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16669' POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION y JOB INSPECTION RECORD JOB ADDRESS //GO c1�� �[ "'^�� ��'�/=- c7"UNIT# _LOT# OWNER V CONTRACTOR '5�:— Z E4 2! CJ PERMIT NUMBER 16669 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180.DAYS OF PERMIT ISSU. ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION DA E INSPECTOR INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL 13E INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. LIFER PREGUNITE PERMIT VALIDATION q ., e%Q pf%jpV ISSUANCE DATE G ELECT PLc. MEC« GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING Of� - , ELECTRICAL MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR - PLUMBING f VALUATVN V g+FT. MECHANICAL ELECTRICAL PERMIT TO c -Fr ELe is FRAMING. - INSULATION STo IES TYPE CONSTn. - OCC. GROUP RES. UNITS ' 'PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID SOFT FLOOR AREA . TOTALACREALE ' j DIAPHRAGM ROOF SHEATHINGRes INOUILDING USEPa 00oN,I ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. - ROUGH SANS ASSESS ORS PA RCE L NO ' PLUMBING - ELECT. ENERGY TUBS & SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO MECHANICAL MECH,ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC. FILE NO ' , FRAMING ELECT. FINAL TEST INSULATION PLUMBING ZONING ENG. SITE NO. GAS TEST GAS MECHANICAL ,FIRE SPRINK v ❑ NF]' ENERGY 1.74 Y ❑ NO COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE Y ❑ N❑ A L U.C. Y ❑ No INTERIOR SHEAR FIRE DEPT. - SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR,LATH ,T,EMPORARY APPROVALS tj SCRATCH COAT ELECTRIC PLAN CHECK FEE - - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, F -ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. ELECTRIC a� PLUMBING' MECHANICAL CONST. TAX TOTAL OFFICE COPY _., -APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FICATION - APPLICATION &PERMIT BUILDING—ELECTRICAL—PLUMBING—MECHANICAL PERMIT NUMBER 16669 ADDRESS d Aon Ess Q �Y G OWNER'$ NAME l/ /� Q✓•I}. PHONE ✓ CITY- ELECTRIC PERMIT FEE PLAN CHECK VALIDATION NAME °R5 I .zG/�Yiii/ uc.Na G.S�� UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ADDRESS S.y/1�✓i/ G PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 sr Q� ONE DATE OF APPLICATION.--! ORRCHITECi ENGINEER LIC. NO PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.G. NO: ISIGNS TRANS. 3.00 nooeess ENG. SPECIAL CIRCUI 5,00 PERMIT VALIDATION EMP. METER78 POLE IN 20.00 ' ZIP (\(�//f►`/'C.J, '- APPLICANT '$ ADDREss ! r Jy Y S qA i[ MOTORS SEE FEE SCH. SERVICE CHANGE 20 LICENSED CON TRACTORS DECLARATION I hereby affirm that I am licensed under provisima of Chapter (commencing with Section 70001 of Division 3 of the Business and Professions Code nd my license is in full fort < c License Class Lie. Nmnber Date Contractor ISSUANCE DATE BLDG. ELECT. PLG. MECH. 0 ❑ ❑ ❑ Cope v OWNER BUILDER DECLARATION I hereby nolle that I am exempt from the Contractor's License Law( Athe followingreason. (Secuiresa,ernut lssand Professions Code r Any city or county which requirese permit to construct, ah`q p � \tY BUILDING PERMIT INFORMATION MISC. — REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION $/FT. ELEC. CONTR_ LIC. NO. ELEC. �Of TOTAL Q t improve, he applicant repair h permit toff pa sigmr to its issuance, also requires licensed the applicant for such permit t° file a signed statement that License he is licensed pursuant to the provisions of the ) ofD Division : inessa and Dtherefrom the Business and Professions Code) or that he is pt therefrom and Professions odeng ) or Section is exempt PERMIT TO QTY. PLUMBING PERMIT FEE the basis for the alleged exemption. Any applicant of Section malty by any applicant fora permit subjects lheopplicam macivil penalty of not more than five hundred dollars : STONES TYPE CONSTR. ALTER-DRAIN&VENT-WATER(EA.) 5.00 O _L my em as owner the property, or my employees with wages as their sole compensation, will Ja the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM -1 INC.4 OUTLETS 6,00 $O. FT, FLOOR AREA TOTAL ACREAGE property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- meritsarenetintendedoroffered for sale. If, however, the building or improvement is Sold within one year of completion, the owner - builder will have the burden of proving that he did not build or am- I GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE Drove for purpose of sale). ❑ L as owner of the property, am exclusively contracting withINDUSTRIAL RES IND CON PB Gore, El 0 El El El WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code: T'n The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 l ASSESSORS PARCEL NO. contracts for such projects with a contraetons) licensed pursuant to the Contractor'sLicense Law. ❑ Iamexempt under Sec. - ,B.&P.C. for this reason SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6,00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE N0. WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION 1 hereby affirm that I have acertifrcateofconHot toself-insure, ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, or a ramified e ocof Isco 3800, Loh.C.l. Z / Polleylicy No Compo y P�Qv�r ❑ Certified copy is her y./' nished. p/ CerI111' CO y es II I pC IOD division. Ap'pilcant! FIRESPRINK YE] N� ENERGY T-24 Yo NE] MISC- REFER TO ORD. CERTIFICATE, 017 EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE (This section need not be completed if the permit is for one PLG, CONTR. LIC. NO. PLG. TOTAL v ❑ N Y ❑ N❑ hundred dollars IS 100) or les,) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any mannerso as to CITY. MECHANICAL PERMIT FEE FEE SUMMARY become subject to the Workers' Compensation Laws of California. ALTER OR ADD TO MECH. 5.00 Date Applicant BUILDING NOTICE. TO APPLICANT: If, after making this Certificate of us- APPLIANCE 5.00 AIR HANDLING UNIT (TO 10MDCF.M.) 4.00 PLAN CHECK FEE emption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.T EXHAUST HOOD (WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name Lender's Address H EATI NG UN IT (O V ER 100,000 B.T.U.) 9.50 ELECTRIC low I certify that I have read onsapplicution and smte that the above VENTILATION FAN (SINGLE) 4.00 information is correct, 1 agree to comply with all city and county ordinances and state laws relating to building construction, and representatives of this'city to enter upon the hereby above-mentioned above-mentioned property torinsp of th purposes. PLUMBING BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP IOver 100,000 BTU) SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of Cupertino against li ilities, judgments, costs and expenses which may in any way term` against said ity in consequence of file g nor % /a MISC. - REFER TO ORD. PERMIT ISSUANCE 10.001CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL TOTAL��- S4 Signat re of Applicant/Contractor D' OFFICE COPY