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17081 POST THIS CARD NEAR FRONT OF BUILDING . PERM IT NUMBER CITY OF CUPERTINO 17081 INSPECTION DIVISION JOB INSPECTION RECORD 1 PERMIT EXPIRATION WO JOB ADDRESS VI LTJ FYi�/(/J1M1�lXu INA /1.11 UNIT# LOT# E� PERMIT EXPIRES IF WORK _ OWNER a CONTRACTOR 01 IS NOT STARTED WITHIN + INSPECTION DATE INSPECTOR IINSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. _ GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB �f 1" �• r r PLUMBING >� I ELECTRICAL ISSUANCE DATE MECHANICAL - _ BLDG, ELECT PLG. Me❑CH ❑ El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - �g,LIN "NG PERMIT AqLe1 f�`1 INFORMATION ' WOOD FLOOR AN 1 l VALUATION siFT. PLUMBING - MECHANICAL City of C IABftIDO PERMIT TO ELECTRICALL. FRAMING — (/ !i I s*ogles TYPE comsR INSULATION OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 50 Fr FLOOR AREA 'TOTALACREAGE • ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IND CON PB oIm• APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El E1 ❑ 0 D ED' ASSESSORS PARCEL N ROUGH SAN.# PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY T MECHANICAL MECH.ENERGY ELECTRICAL - ACC DATE ACC.FILE NO BUILDING ENERGY. - FRAMING ELECT.FINALTEST ZONING ENG SITE NO, INSULATION PLUMBING GAS TEST GAS - FIRE SPR INK ENERGY LIG MECHANICAL ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - v N� v "�' . KLooD ZONE I I A.L a C. EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. v❑ Nv ❑ N[J� SHEETROCK GRADE FEE SUMMAf1Y EXTERIOR LATH BUILDING INTERIOR LATH - TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANQY J I SEISMIC FEE, OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC I- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - ' ' MECHANICAL IMPORTANT! CONST.TAXI PLEASE READ REVERSE SIDE BEFORE *' TOTAL CALLING FOR FINAL INSPECTION. fr (Y) .. OFFICE COPY PPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER mDItDING APPLICATION & PERMIT nd 17081 ADOREs�� , f3� N00� BUILDING — ELECTRICAL—PLUMBING—MECHANICA`i, . Ow EH'S' lV �C ff PLAN CHECK VALIDATION NAME OTV. ELECTRIC PERMIT , FEE v Cffh40AT�F�NE4 c-23 CNAME ONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 rJ C^IQ,'/' [1) uc.NG.$l 4(02'd LIGHTING FIXTURES 10.00/1.00 ADDRESS �I PPLIANCES-RESIDENTIAL 4.00 - *QTJC 4- D PHONE :Jf314:kgJ 1PANELS 10.00 DATE OF APPLICATION OR PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. RR ENGINEER Lie No. SIGNS TRANS, 3.00 ARCH,OR ADDRESS ENG ♦ I - SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. .20.00 J• �A ITOWM l APPLICANT rS MOTORS SEE FEE SCH. I—T V ADDRESS df Ajy� �'[} �" SERVICE CHANGE 20.00 a I IBJ I g' 2 r 0 0 o O LICENSED CONTRACTORS DECLARATION - ¢ O o I hereby affirm that I am licensed under provisions of Chapter 9 -TIAN 19 ISSUANCE DATE as < w (commencing with Section 7000)of Division 3 of the Business and DG. ELECT. _ PLG. MECH. H z Professions Code and my license is In full force andeffect o z w License Class t/Lic.Number 1 _F_ ❑ F a t aa Dale Contractor City (t Capert r E BU ILDIN PERMIT a ¢ 4 OWNER-BUILDER DECLARATION o a Ei INFORMATION X g y I hereby affirm that 1 am exempt from the Contractor's License MISC.— REFER TO ORD o- LL0 J Law for the following reason(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. � 0 Code:Any city orcounty whichrequiresapermittocostral,alter, ac p 4 2' Improve,demolish,or repair any structure,prior to Its Issuance,also ELEC.CONTR. LIC.NO. ELEC. a D ¢ requires the applicant for such permit to file a signed statement flat TOTAL w m LL he is licensed pursuant to the provisions of the Contractor's LicensePERM IT TO z i- Law(Chapter 9(conimencing with Section 7000)of Division 3 ofthe Ip 4 o Business and Professions Code)or that he is exempt thereGons and DTV. PLUMBING PERMIT FEE ¢r m the basis for the alleged exemption.Any violation of Section 7031.5I STORIES TYPE CONSTR. a3� by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(SSOOM: ❑ I,as owner of the properly,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 Contractor's License Law does not apply to an owner of property who builds or improves Otereon,and who does such work FIXTURES,PER TRAP "00 SD.FL FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 ' or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or iso- RES IND CON PB Om., for purpose of sale.)' INDUSTRIAL WASTE INTER. .30.00 ❑ El ❑ El El and owner of the properly,ism exclusively contracting with licensedd contractors to nmt the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:TheeCoContractor's License Law does not apply 1 M , to anowner of property who builds tr es improvthereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 l-ll contracts tot such projects with contacmrts)licensed pursuant m SEWER-SAN ITARV-STORM EA.200ft/10.00 the Contractor's License Law. TRACT-NO.- PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Data WATER SYSTEM •5:00 s ACC.DATE ACC.FILE NO. WORK ERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Luh.C.). Policy No. Company O Cl Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is fled with the city inspection division. O Applicant MISC.- REFER TO ORD. Y❑ N❑ v ❑ N❑ CC CERTIFICATE OF ESIiMPTION FROM WORKERS' PERMIT ISSUANCE ' 4&-.m FLOOD ZONE A.L.U.C. W D COMPENSATION INSURANCE. PLG.CONTE. LIC.NO. PLG. CL 0 (This section need not be completed if the permit is for one 'TOTAL IkUr� Y❑ NEIY E] N❑ hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY U_ F mit is issued,I shall not employ any person in any manner so as to O U become saly le Workers'C mpensatlon—LIScos'of alio air. y Date Applicant BUILDING ;Cit Ic "I ALTER OR ADD TO MECH. 5.00 } W IS I T APPLICANT: IC a to making this Ccrtili lte o Ex- Z emption,you should become subject to the Worker Compensation APPLIANCE F- — 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10,0DOC.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD.(W ITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 6.00 Lender's NameH EATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC IcerlBy.that l have rend thisapplicatioa and state that file above VENTILATION FAN (SINGLE) 4.00 . information a correct 1 agree to Comply with all-city and meanly BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby toriinspection property for representativesof of Bus purposes.city to ratter upon the above-mentioned BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the ranting of this permit. MECH.CONT. - LIC.NO. MECH. �/(� —G TOTAL Sl.,6u Gff p lcant CUntr Da� 'p F TOTAL OFFICE COPY