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17162 POST THIS CARD NEAR FRONT OF BUILDING PERMIT-NUMBER CITY OF CUPERTINO 17162 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION 77 - 01-3-7 JOB ADOR ESS UNIT# - -_LOT# - PERMITEXPIRES IF WORK OWNER. CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE 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 TO COMPLY WITH THE APREGUPPROVED PLANS AND CITY OF PERMIT vnLlOarloN GARAGE SCABS ITE° - CUPERTINO STANDARDS. - GARAGE ' � �- ', � POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED J _ ' -UNDERGROUND /SLAB �tyU PLUMBING - ELECTRICAL - r issINCE ATE MECHANICAL BLDG ELECt. PLG." MECR - 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - . .JAI\ 31_198 BUINFORMATION OIRMATIONNG T WOOD FLOOR VALUATION SIFT. PLUMBING CapertiR MECHANICAL - N ' PER N+rt To ELECTRICAL FRAMING - ' INSULATION - STORIES TYPE CONSTR, OCC.GROUP RES UNITS j[P,LIACE'NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED " 50 fT FLOOR PR(P iOiGL ACREAGE ROOF NOTE:NO FINAL INSP..SHALL BE MADE BEFORE ' DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING Res IND CON Pe 0E APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS KDATE INSP. El 1:10 ROUGH SANS ASSESSORS PARCEL NO PLUMBING _ ELECT.ENERGY — TRACT NO., PARCEL NO TUBS 8 SHOWER PAN Qf- PLUMBING ENERGY - Q(`. ' - MECHANICAL - MECH.ENERGY - ELECTRICAL ACC.DATE ACC.FILE NO BUILDING ENERGY FRAMING ELECT.'FINALTEST zoNlNc ENG.SITE No, INSULATION PLUMBING GAS TEST GASX /N ILy'^(y/'I$- C AC FIRESPRINK ENERGY T-2a' MECHANICAL - hCOVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v ,N v N[],EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZUNE A1UC � .Y INTERIOR SHEAR " FIRE DEPT. YNO 0 N SHEETROCK GRADE FEE SUMMARY 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 OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL•BUILDI NG FINAL ISSIGNED BY BUILDING INSPECTOR', MICROFILM - -- ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC FONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN'PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANTI CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. ALM OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ♦ BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT -' ADDRESB 1716 2 ., � 3 V BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE i G� n NNMERACTORS a 1 t UTLETS-SWITCHES-RECEP 10.00/1.00 1 TO% 'I/Unl`�nx LIC.No. �7 LIGHTING FIXTURES 10.00/1.00 ADDRESS R's PPLIANCES-RESIDENTIAL 4.00 ADDRESS , _. r_(PK +j PHONE V34-�� PANELS " 10.00 DATE OF APPLICATION ARCHITECTPLANCHECK FEE P.C.:NO. on PANELS (OVER 200 AMP) 20.00 ., ENGINEER LIC.No. SIGNS TRANS. 3.00 ` ARCH ENG. - PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5,00 ZIP' TEMP.METER OR POLE INS. 20.00 �7� APPucArvrS MOTORS SEE FEE SCH. -Jl/k`- 0�` AOORE55 tsx 0 fT)I Z SERVICE CHANGE 20.00 o Ir,i I 7CE �+. Foo LICENSED CONTRACTORS DECLARATION • �} 1 <.U I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSIIhhTE H<aa_ (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F D z Professions Code,and my license is in full force IW.Iil' c ❑ ❑ z o m- License Class Lic.Number /9 o-T r w Date + 11 Contractor T'sVist, a as s �j►p BUILDING PERMIT w OWNER-BUILDER DECLARA'PION AINFORMATION E: o a.y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER T ORD 3 u Y' P _ VALUATION $/FT. H LLej Law fa Any flm Countywhing reason, Sec.11,1.1,permit to construct, Professions PERMIT ISSUANCE 10.00 Code.Any city or county which requirese permittocansua c ,also Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. n wO LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO ' $ he is licensed pursuant to the provisions of the Contractor's License `1 H z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �Y1b < Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE 2 l_D 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 too civil penalty of not more than five hundred dollars(S50B.): ALTER-DRAIN&VENT-WATER (EA.) 5,00 - ❑ 1,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 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 docs not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP - 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenotintended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- builder wner GAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or im BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omar ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(See.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO, 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 SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C.far it"' WATER HEATER W/VENT 6.00 - reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACO.FILE N0. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I he,,.certificate ofconsenl to selhinsure, x' ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab,C.). Policy No. Company O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T 24 Z ZO Certified Copy is fled with the city inspection division' - A scant MISC.'- REFER TO ORD. Y❑ N❑ Y ❑ N❑ ~ vaPERMIT ISSUANCE 1G.60 FLOOD ZONE A.L.u.C. jr CERTIFICATE OF EXEMPTION FROM WORKERS' - �G• W > - COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Q " v CL 2 (Phis section need not he completed,if the permit is for one TOTAL Y❑ N❑ V C] N❑ 7 hundred dollars(S 100)or less.) U Q 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner soas to U become subject to the Workers'Compensation Laws of California. O W Date.Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } % NO'T'ICE TO APPLICANT: If,after making this Certificate of Ex- � ? 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 U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE I hereby affirm that there is a'construction Iending'agency for EXHAUST HOOD(WITH DUCT) 5.00 r tiro Civ Cance of the work for which this permit is issued(Sec, HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lenders Name Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC 1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 I_ information is correct I agree to comely with all city and county PLUMBING tx, ordinances and state laws relating to building construction, unit BOILER-COMP(3H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP f0ver 100.000BTU)SEE FEESCH. MECHANICAL above-mentioned property for inspection purposes. (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 uceme against said City in consequence of the and - _ - MECH.CONT. LIC.NO, MECH. TOTAL '�-enn�- I 3I'4y TOTAL Signature of Applicant/Contractor - Date I OFFICE COPY.