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16758IF POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO f DIVISION JOB INSPECTION RECORD. p • UNIT# _'LOT#PERMIT JOB ADDRESS�.NeTRAITII, C ' .. PERMITNUMBER ' 16758INSPECTION PERMIT EXPIRATION EXPIRES IF WORKOWNER IS NOT STARTED. WITHIN 180 DAYS OF PERMIT ISSU- +' ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE ALL GRADING AND DRAINAGE SHALL BE .INSTALLED TO COMPLY WITH THE APPROVED _ PLANSAND CITY OF CUPERTINO STANDARDS. LIFER PREGUNITE- ' PED R PEMIT VALRUATION , I I- / ISSUANCE DATE 'GARAGE SLABS � POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - ,-UNDERGROUND/SLAB PLUMBING PAln' ELECTRICAL. MECHANICAL `Ity �I ,y@� c eLEcr LEI PLG -MEEK. El El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED CDfflRD BUILDIN ERMIT INFORMATION WOOD FLOOR PLUMBING - - VALUATION '. $/FIT' i MECHANICAL ELECTRICAL -. - PERMIT TO - FRAMING INSULATION - „ �;� O STORIES TYPE CONSTR ` PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED OCC GHDUP RES UNITS -' ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID SD. FL FI.COR AREA TOTAL ACREAGE ' - DIAPHRAGM '' ROOF SHEATHING - BUILDING USE Ia BS IND- CON PB 0"", ❑ ❑ ❑ ❑ ' ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. • ROUGH sAN.n ASSESSORSPA HCEL NO. . ' PLUMBING ELECT. ENERGY TUBS &SHOWER PAN - PLUMBING ENERGY' TRACINO. PARCELING MECHANICAL - MECH. ENERGY ELECTRICAL • BUILDING ENERGY ACC Gare ACC FILE NO FRAMING- - ELECT.FINALTEST INSULATION - PLUMBING ZONING ' ENG. SITE NO, GAS TEST - GAS MECHANICAL FIRE SPRINK Y ❑ "❑' ENERGY T.Z4 ` ❑ "❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXYERIOR SHEAR ELECTRICAL RELEASE - FLOOD zorvE ° ❑ "❑ A.Luc.- ° L7 INTERIOR SHEAR FIRE DEPT. - SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH BUILDING' BUILDING INTERIOR LATH - TEMPORARY APPROVALS SCRATCH COAT ELECTRIC - PLAN CHECK FEE • "' GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. ELI ARRANGE FOR INSPECTION BY PHONING 252-4505, F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. zo PLEASEGIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL, OFFICE COPY N" • 0 Z Z, P:0,� c LU _ CL 7 z' 00, LL O L) a' F 'Z U APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT �,. - BUILDING - ELECTRICAL- PLUMBING-MECHANI&AL PERMIT NUMBER 16758 ADoeEss 1 OSBloin; OWNER'S NAME l1roJ Sl )�G J_(� t �/" 1� < 0 I e PHONE O7V. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION NAMCON IE- " LIC. NO, OUTLETS - SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 ADDREssrORs PHONE APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR ENGINEER LIC NO, - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. „ SIGNS TRANS. 3.00 ARCH. OR ENG. ADDRESS ZIP SPECIAL CIRCUIT 5.00 - PERMIT VALIDATION (/ It 11.7 �(PO ISSUANCE DATE EMP. METER OR POLE INS. . -20:60 d nPoes STs MOTORS SEE FEE SCH. SERVICE CHANGE "20.00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full tome and effect. Diems" Class Number Date Contractor C BLDG. O ELECT. 'PLO. MECH. El ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Busi...... d Professions Code'. Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file. signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the mm"car"n a civil penalty o(nol more than five hundred dollars ($500" }� I, as owner of the property, or my employees with wages as then sole com pens. him, will do the work, and the stoicRnc is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Conlructor's License Lew does not apply to an owner of property who huiIds or improves 0tnr ion, and who docs such work himself or through his own employees, provided that salit improve- -cuts are not intendedorOffered for sale. If, however, the building .r Improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did noI build of im- Provefor purpose oriole.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and wit" contracts for such projects with u contmetods) licensed pursuant to the Contractor's License Law. "❑ Imommmptu er Sec. ,B.&P.C. 'orthls reason BUIL ING PERMIT INFORMATION MISC. - REFER TO ORD PERMIT ISSUANCE�9 oZ VALUATION $/FT. ELEC. CONTR. LIC" NO. ELEC. ('J� TOTAL PERMIT TO QTV. PLUMBING PERMIT FEE ALTER -DRAIN & VENT -WATER (EA.) 5.00 STORIES TYPE CONSTR. BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA,CON D. 6.00 FIXTURES -PER TRAP 5.66 GAS-EA.SYSTEM-11NC.40UTLETS 6.00 GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 SD. FT. FLOOR AREA TOTAL ACREAGE - BUILDING USE RES IND CON PB Omar IN CO INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORSPARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owns Date 7 WATER SYSTEM 5.00 WORKERS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of emHent m self -insure, ar a certificate of Workers' Compensation lasurancq or a certified ropy thereof(Sec. 3800, Lab,C.L Policy No. Company ACC.OATE - ACC. FILE NO. WATER TREATING EQUIP, 5.00 ZONING ENG. SITE NO. - ❑ Certified copy is hereby furnished. ❑'Certified ropy is filed with the city inspection division. Applicant FIRE SPRINK Y [:] N 0 ENERGY T$4 Y ❑ N1:1 MISC. - REFER TO ORD. CERTIFICATE OF EXIiMPTION FROM WORKERS' COMPENSATIONINSURANCE (This section need not be completed if the permit is for on. hundred dollars IS 100) or less.) 1 certify that in the performance of the work for which this per- mit is issued, I shall not cnlploy any person in any manner so us to become subject to the Workers' Compensation Laws of California. Date Applicant PERMIT ISSUANCE 10.00FLOODZONE Y ❑ N A.LUC. - Y C] NEI PLG. CONTR. -LIF NO. PLG, TOTAL 0.1.,. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, you should became subject to the Worker,' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked 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.), Lender's Name Lender's Address I certify that l have read this application and state that the above information n correct. I agree to comply with all city and county ordinances formatio and sate laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for Inspection purpows. (We)" -glee to save, indemnity and keep harmless the City of upertino against liabilities, judgments, costs and expenses which ain may in any way cent gs[ glad City in consequence of the .ting this rmi / APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10,000QF.M.) 4.00 AIRHANDLING UNIT(OVER 10=11EM.)6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM _ H EATING NG U N IT (OVER 100,000 B.T.U.) 9.50 ELECTRIC 3 VENTILATION FAN (SINGLE) 4.00 BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00 PLUMBING BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL Misc.- REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. OTAL , TOTAL Signature of Applicant/Contractor Date OFFICE COPY