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17667 POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER CITY OF CUPERTINO 17667 INSPECTION DIVISION JOB INSPECTION RECORD , • // PERMIT EXPIRATION JOBADDRESS 1(002- Cd-\m f " (61 -av UNIT# _LOT# PERMIT EXPIRES IF WORK ` IS NOT STARTED WITHIN OWNER � C... CONTRACTOR INSPECTION DATE. INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF RPRn+rt vALmunoN PREGUNITE CUPERTINO STANDARDS. GARAGE SLABS PAID POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB MAY 91983 C_L I J PLUMBING //1�� { /��.y. �7)' ELECTRICAL VIb DE VYIIGIYDD ISSUANCE DATE BLDG ELECT I PLt I MECH MECHANICAL u 11 13 11 00 NOT POUR FLOOR UNTIL'ABOVE HAS BEEN SIGNED BUILDING PERMIT:; INFORMATION -.-,' .- WOOD FLOOR VALUATI SrFT. PLUMBING QOQ MECHANICAL P RM1IIT TO ELECTRICAL FRAMING STORIES TYPE CONSTR. INSULATION OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED so FT FLOOR AREA TOTALACREAGE ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID — .•'� D CON MG-USE — RES sE ROOF SHEATHING El IND CON PB o l APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED- ' FINALS-•:` DATE'_ ' INSP. ASSESSORS PARCEL NO ROUGH SAN.k PLUMBING ELECT.ENERGY TRACT NO PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC.DATE ACC.FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT,FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING GAS TEST GAB FIRE SPRINK ENERGY T 2 MECHANICAL N� v E NE] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L UC. . EXTERIOR SHEAR ELECTRICAL RELEASE ° No `" L. N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING �U INTERIOR LATH TEMPORARY APPFR Pr— SCRATCH COAT ELECTRIC 71 PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE IJ7 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. MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - CONST.TA% IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APP,L!CANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER ADDRESc APPLICATION & PERMIT 1 [� 67 D� 1'-rd LQ• BUILDING - ELECTRICAL-PLUMBING-MECHANICAL WNER'S / r�mv�D /Jv; PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE PO /G /�c zw� 996 MERAcaoFs 7 NooUTLETS-SWITCHES-RECEP 10.00/1.00 -1 Q /V E/C uc.No LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ADDRESS ' ooREss APPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.06 PLAN CHECK FEE P.G.NO. OR ENGINEER LIC,NC. SIGNS TRANS. 3.00 AADDRESSS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION APPLICANTa ZIP EMP.METER OR POLE INS. 20.00 S- ADDRESSMOTORS SEE FEE SCH. 0SERVICE CHANGE 20.00 ,1 i`K, ✓Cf- 02 0I 2 IUL F o o LICENSED CONTRACTORS DECLARATION < u v I hereby affirm that I am licensed under provisions of Chapter 9 Vf Z i ISSUANCE GATE H ¢ (commencing with Section 7000)of Division 3 of the Business and I{ BLDG. ELECT. PLG. MECH. , ni Professions Code,and my license is in full force and effect. ❑ El El wm G License Class Lie.Number _ I-w Date Contractor City of Ca rtmo a sz i 1 V pCEY BUILDING PERMIT i 0 w ¢ OWNER-BUILDER DECLARATION o A D INFORMATION X ; w I hereby collo that I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION uO¢ Law for the ity owingreason.(Sec. uires a,ermit to Professions S/FT. - J PERMIT ISSUANCE 10.00 Code:Any city Gr coup pairwhich any structure p riot t o consuuc6 alreo M c-C.J 25¢ improve,demolish,or repair anysticture,priorn its issuance,also ELEC.CONTR. LIC.NO. ELEC. V" ii�o LL requires the applicant for such permit to file a signed statement that TOTAL e w mhe is licensed pursuant to the provisions of the Contractor's License PERMIT TO FZQLaw(Chapter 9(commencing with Section 7000)ofDivision 3 of[be -De -K Pio Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE wd le I- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. 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(5500).): ❑ 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 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 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- mentsarenotintendedor offered for Sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS.EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- prove for purpose ofsale.). RES IND CON PB Other ,54 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractors 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 contractor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam ex under Sec. .&P.C. reason m this WATER HEATER W/VENT 6.00 Owner m WATER SYSTEM 5.00 ACC.GATE ACC.FILE NO. WORKERS'COMPENSATIO, ECLARATI WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certific to ofconsent to self-insure. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy hereof f5ec.3800, 1. Policy No.-Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. ❑ ❑ H O Applicant MISC.- REFER TO ORD. Y 11 N Y ❑ N CCN CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. ION UJ COMPENSA> (This section need not beTcompleted Rif thepermitis for one PLG.CONTR. LIC.NO. TOTAL Y LG ❑ N❑ Y ❑ N❑ aQ ::) Z hundred dollars IS 100)or less.) 00 1 certify that in the performance of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. 0. Date Applicant BUILDING } N NOTICE TO APPLICANT: If,after making this Certificate of Ex ALTER OR ADD TO MECH. 5.00 I,- 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 U FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE • 50 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 permit is issued(Sec. MICROFILM 3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG LIN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC I certify that 1 have read his application and slate that the above VENTILATION FAN (SINGLE) 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(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH, MECHANICAL CAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in an way accrue against Said City in const a of the rami ie permit MECH.CONT. LIC.NO. MECH. 7 TOTAL TOTAL a I e S 0 regrarture of A p¢ant/Contractor Dale S- OFFICE COPY