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16064 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY ' W CUPERTINO - 16064. INSPECTION DIVISION JOB INSPECTION RECORD 'PERMIT EXPIRATION JOB'ADDRESS /d 7OO zC.caJ�L•L �? UNIT# _LOT# PERMIT EXPIRES IF WORK 'OWNER L, s� CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE - INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR*180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER NOTE: GRADING AND DRAINAGE SHALL BE INSTALLED s PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. ' GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED l _ UNDERGROUND /SLAB ` PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG ELECT PLG, MECH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED lop - 4% BUN OIRNG MAT OMIT WOOD FLOOR n • PLUMBING `�LgpTI�N SIFT. P` - MECHANICAL ELECTRICAL PERMIT TO FRAMING ION INSULATSTORIES TYPE CONSTR. �� OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED h6REACE ROOF NOTE:NO FINAL INSP.SHALL MADE BEFORE SO IT.FLOOR AREA TOTAL- DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING HES IND ' CON PB om., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS• DATE INSP. ❑ ❑ ❑• ❑ - ❑ ASSESSORS PARCEL NO. ROUGH SAN.# PLUMBING. - ELECT.ENERGY ,n' - .. TRACT NO. !. PARCEL NO. TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL .. MECH.ENERGY ACC.DATE ACG FILE NO ELECTRICAL. - BUILDING ENERGY ' FRAMING ELECT.FINAL TEST ZONING I,NO,SITE N0. INSULATION PLUMBING - GAS TEST GAS MECHANICAL - FIRE SPRINK ENERGY Tsa y COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y [D N❑, N❑ u C. EXTERIOR SHEAR � ELECTRICAL RELEASE � - FLOOD ZONE A L. - INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ NEI SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH - TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK ' GAS - NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ' - SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING ' Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -.SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST..TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY . APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY- 'BUILDING PROJECT IDENTIFICATION - - PERMIT NUMBER tN APPLICATION & PERMIT 1 C O - I U v �} BUILDING-ELECTRICAL=PLUMBING—MECHANICAL , ?, ' - - PLAN CHECK VALIDATION TYELECTRIC PERMIT FEE\ PHONE NAIVE IMERAciDRs AAUTLETS-SWITCHES-RECEP '10.60/1.00 LIC.No. LIGHTING FIXTURES 10.00/1.00 ADDRESS DR'S REss PPLIANCES-RESIDENTIAL 4.00 - PHONE PANELS 1&09 - �L - ' DATE OF APPLICATION' . ARCHITECT P.C:NO.: OR PANELS (OVER 200 AMP) 20.00 'PLAN CHECK FEE ENGINEER uc.No. ISIGNS TRANS. 3.00 ARCH.OR ENG. - ADDRESS SPECIALCIRCUIT� 5.00 PERMIT VALIDATION �' ZIP TEMP.METER OR POLE INS. " 20.00 BPPLICANT'S ADDRESS MOTORS - SEE FEE SCH. `UJ,1(,•Ij,�/. SERVICE CHANGE -" 20.00 / FOO LICENSED CONTRACTORS DECLARATION c+v I hereby affirm that 1 um licensed under provisions of Chapter 9 - ISSUANCEIDATE ^' y a w (commencing with Section 7000)of Division 3 of the Business and BLDG. -ELECT. -PLC. 'MECH. F m z Professions Code,and my license is in full force and effect.' - :❑ 1i, License Class Lic.Numberft3p "� M 0 w t w Date Contractor 1`p� L�N, It rc w El a OWNER-BUILDER DECLARATION "`� BUILDING PERMIT - °` o MISC.— - REFE INFORMATION Z a. LL F I hereby affirm that 1 am exempt from the Contractor's License u O"�" Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION $/FT. - PERMIT ISSUANCE _ y y Code:Any city or county which requires a permit to construct,alter, ' s: ¢ 0 O improve,demolish,Or repair any structure,prior its issuance,also ELEC.DDNTR,ru A,wo Ia requires the applicant for such permit to file a signed statement that PERMIT TO m>, he is licensed pursuant en the provisions of the Contractor's License _ � "1 F24 Law(ChapterProfession,Cong de) a,Section is 00)exempt therefrom ofthe E 4 O Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE - t - m I-m the basis for the alleged exemption.Any violation of$ecthm 7031.5 a. .STORIES -TYPE CONSTR. a. i .- by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 - of not more than five hundred dollars($500).1' ❑ I,as owner of the property,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 ml 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 an owner of ' property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD,FT:FLOOR AREA TOTAL ACREAGE himself,or through his own employees,provided that such improve- mentsarenotintendedorofferedforsales If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not hGAS-EA.SVSTEM'-OVER 4 (EA.) 2.00uild or im- ` BUILDING USE tire prove'for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 - RES IN , -CON PB Other " ❑ as owner of ote property, exclusively contracting with ❑ ❑ ❑ ❑ '. licensedd contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCELNO. I 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 contractors)licensed pursuant to the Contractor's License Law. - SEWER-SANITARY-STORM EA.200ft/10.00 1 ❑ I am exempt under Sec. ,B.&P.C.for this TRACT NO. PARCEL NO. reason WATER HEATER W/VENT 6.00 Own Dat 7 WATER SYSTEM 5.00 ACC.DATE - ACC.FILE NO. WORKERS'C MPENSATION DECLARA ON WATER TREATING EQUIP, 5.00 - I hereby affirm 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 thereof(Sec.3500,Lab.C.), Policy No. - Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with lite city inspection division. O Applicant MISC.- REFER TO ORD. Y N ElO Y H E] N1:1 = W CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLDDD ZONE A.L.U.C. + W COMPENSATION INSURANCE PLC.CONTE. .LIC.NO. PLG., ' CL O (This section need not be completed if the permit Is for one - TOTAL Y❑ N❑ V ❑ ry❑ Z hundred dollurs(5100)or less.) U O 1 certify that in the performance of the work for which this per OTV MECHANICAL PERMIT FEE FEE SUMMARY IL I- mit is issued,I shall not employ any person in any manner so us to become subject to the Workers'Compensation Laws of California. 0 y Datc Applicant ALTER OR ADD TO MECH. ,5.00 BUILDING } So NOTICE TO APPLICANT: If,after making this Certificmc of Ex- � ? emption,you should become subject to the Workers Compensation APPLIANCE 5.00 - 'PLAN CHECK provisions of the Labor Code;you most forthwith'comply with ' CJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10ACC.F.M.) 4,00 FEE CONSTRUCTION LENDING AGENCY AIRHIANDLING UNIT(OVER IO,OOD ORM.),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 [lits permit is issued(Sec. MICROFILM 3097,ON C.). HEATING UNIT(TO 100,000 B.T.U.)•-8.00 Lender's Name HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC . pZ S� Lender's Address I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 - information is correct. I agree to comply with all city and county BOILER H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and slate laws relating to building construction, and - hemby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTM SEE FEE SCH. _ MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. - upertino against liabilities,judgments, cos and expenses which PERMIT ISSUANCE 10.00 CONST.TAX: " may any way accrue sins[ said City n consequence of the - T- [in of this permit. MECH.CONT. LIC.NO. MECH. TOTAL TOTAL OIAPPfic1Q/,C1,IPhffCtor are ' OFFICE COPY