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16562 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER, CITY 01 CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD ' T..� - - PERMIT EXPIRATION' JOBADDRESS .��.� �A7Tcs'/Z O-S-K _( / UNIT# _LOT# " PERMIT EXPIRES IF WORK r OIN4R LlU CONTRACTOR C , - L IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- i FOUNDATION - - - . ANCE OR 180'DAYS FROM NOTE: LAST CALLED INSPECTION. UFER ALL GRADING AND DRAINAGE.SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. " POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED P UNDERGROUND /SLAB PLUMBING • - — ' ELECTRICAL - ISSUANCE RATE MECHANICAL BLDG. ELECT I PLG,. MECH. ❑' ❑. ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION • WOOD FLOOR VALUATION siET. PLUMBING MECHANICAL ELECTRICAL PAID PERMIT TO FRAMING INSULATION STORIES TYPE CONSTR DCC-GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sa.Pr FLOOR ABPA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING • RES INo ILDCON USEPH O APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS FDATEINSP: I] ❑ El 11ASSESSORS PARCEL NO ROUGH SAN.H PLUMBING ELECT.ENERGYTRACT NOPARCEL NO TUBS&SHOWER PAN PLUMBING ENERGYMECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY - _ Acc.OATS AccEILE rvO. FRAMING - ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION- PLUMBING' GAS TEST GAS MECHANICAL - - PIRESPR INK 'ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING .. Y ❑' "D ` "C EXTERIOR•SHEAR ELECTRICAL RELEASE _ FLOOD ZONE II L uc. INTERIOR SHEAR FIRE DEPT. Y E] N❑ Y ❑ N❑ 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 BEENSIGNED JOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252,4505, ELECTRIC 0 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING '.� PLEASE GIVE JOB ADDRESS WHEN PHONING. z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX ' PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ` BUI LDI NO PROJECT 1 DENTI FICATION , - APPLICATION & PERMIT •PERMIT NUMBER oILDIN As 57,8f� D BUILDING —ELECTRICAL—PLUMBING—MECHANICAL 16562 ' OWNER'S PLAN CHECK VALIDATION NAME CITY. ELECTRIC PERMIT FEE COAJ Rs NAME DTD / UTLETS-SWITCHES-RECEP 10.00/1.00 NAME I uc.rvo LIGHTING FIXTURES 10.00/1.00 .0 TRACTOR'S APPLIANCES-RESIDENTIAL 4.00 ADDRESS 1 LD (� , / PHON �d PAN ELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.OiNO. OR ENGINEER uc.NO. SIGNS TRANS. 3.00 ARCH.OR ENG. - SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS. 20.00 ,�•� APPLICANT'S - - - MOTORS SEE FEE SCH. ADDRESS . SERVICE CHANGE 20.00 �o o LICENSED CONTRACTORS DECLARATION - U u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE v,a i (commencing with Section 7000)of Division 3 of the Business and BLOG- ELECT. PLG. MECH. r w z Professions Co -a license is in fall for El11D w— License Class Lie.Number q w Date Contractor BUILDING PERMIT Lr ¢ se u OWNER-BUILDER DECLARATION INFORMATION K 3 LL N 1 hereby affirm that 1 am exempt from the Contractor's License MISC._ REFER TO ORD p VALUATION $/FT. FLLo J Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, or ¢Q Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. D ¢ requires the applicant for such Permit to file a signed statement that TOTAL PERMIT TO - d au m he is licensed pursuant to the provisions of the Contractor's License Fzi Law(Chapter 9(commencing with Section-7000)of Division 3 ofthe �L-a �- et Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE i O STORIES TYPE CONSTR. ¢ r $ the basis for the alleged exemption.Any violation of Section malty by any applicant fora permit subjects the 00.)applicant oacivilpenalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(my em): ❑ I,as owner at the property,or my employees with wages as BACK FLOW PROTECT. DEVICE OCC.GROUP RES.UNITS their sole compensation,will the work,and the structure is not intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 5.00 Code:The omrad License Law does not apply to an owner of property whh or builds Or improves thereon,and who does such work FIXTURES-PER TRAPD SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1 LE 6.0 ments are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) B((I BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Omar prove for purpose of sale.). INDUSTRIAL WASTE INTER. .00 ❑ ❑ El El 11❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I 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 contractor(s)licensed Pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ',B. .P.C.for this WATER HEATER W/VENT 60 reason Owner Date WATER SYSTEM 5.00 ACC,-GATE ACC.FILE NO. WORK ERS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a cerfificale of consent to self-insure. ZONING ENG.SITE NO. - P ertificate of Workers' ompensytua insuranpe,or u certified r f( 00,LaC.NA/.zw$07_�/3— �lV6 Compal kI K Q dey is hereby furnished. FIRE SPR INK ENERGY T 24 Z Zterrified y i filed v ilh the city inspection division. REFER TO ORD. Y ❑ N❑ Y ❑ N❑ P: Ocanl ,M yCI RTIFI ATI:OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 2X30 FLOOD ZONE A.L.U.C. LU >_ COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG ^y' 1 O (This section need not be completed if the permit is for one - TOTAL N Y❑ IN Y[:] NE] D Z hundred dollars($100)or less.) U O 1 certify that in the performance of the work for which this per- GTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,1 shall not employ any person in any manner so as to Q L) become Subject to de,hWorkers'Compensation Laws of California. BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 } rt, NOTICE TO APPLICANT: If after making this Certificate of Ex- emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with FEE (� such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction leading agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.CJ. Lender's Name 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 n correct. I agree to comply with all city and cmuN1d BOILER H.P.or 100,000 B.T.U.) 6.00 PLUMBING QO ordinances and slate 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. agree to save, indemnify and keep harmless the City of MISC.- (we) REFER TO ORD. Cupertino agai st liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 . CONST.TAX may in any w' accrue against Said City in consequence of the ing Of this fruit. MECH.CONT. LIC.NO. MECH. TO �T71 TOTAL TOTAL Si12.m of Applicantlicanl/C�cor Date OFFICE COPY