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14367 n POST TH IS CARD-NEAR .FRONT OF BUILDING PERMIT NUMBER C'ITY'' OF .-CUPERT,INO' . 1436' INSPECTION'DIVISION ' +' } JOB INSPECTION.RECORD 10421.'CASTINE AVE PERMIT EXPIRATION y JOB ADDRESS UNIT# "LOT# 7 . , COOLEY PERMIT EXPIRES,IF WORK OWNER CONTRACTOR BLEICKER IS NOT STARTED WITHIN • INSPECTION DATE INSPECTOR INSPECTION RE CORD 180DAYS OFPERMIT ISSU- FOUNDATION .� ANCE.OR 180'DAYS FROM NOTE: LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. PREGUNITE - 'TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMIT VALUATION GARAGE SLABS' CUPERTINO'STANDARDS., �• ' • POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' t UNDERGROUND PSLAB / PLUMBING' - v - aQf//fir ELECTRICAL - cE DATE °6 MECHANICAL ' ' - B ro PLG. kk{MIE��CIH. . Y El tt- DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 91 MATMOiNG PERMIT WOOD FLOOR - - i, INFORMATI N .PLUMBING - VALUATION $JET. MECHANICAL - "" • - T�- � - . .. ELECTRICAL - HEamlT To ,. FRAMING _ INSULATION STORIES - TYPE CONSTR. - Cit - OCC GROUP . RES UNITS, PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED " ROOF _ $U.FT.fLOUH AREA TOTAL ACREAGE _ NOTE:NOFINAL INSP.SHALL BE MADE BEFORE' ' DIAPHRAGM THE CONSTRUCTION TAXIS PAID I ROOF SHEATHING ' ' - HES' IND ILU`ON USEPB �pnr p APPLY NO ROOFING UNTIL ABOVE HAS.BEEN-SIGNED— FINALS 'DATE` INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ' ROUGH sAN.n, , PLUMBING ELECT.ENERGY • - TUBS&SHOWER PAN . 'PLUMBING ENERGY TRACT NO. PARCEL NO, MECHANICAL ' - MECH.ENERGY - ELECTRICAL - ACC.DATE T ACC BUILDING 2- - BUILDING ENERGY FRAMING ELECT.FINAL TEST 'INSULATION. _ PLUMBING4_3�: zomwc ENG srtE No. GAS TEST GASMECHANICALFIRE SPRINK ENERGY T24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED. HEATING Y ❑ N❑, Y N❑, EXTERIOR SHEAR ' ELECTRICAL RELEASEINTERIOR SHEARFIRE DEPTSHEETROCK -AZ. GRADEFEE SUMMARY ' EXTERIOR LATH BUILDING Ly'b_ V_ :INTERIOR. LATH., •.., TEMPORARY APPROVAL 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 BUIL DING"FINALISSIGNED BY,BUILDING INSPECTOR. MICROFILM t . i ARRANGEFOR INSPECTION BY PHONING 252-4505, ELECTRIC "� / ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING PLEASE GIVE-JOB'ADDRESSWHEN PHONING Z , 'MECHANICAL i',I. — SEE PERMIT FOR EXPIRATION DATE _ IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE', Gr CALLING FOR FINAL'INSPECTION. TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY _ ' � BUILDING PROJECT IDENTIFICATION PERMIT NUMBER• App�ICgTION & PERMIT - /.�j) ADDRESS A rJ /aE.. - . �/E'� _ ' BUILDING_ELECTRICAL-PLUMBING-MECHANICA /•0 /lam L , \� OWNER'S 67 NAME PLAN CHECK VALIDATION FCrE 1Ft�AN,J .`DOLE � OTY. "ELECTRIC PERMIT FEE - P�HONE ASS--0383 CONTRACTOR'S yyAME I -` q // OUTLETS-SWITCHES-RECEP . 10.00/1.00 LoU15El B�FICkE� LIQNO.B J�IS•/ x LIGHTING FIXTURES0.00/1.00 ADDRESS OR's S14� sE APPLIANCES-,RESIDENTIAL 4.00 licribGUat-iIveAve' PHONE 243-375L PANELS - 10.0-0 DATE OF APPLICATION ORcwa'ecT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.No. ENGINEER LIC,NO. SIGNS TRANS. 3.00 ARCH.OR ADDRESS ENQ SPECIAL CIRCUIT 5.00 - PERMIT VALIDATION zIP TEMP.METER OR POLE INS. 20.00 /'��" APPLICANTS ' ADDR((E��ss \ - -} MOTORS - SEE FEE SCH. - -1� {JO UGL LVE V�. SIT dOf C' .SERVICE CHANGE 20.00 wo o LICENSED CONTRACTORS DECLARATION. - Q� ar ZO I hereby affirm that 1 am licensed under provisions of Chapter 9' - ,1 1 i7 Q y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECTNCE PLGE MECH. r y z Professions Code, my license is in full Poo d effect: ❑ o 0 w o License Class - Lic.Number F m L J " Date-ia Contractor v a, Wa ,OWNER-BUILDER DECLARATION , BUILDING PERMIT ' w- o a . ' INFORMATION ; ti I hereby affirm that 1 am exempt from the Contractor's License 'MISC.- REFER TO ORD LL O at • Law for the following reason.(Sec.7031.5,Basin ass and Professions _ VALUATION SIFT. r - at PERMIT ISSUANCE .'10.00 w g Code:Any city or county which requires a permit to construct,alter; Q u (C o O improve,demolish,or repair any structure,prior to its issuance,also' ELEC.CONTR. LIQ N0. ELEC. ] iL m LL requires the applicant for such permit t0 file a signed statement that - TOTAL ✓ X he is licensed pursuant to the provisions of the Contractor's License PERMIT,TO- H.ii Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe ��(T�V�'. 4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE Ic f $ the basis for the alleged exemption.Any violation of Section 7031.5' STORIES TYPE CONSTR. a 3 by any applicant for a permit subjects the applicant too civil penalty ofnot more than five hundred dollar,(S500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 , their sole compensation,will do the work,and the structure is not, OCC.GROUP RES.UNITS intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 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 50.FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve. Inenlpme notmlonded oroffered for sale.If,however,the building • GAS-EA.SYSTEM-l1NCAOUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 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- Other ❑ I,as owner of the property,am exclusively contracting with - - 0 licensed contractors to construct the project(Sec. 7044,Business LAWN,SPR INKLERS-I INC 5 V.B. 6.00 ASS ESSORS 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 contmetorts)licensed pursuant to - theCmttractor'sLicenseLaw. SEWER-SANITARY-STORM EA,200ft/10.00 TRACT NO. PARCEL NO. ,. ❑ I am exempt under Sec. ,BAP.C.for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE Ace.FILE No. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP-5 00 I hereby Winn 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(See.3800,Lb.C.). - ! Policy No. Company - 0 .Certified copy is hereby furnished. FIRE SPRINK ENERGY T-ZO Z Z Certified ca s filed with the city iyspection division. Y NE] Y. �N� � Hy Aplicunlf fid. ,-/� /� • MISC.- - REFER TO ORD. = - CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE .AU.U.C: LU > COMPENSATION INSURANCE PLG.CONTR. 1 LIC.NO. PLG. - Y N Y N (This sectidn need not be completed if the permit is for one - TOTAL Z) Z hundred dollars IS 100)or leas.) 0 O . 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 so as to 0 U become subject to the Workers'Compensation Laws of California. d• Date Applicant - BUILDING" S"n >_ Z, NOTICE TO APPLICANT: If,atter making this Certificate of.Ex- ALTER OR ADD TO MECH. 5�.�' ��Q F _ emption,you should become subject to the Workers'Compensation APPLIANCE - - 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with -V' 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 10p00C.RM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency to, EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Cie.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00 - Lender'sAddr HEATING UNIT 100,000 B.T.U.)9.50 - OY1 Lenders Address ELECTRIC � I, C . t - I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) - '4.00 1� information is correct.1 agree to comply with all city and county BOILER-COMP.(3 H.P.or 100,0008.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and _E BOILER-COMP (Over 100,000 BTU)SEE FEE hereby authorize representatives of this city to enter upon the SCH. MECHANICAL X4;5 above-mentioned property for inspection purposes. " (We)'since to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. _ Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE .. U CONST.TAX may in any way accrue against said City in consequence of the 10.00 mop of thispe t 1 MECH.CONT. LIC.NO. MECH. TOTAL,/ S d�u' TOTAL � 7 a Signature of APPLICant ontmctor Date - " OFFICE COPY