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17113 r. POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF -CUPERTINO 17113 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS ID74 1 UNIT# _LOT#T L PERMIT EXPIRES IF WORK OWNER C WE CONTRACTOR I J' IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF.PERMIT ISSU- FOUNDATION - - - -ANCE OR 180 DAYS FROM NOTE: -LASTCALLED INSPECTION. UFER' ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVEDRLANS AND CITY OF PERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. .t ^• - J T:I "I POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL - ISSUANCE uniE MECHANICAL G. F.L.ECT I PLO. MECH ElEl -Elr'� ' DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - INFORMATION PLUMBING VALUATION , MECHANICAL ELECTRICAL ER - _ - � MIT TO_ �'� FRAMING �� • INSULATION - STORIES TYPE CONSTR. - OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - - SO,FL,FLOORARfn TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING Res IND cory PB on... APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDIMECH. IENERGY v INSP. ❑ ❑ ❑ ❑. ❑ nSSESSOR5 PARCEL No ' ROUGH � PLUMBING - - TUBS-8SHOWER PAN TRACT rvO. PARCEL NO MECHANICAL - - ELECTRICALACC DATE -ACE.PILE NO. FRAMING" ' INSULATION PLUMBING ZONING ENG.SITE NO. GAS TEST GAS MECHANICAL 9, TIRE SPRINK ENERGY T2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _ Y ❑- N❑ ° ❑ N❑' EXTERIOR SHEAR - ELECTRICAL RELEASE ELaoO zarvE ^A LU C. INTERIOR SHEAR FIRE DEPT. Y [3N El ` Y❑ "❑' SHEETROCK GRADE - FEESUMMARY EXTERIOR LATH BUILDING ' INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC , PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE -' OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBYBUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ll PLEASE GIVE JOB ADDRESS WHEN PHONING. f z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL �{ IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL. 'CALLING FOR FINAL INSPECTION. OFFICE COPY A-RPJLANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT 1 DENTI FICATI ON PERMIT NUMBER BUILDING APPLICATION & PERMIT 17113 AOORES/O � 1 4 r.G�k ` BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME . I 11 p - p1 soZ'Nli� TY. ELECTRIC PERMIT FEE s) CONTRACTORNAME TLETS-SWITCHES-RECEP 10.00/1.00 LLIC.ND. OSd40 IGHTING FIXTURES 10.00/1.00 CONTRACADDRESS TD•R��B�� •1i � LIANCES-RESIDENTIAL 4.00 ' SJ r-(Yq �Q 5 'HONE 3r PAN S 10.00 DATE OF APPLICATION ' ORRcwTECT PANEL (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINE 3.G6 ILC.No. SIGNSTR NS. ADDRESS ARCH.OR ENG. SPECIAL CI UIT S.00 PERMIT VALIDATION Z". EMP.METER POLE INS. 20.00 APPLICANT SSTs MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 '09 Foo LICENSED CONTRACTORS DECLARATION f`O'I re u w I hereby affirm that I am licensed under provisions of Chapter 9 Jct J h a n (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE BLDG. ELECT. PLG. MECH. H N i Professions Code,apd my license is in full fort Fand effect �� ❑ ❑ Z 0 w License Clyss C-- A42 • Lia Numbers 1��1L-.Lp- m r w Date CJT13 _ Contractors}I, ¢ ¢ w¢ ' OWNER-BUILDER DECLARATION BUILDING PERMIT ' 0 W,U MISC.- REFER TO RD INFORMATION w ; LL w I hereby affum that I am exempt from the Contractor's License u 0< Law far the followin reason.(Sec.7031.5,Business and Professions 1o,00 VALUATION $/FT. H - g PERMIT ISSUANCE. Code:Any city or county which requirese permit to construct alter C <0 improve,demolish,or repair any structure,prior[o ifs issuance,also ELEC.CONTR. LIF NO, ELEC. E m a,requires the applicant for such permit to file a signed statement that TOTAL a w he is licensed pursuant to the provisions of the Contractor's License MPERMIT TO H z rt Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe i 0 Business and Professions Code)or that he is exempt therefrom and QT PLUMBING PERMIT FEE ' ICIi 0CH o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. i;`^ by any applicant for a permit subjects the applicant loacivil penalty A TER-DRAIN -WATER (EA.) 5.00 of not more than five lmndred dollars($500).): ❑ 1,as owner of the property,or my employees with wages as BAC LOW PROTECT. DEVICE 4.00 Oce.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered fur are (Sec. 7044, Business and Professions DRAINS- LOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of - propertywhobuilds orimproves thereon,and who does such work FIXTURES- ER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended orulfeyed for sale.IC however,the building GAS-EA.SYST -I INC.4 OUTLETS 6.00 be improvement is sold within one year of completion,the owner- ` builder will have the burden of proving that he did not build or im- GAS-EA.SVSTE OVER 4 IEA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WAST NTER. 30.00 RES IND CON RB Other I,as owner of the property,am exclusively contracting with. ❑ ❑ ❑ ❑ ❑ licensed contractors to construct Ilse project(Sec. 7044,Business LAWN SPRINKLERS- 1 C 5 V.B. 6.00 ASSESSORS PARCEL NO. ' and Professions Code:The Contractor's License Law does not apply 1 to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OV 5(EA.) 1.00 . contracts for such projects with a contructogs)licensed pursuant to V_ the Contractor's License LAW. SEWER-SANITARY-STORM .200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C.her this WATER HEATER W/VENT 6.00 reason O Owner Uele WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WORK HRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 y I hereby of irin that I have a certificate of consent to self-insure. or a certificate of Workers'Compensation Insurance,or a Certified ZONING ENG.SITE NO. Copy there f c.3800,Lab.CJ. Policy N "a Company 5 , for A) I ❑ Certifiedcopyisherebyfurnished. FIRESPRINK ENERGY T-I4 Z Z `Q' Certified copy is filed with the city inspection division. ❑ ❑ ❑ ❑ � O Applicant hilt) MISC.- REFER TO ORD. Y N v N N. CERTIFICATE OF 1 XEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C. LU 7 • COMPENSATION INSURANCE PLG.CONTR. LIC.NO. TOTAL Y N Y N CL O (This section need not be completed if the pernsil is for one ❑ ❑ ❑ ❑ 0 Z hundred dollars IS 100)or less.) U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mil is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of California. Date Applicant BUILDING } tai) NOTICE TO APPLICANT: If,alter making this Certificate of lie- ALTER OR ADD TO MECH. 5.00 F Z emption,you Should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE V such provisions or[his permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MOC.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 lending agency for EXHAUST HOOD (WITH DUCT) 5.00 (lie performance of the work for which this permit is issued(Sec. MICROFILM 3097,Cie.C.). / HEATING UNIT(TO 100,000'B.T.U.) .v0 Lender's Name H EATI N G UN IT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4,00 n clI information is correct, I agree to comply with all oily and county PLUMBING y., ordinances and stale laws'relating to building construction, and SCH. MECHANICAL ver BOILER-COMPI3 H.P.or 100,0008.T.U.) 6.00 t hereby authorize representatives of this city to enter upon the BOILER-COMP (O100,000 BTU)SEE FEE +M f above-mentioned property for inspection purposes. 2 L-�LJJ (We) agree tD Save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX " ay n any way accrue against said City in consequence of the I PERMIT ISSUANCE 0 CDU m Il�of l�h'`pennLL� MECH.CONT. LIC.NO. MECH. I 'C,�ovE `21l fi tf,{1o5 �lolD TOTALat �Q TOTAL Signature of Applicant/Contractor Dale OFFICE COPY