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17627 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER ` CITY OF CUPERTINO 17627 INSPECTION DIVISION 0 JOB INSPECTION RECORD _ pp�rf), //T� `•, ,E /I T n r— ✓' PERMIT EXPIRATION JOB ADDR ESS Z( rD 'T�rly l'e l Y 1 UNIT# _LOT# E� PERMIT EXPIRES IF WORK OWNER Ar V .] CONTRACTOR - IS NOT STARTED WITHIN INSPECTION - DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION , ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION PREGUNITE CUPERTINO STANDARDS. n. GARAGE SLABS 'C,•�'y /l' _ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - - �� �•� UNDERGROUND /SLAB APR /' PLUMBING Cl !'7 vk �' �•�'rC I ELECTRICAL city at cupQ - ISSUANCE DATE fILOG, ELECT PLG. MECH. MECHANICAL El 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT " INFORMATION WOOD FLOOR + _ VALUATION $/FT. • PLUMBING '- nI V I 00 MECHANICAL _ '" © PERMIT rU ELECTRICAL - FRAMING I I STORMS TYPE ONSTH. INSULATION OCC.GROUP • RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - SQ IT FLOOR AREA i01AL ACREAGE. -,ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING Hes IND- CON PR on— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.# - PLUMBING ELECT.ENERGY TUBS B SHOWER_PAN PLUMBING ENERGY ,f' HRCT No. PARCEL No: . MECHANICAL - - MECH.ENERGY ' ACC,DATE ACC,FILE NO ELECTRICAL BUILDING ENERGY FRAMING —'L 1 ELECT:FINAL TEST .. ZONING ENG.SITE N0. INSULATION PLUMBING GAS TEST - GAS - RIREST'RINA ENERGY L'I4 _ MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑' ° ❑' "❑ EXTERIOR SHEAR ELECTRICAL RELEASE - FLOOD rorvE aL u.c. i INTERIOR SHEAR FI RE DEPT. Y❑ N❑ - Y ❑ .N❑ SHEETROCK —2 GRADE 7 FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS - BUILDING _ ;0'O' SCRATCH COAT ELECTRIC PLAN CHECK - GAS . FEE1 NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - ' _SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMIT.TED UNTILBUILDING FINALISSIGNED BY.BUILDING INSPECTOR. "'M, ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC 2f 0o Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z0�. PLEASE GIVE JOB ADDRESS WHEN.PHONING.. -"SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL 6 CALLING FCIR..FINAL INSPECTION. OFfICECOPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT.PEN ONLY Buipil NG PROJECT I DENTI FICATI ON PERMIT NUMBER BD,LD,NG APPLICATION & PERMIT 1�,a• •/�/ ADDREES - 17o Z 7 2Q T (J2• BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OwrvERE - I PLAN CHECK VALIDATION NAME-� 'N qR f 1I 1S PRONE /' ^j 3 3 r((''ee'� CITY. ELECTRIC PERMIT FEE 1 a� NAMER croHs OUTLETS-SWITCHES-RECEP 10.00/1.00 Iv _ uc.NO. LIGHTING FIXTURES "1 0/1.00 1 CONTRASDDRESS oRs APPLIANCES-RESIDENTIA .00 PHONE PANELS 1 ,00 DATE OF APPLICATION 0RcH,recr PANELS (OVER 200 AMP 0.00 PLAN CHECK FEE P.C.N0. ENGINEER LIC.NO SIGNS TRANS. 3.00 ADDRESS END SPECIALCIRCUIT 5.0PERMIT VALIDATION ZIP TEMP.METER ChkPOLkINS. 2 . ADDAcsars MOTORS SE E SCH. ` SERVIC C NGE _ I ,pp �,}1 I1�, O ¢ z V 0 \ ( T-� YIIXL 0 � LICENSED CONTRACTORS DECLARATION < u I hereby affirm Thal 1 am licensed antler provisions of Chat pier ., 2 w ISSUANCE DATE N 4 N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H m z Professions Code,:uul my license is in full force and effect �.{�� J ® ❑ ❑ o i m License Class Co Number Cu WID . y H Date Contractor a r � BUILDING PERMIT tc w4 OWNER-BUILDER DECLARATION U C. EFER TO ORD INFORMATION w ;u y I hereby affirm that I am exempt front the Contractor's License VALUATION $/FT. r- LL O a Law for the following reason.(Sec.7031.5,Businessand Professions PER SUA _ 10.00 Z O D Q V Cade Any city Or count,which regal res it permit to construal,nlmq / D rt ¢Qimp rove,demolish.or repair any structure,prior to its issu love,also ELEC.CONT H. LIC.NO: ELEC, r O u requires the applicant for such permit In file a signal statement that TOT wm he is licensed pursuant to the provisions of the Contractor's License PERMIT TO N Law(Chapterand Pro(commencingsinsode)or Shahan 7s 00)exempt ivision 3 of and �{ ce 4 O he Business and lia alleged Cod.)or that he is cion of therefrom and CITY. PLUMBING PERMIT FEE 1 ` I t ,-$ the basis for the alleged exemption.Any violation t to.cion malty STORIES TYPE CONSTR. i 3 - by any applicant for a permit subjects the 0h.): nm In a civil penalty of not more than five hundred dollars($500h.): ALTER-DRAIN& VENT-WATER'(EA.) 5.00 ❑ I,as owner the property,e 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 (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of Properly who builds or improves that.....,and who does such work FIXTURES-PER TRAP5.00 5D.FT,FLOOR AREA TOTAL ACREAGE himself or through his own on,ph yeas,provided That Such imprnvo- ments are not intended or offered for sale.If,however,the building . GAS-EA.SYSTEM-1INC.4 OUTLETS 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 GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer -❑ I,as owner of the properly,am exclusively cmu'acling veld, • ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the Project(See. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Codc:The Contractors License Law does not 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 c.rhaetor(s)licensed pursuant to the Contractor's License Law. I SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. -❑ 1 am exempt under Sec. ,B.&P.C.for this reason WATER HEATER W/VENT - 6.00 Owner Dute ! - WATER SYSTEM 5.00ACC.DATE ACC.FILE-No WORK ERS'COMPENSATION ULCLA RAT ION ' WATER TREATING EQUIP.' 5.00 I hereby affirm that I have a certificate ofconscnl to self-insure. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.0). - Policy No. Company Q ❑ Certified cop,is hereby funtished FIRE SPRINK ENERGYT20 Z ❑ Certified copy is filed with the city inspection division. P: O ARONC:ml MISC.- REFER TO ORD. Y ❑ N❑ v ❑ No �. L4 CERTIFICATE OF I!XCMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C. LU > COMPENSATION INSURANCE PLC,CONTR. LIC.NO. PLG, D' O (This vection need not be completed if the permit is for one TOTAL Y[:] N❑ Y❑, N❑ Z hundred dollars IS 100)or Tess.) U O 1 cerlify that in the perfommuce of the work I'or which tl,is per- QTY_ ' MECHANICAL PERMIT • FEE FEE SUMMARY LL I- mil is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of Califumia. - ' � y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING �J ' �V } W - NOTICE TO APPLICANT'If,after nmking this Certificate of Ex- Z emption,you shroud become subject to(lie Workers'Conporimima APPLIANCE 5.00 PLAN CHECK t provisions of the.Labor Code, you nwst hothwilh comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.FAU 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVEB 10=C.FM.) 6.00 SEISMIC FEE . �0 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 Lender's Name H EATING U N IT(OVER 100,000 B.T.U.)9.50 / . Lender's Address 'ELECTRIC ` 1 cerlify Ila,I have read this application and scamtha(tine 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 huilding,construction, and BOILER-COMPI3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives is inspection on city to enter upon the .. BOILER-COMP(Over 100,000 BTU)SEETEE SCH. MECHANICAL above-mentioned property(orinsp of fli puity to (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' by accrue against said City in consequence'of the PERMIT ISSUANCE 10.00 Ita ng aft pe MECH.CONT. LIC.NO. MECH. jy _l 1 = TOTAL TOTAL Signature of Applicant/Contractor Dale_ • 1 OFFICE COPY Q�