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15778 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO. 15778 wv _ -; INSPECTION DIVISION JOB INSPECTION RECORD 1 �r S lollI PERMIT EXPIRATION JOB ADDRESS P- WD4 'Q UNIT# _Lor# ' . PERMIT EXPIRES IF WORK OWNER N L .d S ("e CONTRACTOR yp R` C'o Y�•1T cu IS NOT.STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYSOF PERMIT ISSU- ANCE OR 180-DAYS FROM, NOTE: LAST CALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED I J UNDERGROUND /SLAB"L PLUMBING ELECTRICAL, ISSUANCE DATE MECHANICAL BLDG ELECT I PLA. MECH. ( ❑ ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION _ VALUATION SIFT. PLUMBING ?_ 0 '00 MECHANICAL ELECTRICAL p,/� �PERMIT TO 1,I FRAMING - l�W�� - ..v'T`'� - PSV, INSULATION jig STORIES TYPE C NSTR. OCC GROUP RES UNITS City.Ot Cupertino' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED .SO FT FLOOR AREA TOTAL ACREAGE ROOF. NOTE:NO FINAL INSP.SHALL BE MADE BEFORE I ® NES IND CO DIAPHRAGM THE CONSTRUCTION TAX IS PAID ' IIII ROOF SHEATHING _ euaDlONuse N PB DInPr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 D 0 0 ASSESSORS PARCEL NO ROUGH SAN.H PLUMBING ELECT.ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT No. PARCEL No MECHANICAL MECH.ENERGY ' ELECTRICAL BUILDING ENERGY ACD DATE ACC FILE NO FRAMING, ELECT.FINAL TEST zomwc ENC,.SITE NQ. INSULATION PLUMBING r GAS TEST GAS MECHANICAL fIRE SPR INK EN ERG T2 'jl�� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING �Y 0 NE Y 0, NF], EXTERIOR SHEAR ELECTRICAL RELEASE •�.�{'�' Y El Na Y Q FLOOD ZONE A.L.0 c. N❑ INTERIOR SHEAR FIRE DEPT. IJ L: SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVAL BUILDING ^fCA(,�SU SCRATCH COAT ELECTRIC PLAN CHECK /�• GAS FEE ` NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE }� OCCUPANCYOF BUILDING ISNOT'PERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM JU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY'BEFORE REQUIREDINSPECTION. PLUMBING 0�. PLEASE GIVE JOB ADDRESS WHEN PHONING. z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANTI coNST.rnx PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. --- OFFICE COPY i - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROSECT I DENT]FICATI ON •PERMIT NUMBER BUILDING 10123 rt. YKaLI=C pcY�'GD APPLICATION & PERMIT �J O .�� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1 I [J7 18 a OWNER'S -t/zr•Ic- (iolr6Jc-i< PLAN CHECK VALIDATION NAME r` ,� WILiD A.GPfs/vFZL�1J1vorG bl41.(6 DTV. ELECTRIC PERMIT FEE - FY3PHOrvE J NAME CONTRACTORS OUTLETS-SWITCHES-RECEP 10,00/1.00 TNR.�a: Co...-rT2u cvso..J .tr^�- Nor 144411.4.1kJ LIC.NO.•.37le'l IF LIGHTING FIXTURES 10.00/1.00 CONTRACTOR• Y�8- PPLIANCES-RESIDENTIAL 4.00 ADDRESe•5�.. Gm3o Ai II W-/•CCPHONE zc5-OT01L PANELS 10.00 DATE OF APPLICATION ARC RITECT III ARGL+fTE TOKOF PANELS (OVER 200 AMP1 20,00 PLANCHECK FEE P.C:NO. ENMNEEfl 6GF 7Ia-1*.I�i�(4e IJ q LIC.NO.G' p SIGNS TRANS. 3.00 AARCH OR DDRESS ENG./rl N,F�I��SC, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION zo,151 TEMP.METER OR POLE INS. 20,00 APPLICANTSMOTORS SEE FEE SCH. ADDRDDRESSSS SERVICE CHANGE 0,00 02 LICENSED CONTRACTORS DECLARATION a u U I hereby affirm that I am licensed under provisions of Chapter 9 I- ISSUANCE DATE ¢ "' (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT- PLG. MECH. N i Professions Cppde,and myy�license is in full force and effect. be ❑ ❑ ❑ z 0 y - Liccnsc�Iaz A-6-"i �i.ic,Number'.$-�'I Y-7_r_- o H� Uote //-/3_"_Contractor7�11ei�LE City.of Cupertino a y E GuA.flrtrcn BUILDING PERMIT ¢ ¢ w¢ OWNER-BUILDER DECLARATION INFORMATION 0t- MISC.- REFER TO ORD X ;u w I hereby affirm that 1 sm exempt from the Contractor's License LL o¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. -v+ Cnde:Any city.,county which requiresa permit to construct,alloq //��/�� Q Q Q p Improve,demolish,or repair any structure,prior 10 Its issuance,also ELE6 CONTR, LIC.NO, r • �� ELEC. V� d - O M requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO sem heislicensed pursuant to the provisions of the )Contractor's Division License (�. fp I` } 111 �- Hzi Law(Chapter 9(commencingwith Section 7000)0(Division3 of(lie I�"Ifv rl1 '�V a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢HO the basis for the alleged exemption.Any violation ofSection 7031.5 STORIES TYPE CONSTR. n;$ by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollar,0500j): ALTER-DRAIN&,VENT-WATER IEA.) 5.00 ❑ h as owner of the property,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 structure is not intended or offered for sale(Sec. 7044, Business and I'mirohms DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's Liccnsc Law does not apply to in 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 of iolc his own employees provided thus such improve- mentsarrthrouicndedoroflered foroyees,provided e. ed thathowevr.Suhe building GAS-EA.SYSTEM-1INC.4'OUTLETS 6.00 Or is is sold within One year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.). 2.00 BUILDING USE builder will have the burden of proving that he did not build ur inn- ' REB IND CON PB Omer Prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 13 El ED E3 ❑ ❑ I,as owner of the property,am exclusively conlruchiu;with licensed contractors to construct file project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASS45SORS PARCEL NO. and Professions Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for projects with a contractor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL N0. ❑ I am exempt under Sec. ,BAP.C.for thisWATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORAERS'COMPENSAT1ON IjECLARATION WATER TREATING EQUIP, 5.00 1 hereby affirm that 1 have a certificate of consent to self=insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Seo.3800,Lab.C.). Policy No. Company f(4-CMOFISV-ft Paw O ❑ Certified copy Is hereby famished. FIRE SPRINK ENERGY T-24 Z 2 ❑ Certified o Y is EIL• ith 1¢ city inspect iq�liv�ision. O APplicant'f'( 1�ve G7 zzlr;LC7_tOeLRI-^mac_ MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ P W 4Cf CERTIFICATEOF EXEMPTION FROM WORKERS'• PERMIT ISSUANCE - 10.00 FLOOD ZONE A.L.0 c. LLI > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. IL 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ IN :D Z hundred dollars IS 100)or less) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERF411T FEE FEE SUMMARY LL F out is issued,I Shall not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of California. 7 p Date Applicant ALTER OR ADD TO MECH. 5.00 vC 0 } N NOTICE TO APPLICANT: If,after making this Certificate of lix- 2 emption,you should become subject to the 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=C.F.M.) 4.00 p CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,000C.F.M.) 6.00 SEISMIC FEE 3 S I herehy affirm Umt there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for whit) this permit is issued fSe, MICROFILM 1 3097,Civ.C.). ��_II HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name UA r 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 BOILER-CC1MP(3 H.P.Dr 100,0008.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes, - ts! ,agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. o against liabilities,judgments, costs and expenses which CONST.TAX any way accrue agai t said City in consequence of the PERMIT ISSUANCE 10.00 ofthispa�mif. / �QQQ MECH.CONT. LIC.NO: MECH. p( �r-IS t-� TOTAL TOTAL 1 eo Applicant/Contractor Date OFFICE COPY