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18368:POST THIS CARD NEAR -FRONT OF BUILDING ,,FCITY*OF CUPERTIN_O INSPECTION DIVISION . JOB INSPE TION RECORD JOB ADDRESS 699WZF - UNIT# LOT it OWNER " - CONTRACTOR (PERM IT NUMB - 18368 PERMIT EXPIRATION' PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYSOF PERMIT ISSI ,ANCE OR 180 DAYS FROM . "LAST CALL EDI NSP ECTION. " INSPECTION DATE -INSPECTOR' INSPECTION RECORD FOUNDATION- . , NOTE: •' ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CIN OF CUPERTINO STANDARDS. r� - LIFER - PREGUNITE." - - •'' PERMIT VAL DnnON . .� t,.'*i„ Imo{ -• } 09 c: .r DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED- - h J: ' .UNDERGROUND/SLAB PLUMBING. • ' City -ISSUANCE ELECTRICAL � MECHANICAL ._ - .. .. .BCD(l .ELECT. . E] ❑T, PLG. MECR, ❑ ❑ DO NOT POUR FLOOR UNTIL'ABOVE HAS BEEN SIGNED • BUILDING PERMIT INFORMATION - WOOD FLOOR PLUMBING �"' �� ,. . I _- VALUATION - S/FT. MECHANICAL ELECTRICAL - PERMIT To - • I,�{_..N . FRAMING INSULATION - - - STORIES tYPFCONSTH. - OCC. GROOT RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ROOF - � NOTE: NOFINALINSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID"- .. '.. 1. T,FLO()H FRED TOTAL ACHEAGC DIAPHRAGM ROOFSHEATHING ` LULNON USEpaOu,. RES P IND ❑ ❑ OL ❑ ❑ APPLY NO ROOFING UNTIL ABOVE'HAS BEEN SIGNED- FINALS DATE INSP. ROUGH . SANA, —" nsssssovs PnncELNo. PLUMBING., L ELECT ENERGY - TUBS 6 SHOWER PAN PLUMBING ENERGY THACTNU � PARCEL NOL ' MECHANICAL. MECH.ENERGY ' - - ELECTRICAL BUILDING ENERGY ' 'ACC DATE- Acc. FILE No ' FRAMING .. ,' ELECT. FINAL TEST,. INSULATION - PLUMBING. ZONING - -ENG, SITE N0. GAS TESTI - . GAS MECHANICAL FIRE SPRINK ❑ N❑ ENERGY T.24 ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR _ ELECTRICAL RELEASE FLOOD ZONE-A.L Y❑ N❑ u.C. . Y, _1IN INTERIOR SHEAR - FIRE DEPT,�— SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH .. - - - BUILDING BUILDING , , INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC } ..'PLAN CHECK' FEE - - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED_ BY BUILDING INSPECTOR. MICROFILM ELECTRIC ' ARRANGE.FORINSPECTION BYPHONING 252-4505, ILL! ONE -WORKING' DAY. BEFORE REQUIRED INSPECTION..;1 z PLEASE GIVE JOB ADD1.RESS WHEN PHONING. —SEE PERMIT FOR EXPIRATION DATE - '1 PLUMBING MECHANICAL r 7 coNST. rnx IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL cl OFFICE, COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BU I LDING PROJECT IDENTIFICATION ` APPLICATION &PERMIT BUILDING—ELECTRICAL—PLUMBING—MECHANICAL - PERMIT NUM R ^ e ADDRESS • +�' ^'�h�pl OwNER'S - \r(�p' -1�t: NAME . AM PHONE - - OTV. - ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTO 'S NAME Dal�1 \ uc. No. OUTLETS -SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES. 10.00/1.00 CONTRA VL7 3Z\— ADDRESS PPLIANCE_S- RESIDENTIAL •' 4.00 .PHO I' PANELS 10.00 DATE OF APPLICATION' Oqc ECT - ENGINEER LIC, NO PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NU. SIGNS TRANS.,' 3.00 ARC H. oR ENG. ADDRESS ' ' - ZIP $PEDIAL CIRCUIT PERMIT VALIDATION �Op �I P-Iq EMP. METER OR POLE INS. 20.00 APPLICANT'S - " ADDRESS - MOTORS , SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby arDrm thal-I am licensed under provisions of Chapter9 ' (commencing with Section 7000) of Division 3 of the Business and ISSUANCE DATE Putl'cssiuns C'o oulyyN l�ensc is in lull forL� yy Fff (� LiccllPq C�jss f" il�.. -. Cin. ract, x�T— Dale (sjC\___ Con[ rano V OWNER -BUILDER FECLL , C— , ELECT./ PLG. MECH. ❑ E '' ❑ , ❑ LJ BUILDING PERMIT 1 f , V CI )3 198 . I hereby affirm that 1 am exempt from the Coritraetor'.s License INFORMATION MISC. — REFER TO ORD Law for the following reason. (Sec. 7031,5, Businessand Professions Code: Any city or calmly which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation Of Section 7031.5 by any applicant for a permit subjects the applicant too civil penally = of not more thin five hundred dollars ($5001.): ❑ L US 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 Code: The Contractors License Law does ,orapply to an owner of property who builds or improves thereon, and who does such work himself Or through his own employees, provided that smelt improve- PERMIT ISSUANCE - - VALUATION $/FT. ELEC. CDN LIC. NO. ELEC. 5� M Cis ` TOTAL ' 9150 PERMIT TO CITY. PLUMBING PERMIT FEE 1 ALTER -DRAIN& VENT;WATER (EA.) 5.00 STORIES'TYPE _ CONSTR. . BACK FLOW PROTECTDEVICE 4.00 ODD. GROUP ' RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES -PER TRAP 5.00 ' so. PT. FLOOR AREA TOTAL ACREAGE mems are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner. builder will [lave the burden ofrovin g that he did not build or im. P 6 prove for 1, aso neeose of sale). ❑ L as owner of the property, he exclusively contracting with licensed nsCacontractor, to construct the Project (Sec. 7044, Business anA Professions Code: The Comructor's License Law does not apply GAS - EA. SYSTEM -11NC.40UTLETS 6.00 - GAS - EA. SYSTEM - OVER 4 IEA.) 2.00 - BUILDING USE RES IND CON PB• 'ONer 1' ❑ ❑ El INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. to an owner of property who builds or improves thereon, and who contracts for such projects with a tOntraclor(s) licensed pursuant to the Contractors License Law. ❑ I am exempt under Sec , B.&P.C. fmr this' reason' LAWN SPRINKLERS -OVER 5 (EA.) 1.00 SEWER-SANITARY-STORM EA. 200ft/10.00 TRACT No. PARCEL No. WATER HEATER W/VENT 6.00 Owner Date WORKERS'COMPIiNSATION DIPCLA RATION I hereby dffirm that I have a cerlifcaie ofconsent to sel Ginsure, WATER SYSTEM 5.00 ACG DATE ACC. FILE NO. WATER TREATING EQUIP, -5.00 - or n certificate of Workers' Compensation Insumn c, or a cernfiad- copy the ��'! 00, Lab.C.) • Policy Ndl I rompany '..�� '' -❑ Certified copy is h erebyl , ZONING ENG. SITE NO:. -. FIRE SPRINK YE N� ENERGY T 2 YE' NE] Cerld �(L co�ty, is f11a�1 with t c city Ispcction division. pplicanl-LJ• YL L'_rr Lpt� - MISC.- REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' "COMPENSATION INSURANCE. .. (Phis section need not be completed if the permit is for one hundred dollars IS 100) or less.) PERMIT ISSUANCE - 10.00 FLOOD ZONE Y [:] IN A.L.u.C. PLG. CONTE. LIC. NO. PLG. TOTAL CITY. MECHANICAL.PERMIT FEE 'FEE SUMMARY' ' I certify thal,in the performance at the work for which this per- mit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant N. NOTICE 'f0 APPLICANT: If, after making this Certificate BUILDING' ALTER OR ADD TO MECH. .5.00 m emption, you should become subject the Worker Compensation tion ion provisions the. Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. • APPLIANCE 500 AIR HANDLING UNIT (TO 10,000GF.M.) 4.00 PLAN CHECK FEE CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10ACC.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issue) ISec. Lendes Name Lender's Na EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT(TO 100,000 B.T.U.) 8.00 9r Lender's Address HEATING UNIT (OVER 100,000 B.T:U.)8.50 ELECTRIC 9 — VENTILATION FAN (SINGLE)' 4.00 BOILER- COMP(3 H.P. or 100,000 B.T.U.) 6.00 I certify that I have read this application and slate that I..L above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives ofthis city to enter upon the above-mentioned property for inspection purposes. (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 ranting of this permit. - Mr.�.. 5 alme� t �- `1--V4�i Stgna re of pphcantl ntruc or Date .f PLUMBING BOILER -COMP (Over 100,000 STUI SEE FEE SCM. MECHANICAL 21 O MISC. - REFER TO ORD. PERMIT ISSUANCE HEI.. 12 CONST. TAX MECH. CONT LIC. NO. MECH. CNIN11 K.M�u�lr ZI�iCr TOTAL � 2j. �' TOTAL Si qO OFFICE COPY