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17534 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 17534 INSPECTION DIVISION JOB INSPECTION RECORD • ��/�� / v�� _ - PERMIT EXPIRATION JOB ADDRESS —UNIT,# _LOT* - PERMIT EXPIRES IF WORK OWNER 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 PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PAID PLUMBING' 'I 9 �I ELECTRICAL MAY • p 1 �� ISSUANCE DATE MECHANICAL BLDG ELECT PLG. MECH City of CDP i& D ©�L 11 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WINFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL - ELECTRICAL PERMIT TO FRAMING jtrtb STORIES TYPE CONSTF. INSULATION • DEC GROUP •RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so r,.FLOOR AREA rorAL ACR EACF , DIAPHRAGM THE CONSTRUCTION TAX IS PAID . BUILDING USE ROOF SHEATHING HES IND -CON PB at,,, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Q E] ❑ E) D ASSESSORS PARCEL NO ROUGH. SANA PLUMBING - ELECT.ENERGY TUBS&SHOWER PAN PLUMBING ENERGY ranrr No. PARCEL No MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC.DATE ACC,PILE No FRAMING ELECT.FINAL TEST ZONING ENE.SITE NO. INSULATION PLUMBING - ��9^ GAS TEST GAS FIFE SPgINK [NE0 T-74MECHANICAL . COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ I "❑ EXTERIOR SHEAR ELECTRICAL RELEASE FL000 ZONE ALuc. INTERIOR SHEAR FIRE DEPT. Y p N❑ Y0 NO SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH , TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY..PHONING 252-4505„ ELECTRIC F 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 1GI r' CALLING FOR FINAL INSPECTION. OFFICE COPY -)ItAPPCICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER APPLICATION & PERMIT r° ADDRESS 17534 ADDnE55 ^�� // -I 7 IsµJV`I2� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL �. OWNER'S I PLAN CHECK VALIDATION NAME ,I 9{` •n/(/ TY. ELECTRIC PERMIT FEE • OR FNorvE /V �/V CONTRACTORS NX ME UTLETS-SWITCHES-RECEP 10.00/1.00AICO , uc.ND LIGHTING FIXTURES 10.00/1.00 CONTRACTOR croR's ADDRPP L IANC ES-RESIDENTIAL 4.00 CO �l NE O' PANELS 10.00 DATE OF APPLICATION ORPANELSPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.,NO. ENGINEER LIC.NO. SIGNS TRANS. 3.00 ADDRESS Ervc' SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 r ,,1 APPLICANT'S MOTORS SEE FEE SCH3-Al-�1 wric i . ADDRESS Q n SERVICE CHANGE 20.0 D¢ i r o o LICENSED CONTRACTORS DECLARATION rt p1+U I hereby affirm tivat I am licensed under provisions of Chapter 9MAY - ISSUANCE DATE r z w (emomencin with Section 7000)of Division 3 of the Business and y ¢ A g OG. ELECT. PLG. 'MECH. 7 Professions Cod e,a license Is in fullro c' d tri /� ❑, Z,i H o License Class�`-r Ily Lic.Nwnber *O2 VI Cupe ❑ ❑ W F w Uute ContraClor_ a M s < - BUILDING PERMIT ¢ 0 u U OWNER-BUILDf:R DECLARATION INFORMATION w3 u y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD Foo J Lew forthe following reason.(Sec.7031.5,Business and Professions pERM1T ISSUANCE 10.00 VALUATION $/FT. w Code:Any city orcounly which requires a permit to construct.alter, ac ¢ ¢ improve,demolish,or repair any stmehov,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. E o¢ requires the applicant for such permit to file a signed statement that TOTAL n w m" he is licensed pursuant to the provisions of the Contractor's License �y PERMIT TO rzi Law(Chapter 9(commencingwi[h Section 7000)of Divisian3oflhe r 'IJ1b a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE 1 , M¢ o ¢I- $ the basis for rhe alleged exemption.Any violation of Section malty STORIES TYPE CONSTR. a ; _ by any applicant fora permit dollars the$500).licannoucivilpenalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than flue hundred dollars($SOOIJ: ❑ I,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 Professions DRAINS-FLOOR,ROOF,AR EA,COND.. 5.00 Code:The Cmitoular'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- incdo,a.not intended or offeredl'or sale.If,hnwever,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM OVER 4 (EA.) 200 builder will have the burden of proving that he did ,or build or im- . - . . BUILDING USE prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ 1,as owner of the property,um exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to Construct the project(Sec.7044,Business 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-OVER 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ Iqm exempt under Sec.-,B.&P.C.for thisreason WATER HEATER W/VENT 6.60 O Owner Dau WATER SYSTEM - 5.00 ACC.GATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to sell'-insure, ZONING ENG.SITE N0. or a certificate of Worker'Comp ensatiyn Insurance,or a certified copy rhe y[(,Sgya/f00,i M1., /I,/A_' Policy ept 72&S7Conlp ny ✓, wE=dl Q O rti dcopy is here yfurnuhed. FIRE SPRINK ENERGY T24 Z Z Corti 'e copy Is hl with the city inspection division. - MISC.- REFER TO ORD. O Appbcant t�� V❑ N V❑ No ~ N zzz- PERMIT ISSUANCE ( FLOOD ZONE A.L.U.C. LU CIiR1'F CCOMPE COMPENSATION INS FROM WORKERS' W COMPENSATION INSURANCR PLG.CONTR. LIC.NO. PLT Y E] N❑ Y E] N❑ CL C1 (This section need not be completed if the peon it is for one TOTAL hundred dellars($1001 or less.) U O I certify that in the performance of the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not employ any person in any manner sn as m O W become subject to the Workers'Compensation Laws of California. y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } m NOTICE TO APPLICANT': If,Ther making this Certificate of 17x-- emptied,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 he deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MCF.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency lot EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work lot which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is corn"(. I agree to comply with all City and county PLUMBING (JD ordinances and stare laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby Lutheran representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection'purposes. (We) agree to save, Indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino ago st liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ay in any w accrue against mid City in consequence of the rantingofthis gnat. _ MECH.CONT. LIC.NO. MECH. 4 TOTAL TOTAL JG�oo Sign=e Of Applican r/Contractor Date, - V OFFICE COPY