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15517 POST THIS CARD NEAR FRONT OF BUILDING PERMIT Nl1MRF.R, CITY OF .'CUPERTINO 15517 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS !�/�w I"1 �� I UNIT,# -_LOT# � /p ` - PERMIT EXPIRES IF,WORK OWNER ' CONTRACTOR E V7T�1� IS NOT STARTED WITHIN ', INSPECTION DATE INSPECTOR INSP CTION RE RD 180 DAYS OF PERMIT ISSU . FOUNDATION - ANCE OR 180 DAYS FROM NOTE: LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PFRMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ' - PLUMBING c ELECTRICAL ' ISSUANCE DATE MECHANICAL BLDG ELECT Pu;. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ` BUILDING PERMIT V OINFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING - � •. C� .. t MECHANICAL - - " ELECTRICAL PERMIT TO -` FRAMING INSULATION STORIES TYPE CONSTR. OCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF I NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID , BUILDING USE ROOF SHEATHING - RES - IND CON PB Otl '. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDFINALS DATE INSP. ❑ 0 ❑ ❑ El ROUGH SAN..4 ASSESSORS PARCEL NO PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO. TUBS&SHOWER'PAN PLUMBING ENERGY - MECHANICAL MECH.ENERGY ELECTRICAL - - BUILDING ENERGY - .ACC DATE ACC,FILE NO FRAMING ELECT.FINAL TEST . INSULATION ZONING ENG.SITE NO. - PLUMBING GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY 1 7 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZONE aL u.c. INTERIOR SHEAR FIRE DEPT. Y O •N[3 v ❑ NC] SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH BILDINU . INTERIOR LATH s D - •TEMPO RARY APPROVALS BUILDING SCRATCH COAT ELECTRICPLAN CHECK , GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE t OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� •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 J CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WI7HIN'RED LINES - USE BALL POINTPEN ONLY 1;11 " ""BUILDING PROJECT IDENTIFICATION - � - - PERMIT NUMBER BUILDING APPLICATION & PERMIT ' ' ADDRESS - I 'I /O 8' BUILDING ELECTRICAL- A. 1 1 , OWNER'S •PLAN CHECK VALIDATION NAM /� - DTV. ELECTRIC PERMIT ' FEE v .t�- PHONE CONTRACTORS - OUTLETS-SWITCHES-RECEP 10,00/1.00 h : I NO, LIGHTING FIXTURES 10,00/1.00 CONTRACTORS DRESS R's APPLIANCES-RESIDENTIAL 4.00 -• - PRONE PANELS` ( 10.00 GATE OF APPLICATI ON ogchsrcecr - PANELS (OVER 200 Awl 20.00 PLAN CHECK FEE I. No. r ENGINEER uc.NO. SIGNS TRANS. 3.00; AARCH,08 DDRESS ENG, SPECIAL CIRCUIT 5.00 , PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 - APPLICANT'S ADDRESS MOTORS , SEE FEE SCH. _ ` SERVICE CHANGE 20.00, jam/y�./�� t w o o LICENSED CONTRACTORS DECLARATION - V '(' � a v I-hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE r i (commencing with Section 7000)of Division 3 of the Business and y¢ m BLDG.' ELECT. PLG. MECH. r O Professions Cod I m m license is in full for •: < ffept ❑ El z O - License la Lia Number / - '., 0 =w Date��%� Cnntmdor . ¢ >< IC < LDING PERMIT E O a O OWNER-BUILDER DECLARATION FORMATION W g LL r 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD- w VALUATION SIFT. n O¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE - 10.00 w�E Code:Any city or county which requires a permit to construct,alter, ¢ . ¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.-CONTR. LIC.NO. - ELEC. C1►p W - a O', requires the applicant for such permit to file a Signed statement that TOTAL V WW - PERMIT TO - xm he Is licensed pursuant to the provisions of the Contractors License eLaw(Chapter 9(commencing with Section 7000)of Division 3 of the i O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE M r m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. n by any applicant fur a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 r_ of notmomthan five hundred dollars($500).): ❑ 1,as owner of the property,or my'employees with wages as BACK FLOW PROTECT.DEVICE 4.00 oCC:GRDUP 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,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to anowner of property who builds Or improves thereon,and who does such workFIXTURES-PER TRAP -?.'00 a So.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such imp rove GAS-EA.SVSTEM-11NC.4OUTLETS 8.00 " .Cuts are not intended or offered for sale:If,.however,the building or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4(EA.) 2.00 • BUILDING USE builder will have the burden bf proving that h - .e did not build or im- - RES IND CON PB Other. prove for purpose of sale.). INDUSTRIALWASTE INTER. : 30.00 LII,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 N0. 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 . X contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ff/10.00 the Contractor's License Law. TRACT NO.- PARCEL NO. ❑ I am exempt under Sec. ,B.&P.0 for this WATER HEATERW/VENT 6.00 - ' lesson Owner ' Date WATER SYSTEM - 5.00 ACC.OATE ACC.FILE NO. WOR KERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 - • ' I _hereby affirm that I have a certificate of consent to self-insure, ZONING or a certificate of WorkerENG:SITE NO. Workers'Compen5atignurµnf � certified - copy thereof(Sec.3800,Lab C) Policy Nrt Compo y nr r� Q ❑ Cetitiedcopy ishereb furnished. Irk n FIRE SPRINK ENERGY TZO Z ❑ Certified c is fde wit the cit 'nspection division. A licant MISC.- REFER TO ORD. v N v - N p pp E� Z r+ Ar t ❑ ❑ ❑ ❑ F '.-?9:'CO �= cc CERTIFICATE E PT ION FROM WORKERS' PERMIT ISSUANCE RS' FLOOD ZONE A.L U.C. W ? COMPENSAENSATION INSURANCE PLG.CONTR. un.No. PLG: Qp ' d' (This section need not be Completed If the permit is for one 'TOTAL Y❑ N❑ Y❑ N❑ 0 Z hundred dollars($100)or less) " L) p I certity that in the performance of the work for which this per- QTY. MECHANICAL PERMIT : FEE FEE SUMMARY ' LL H- mil is issued,1 shall not employ any person in any manner so as to OW become subjecLlo the Workers'Compensation Laws of California. , Q. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } N NOTICE TO APPLICANT: If,after making this Certificate of fix- - Z 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 - U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY • AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 EVE 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 permiLis Issued(Sec. MICROFILM ' 3097,Gv.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 .ELECTRIC Lender's Address I CcHLy,tha'l havemad this application and state that the above VENTILATION FAN ISINGLEI '4.00 information is correct, I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or 100,000B.T.U.) 6.00 < hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. 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 liaetdgm&n and expenses which - CONST.TAX may in any Aiay acn consequence f the PERMIT ISSUANCE , 10.00rantingOf rspeh ! MECH.LONT. LIC.NO. MECH.TOTALTOTALoP Appllca Date - - - OFFICE COPY