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16561 POST THIS CARD NEAR'FRONT OF BUILDING CITY OF CUPERTINO PERAIITN6561 65 INSPECTION DIVISION JOB INSPECTION RECORD I� 'L- y K c� PERMIT EXPIRATION JOB ADDRESS 2,9,941 l,( h--n -�I UNIT# LOT# - - ` 1 L PERMIT EXPIRES IF WORK .OWNER CI coNTRnc*oa IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION UFER NOTE: ANCE OR 180 DAYS FROM - ' ALL GOADING AND DRAINAGE SHALLBE INSTALLED LASTCALLED INSPECTION. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLHMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .. UNDERGROUND /SLAB PLUMBING P J ELECTRICAL ISSUANCE DATE MECHANICAL •BLDG ELECT PLfi. mECR ❑ ❑ �{❑ ❑ —CO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR �I.� INFORMATION PLUMBING - - VALUAnoN $LFT. MECHANICAL ELECTRICAL y�RMli TO L FRAMING r`I INSULATION of cup, __stORFEs TYPE CONSTR. DCC GfOUP RES.UNITS PLACE ND SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ROOF NOTE:NO FINAL INSPSHALL BE MADE BEFORE so.Fr ROOF AREA TOTAL ACR CAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING BUILDING USE FEES IND CON PB UPm, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE IN ❑ ❑ ❑ ❑ ❑ ROUGH SAN.# ASSESSORS PARCEL NO PLUMBING ELECT..ENERGY TUBS&SHOWER PANPLUMBING ENERGY TRACT NO PARCEL No , MECHANICAL MECH.ENERGY - F ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO FRAMING ELECT.FINAL TEST INSULATION PLUMBING L ZONING ENG.SITE NO. GAS TEST GAS ' MECHANICAL FIRE SPRINK ENERGY T}A COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING .. Y ❑ N❑ Y ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.Luc. IN SHEAR FIRE DEPT. Y❑ N Y ❑ N❑ . SHEETROCK GRADE - - EXTERIOR LATHFEE SUMMARY BUILDING INTERIOR LATH TEMPORARY APPROVALS - BUILDING SCRATCH COAT ELECTRIC PLANCHECK GAS FEE NOT OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE OCCUPANCY OF RUILDI NG IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505,' ELECTRIC . ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING 00 — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL tf IMPORTANTI CONST.TAX PLEASE READ.REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION: TOTAL OFFICE COPY p/jPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY PERMIT NUMBER BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT 9m LONG 16561 AD DRE s_ „ 6,d)7&J s eUILOING-ELECTRICAL-PLUMBING-MECHANICAL PLAN CHECK VALIDATION OWNER b NAME O QTY. ELECTRIC PERMIT FEE PHONE O CONTRACTOR'S - OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME P N LIC.NO LIGHTING FIXTURES 10.0011.00 CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 AODRE55i PANELS 1000 DATE OF APPLICATION S• PHDNE (J PLAN CHECK FEE P.C.NO. Ali PANELS (OVER 200 AMP) 20.00 OR ENGINEER LIC.NO. SIGNS TRANS. 3.00 PERMIT VALIDATION AR.OR ENG. SPECIAL CIRCUIT 5.00 ADDRESS ZIP EMP.METER OR POLE INS. 20,00 APPLICANT'S MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 OK Z /� ' H o O LICENSED CONTRACTORS UECLARA'f10N C/ a v U I hereby affirm that I am licensed under ptnvisions of CImPuu 9 BUAN E DATE - y G y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, P MECH. r wi Professions Co1y.1 ilrffl rryq license is in 1Idl f tj (ICL ❑ Z O m License Class Lic Nmnbe 9 m Date Commcmr _ BUILDING PERMIT ¢ w u OWNER-BUILDER DECLARATION INFORMATION w 3 LL N I hereby affirm that I am exempt from the Contractor's License MISS.- REFER TO ORD VALUATION u.o a Law for the following reason.(Sec.7031.5,Business and Professions pERM1T ISSUANCE 10,00 rNo Code:Any city or County which requimsa permit to constRuct,aller, ¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTIL LIC.NO. ELEC. D¢ requires the applicant for such permit to lite a signed statement,ihat ITOTALERMI TO ¢ w m LL he is licensed pursuant to Ole provisions of the Contractors License rzi Law(Chapter 9(commencing with Section 7000)of Division 3 of the a Business,and Professions Code)or Him hu is exempt therefrom and OTV. PLUMBING PERMIT FEE ¢ r $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for apermit subjects the applicant too civil penalty "&VENT-AIN&VENT-WATER (EA.) 5. 0of not more than five hundred dollars(S500)J: ❑ 1,as owner of the progeny,or my employees with wages asW PROTECT.DEVICE 0 GRODPRES.urvrt5 their sole compensation,will do the work,and the structure is notintended or offered far sale (Sec. 7044, Business and ProfessionsLOOR,ROOF,AREA,COND. 5.09Code:'Fite Contractor's License Law does not apply to an owner ofproperty who builds or improves Ihercan,and.who Joes such workS-PER TRAP -5'.00 G SQ fT.FLOORAREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsurenot intended or nlfered for sola 11.howeveq thcbuilJingSYSTEM-11NC.40UTLETS 6.00or improvement is sold within one year of completion,the ownerSYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Om i, prove for purpose of sale.). IAL WASTE INTER. 30.00 ❑ 13 ❑ I,as owner of the property,am 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 contmctoos)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT ND. - PARCEL NO. the Contractor's License Law. - ❑ Iain exempt under Sec..,B.&P.C.lie this WATER HEATER W/VENT reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE No. WORK ERS'COM PIiNSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to scl Ginsum. ZONING ENG.SITE NO. or a certificate of Worker'Compensation Insurance,or a certified Copy the f�00.L b.C.). Policy No. Comp' yJ Q ❑ Ce i e opyis lmreb fornlshe FIRE SPRINK ENERGYTY< Z Z (.'er1I I opy 's Ole will, the city Inspection division. MISC.- REFER TO ORD. y � N� V � No E-' O Alp r9{ -'�- . '„ c W CERT1 9 A'FE 01:EXEMPTION FROM WORKERS' PERMIT ISSUANCE W FLOOD ZONE A.L.U.L. LLI COMPENSATION INSURANCE PLG.CONTH. LIC.NO. TLG OTAL OD Vo N� V� N� D- O (This section need not be completed if the permit is for one D Z hundred dollars(S 100)or less.) FEE SUMMARY U O I certify that in the perlo mance of Ila work far which O,is per- OTV MECHANICAL PERMIT FEE h mit is issued,I shall not employ any person in any manner sit as to O w become subject to the Workers'Compensation Laws of California. BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 } y NOTICE TO APPLICANT': If,after making this Certificate of I, F ? emption,you should become subject to Him Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply w'itR AIR HANDLING UNIT(TO 10,OODCF.M.) 4.00 FEE 1..1 such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ C.). ' Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 PLUMBING s� ® ordinances is correct I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 ordinances and xmte laws relating to building construulian, and hereby authorim representatives of this city to enter upon the BO(LER-COMP love,100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We-) agree t save, indemnify and keep harmless the City of MISC.- REFER TO ORD. uPcrtino against had, itics,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may any way cerue against said City in consequence of the ing f this peri 'l. MECH,CONT. LIC.NO. MECH. , TOTAL TOTAL 60 Signet of Applicant/Contractor Date OFFICE COPY j