZONING .ENG.SITE NO INSULATION PLUMBING GAS FIRE SPRINK ENERGY T24 MECHANICAL v ❑ N� v ❑ NE] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNEDHEATING LATH—INTERIOR ELECTRICAL FLOOD ZONE AT,U c -'� LATH—EXTERIOR. - FIRE DEPT. Y❑ N� Yo N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR . BUILDING f SHEAR EXTERIOR - - TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS - FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JGCCUPANCY, SEISMIC FEE ' OCCUPANCY OF BU I LDI NG I S NOT PERM ITTE D U NTI L BU I LD I NG F I NA L ISS I G N E D BY B U I LD I NG I NSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC I- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z� PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION,DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL D CALLING FOR FINAL INSPECTION. OFFICECOPY I APPLICANT TO FILL IN INFORMATION WITHIN RED LINES --USE BALL POINT PEN ONLY EaILOIMD BI'I LDI NG PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER -' AOD[ 5 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL *13850 OWNER', PLAN CHECK VALIDATION ""ME 3c96 f��7/ CITY. ELECTRIC PERMIT FEE PHONE CONTRACTORS r UTLETS-SWITCHES-RECEP 10.00/1.00 E Z)UA�� f,f� LIc.No.� J LIGHTING FIXTURES 10.00/1.00 CONTRACTOR,TO S, PPLIANCES-RESIDENTIAL 4.00 �, i I j PHON vJJ 11 D PANELS 10.00 DATE OF APPLICATION Rc"rcecrPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C,N0. OR JLI� ENGINEER•,I I..T' IC.No. SIGNS TRANS. 3.00 ARCH.OR END SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS 6 &L Z,pqtbZ TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRE ` _r SERVICE CHANGE 20.00 � woo_ LICENSED CONTRACTORS DECLARATION '"O Ov+f'+/7 H ¢ U w I hereby affirm that I am licensed under provisions of sines,Chapter 9 - ISSUANCE DATE w G w (commencing with Section 7000)of Division 3 of the Business and SLOG. ELECT. PLG. MECH. Professions Code,and my license is in full for ettil eQp- a, o Lice n Lic Nwnbcr. OO VV lQ 11 ❑ ❑ ❑ 0 z H 0 Dale /SContraclor_ R, x s ,II BUILDING PERMIT ¢ ¢ mu OWNER-BUILDER DECLARATION INFORMATION is;u y I hereby affirm that I am exempt from Ne Contractor's License MISC.- REFER TO ORD .. o ¢ Law for the following reason.(Sec.7031.5,Busines.and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. � - A _J Code:Any city orcounty which requires a permit to construct,alter, 7 ac ¢ <0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. a� DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO A w he is licensed pursuant to the provisions of the Contractor's License HiQ Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �NT�4�O{ /6fO11 f 4 o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE ¢ H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a ; by any applicant for a permit Subjects the aplicant to a civil penalty gLTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(S50s).): ❑ 1,as owner of the property,or my employ,,,with wages as BACK FLOW PROTECT.DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business end Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code.The Contractor's License Law does not apply IO an owner of properly who builds or improves thereon,and who does such work. FIXTURES-PER TRAP 5.00 MFT.FLOORAREA TOTALACREAGE 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.40UTLETS 6.00 } or improvement is sold within one year of completion-the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDwG USE . ,' builder will have the burden of proving that he did not build or ire- RES IND CON PB Omer prove for purpose of sale,). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,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 PAHCELNO. .l and Professions Code:The Contractor's License Law does not apply t0 an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractons)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I um exempt unJcr Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Dale WATER SYSTEM 5.00 _ ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of e.n vnt to scl6o,uov, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,lab.C.). No.- fIi� �S Policy No. CO 0 ❑ Certified copy s hereby (urnisbcd. FIRE$PRINK ENERGY T24 Z = ❑ Certifie gpy.n filed with the city inspection divisions. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ O Applicant- �f-J v N v N Cr CERTIFICATE OI'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE AT. C. > COMPENSATION INSURANCE PLG.CONTR. ❑C.No. PLG. CL O (This section need of be completed if the permit L n, for u TOTAL Y F] IN Y [:] IE]Z) Z hundred dollars IS 100)or less.) 0 O 1 certify that in the Performance of the work for which this perOTV. MECHANICAL PERMIT FEE FEE SUMMARY LL F mil is issued,1 shall not employ any person in any nomme, o as t0 0 W become subject to the Workers'Compensation Laws of Calilomu. BUILDING Is. Dale Applicant ALTER OR ADD TO MECH. 5.00 } rn NOTICE TO APPLICANT: H,after nmking this Certificate of Ex- F ? emphon,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK plsions of the labor Code, you must forthwith comply with FEE avi U such provisions err this permit shall be doomed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the Ix,fimin arice of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.CJ. HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lenders Address Icertify that IhavCrcedthis application and state that the above VENTILATION FAN (SINGLE) 4.00 information is cornet. I agree to comply with all city and county PLUMBING 1, BOILER-CANP I3 H.P.or 100,0008.T.U.1 6.00 Trdinanand stale laws relating to building construction, and ms nereby aulhorve representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEESCH. MECHANICAL 14, above-mentioned property for inspection purposes. (We) agree 1. save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX ma in any way ace regal 1 id City in c nsey encs of the PERMIT ISSUANCE. 10.00 gr ng0(lhuperm /, IYn_ MECH.CONT. LIC.NO. T0TAL TOTAL ��a B° S' atare of Applicant/Contractor Date f4 OFFICE COPY