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16465 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16465 INSPECTION DIVISION ^� JOB INSPECTION RECORD • ' '/ �.1-� ,, �i PERMIT EXPIRATION JOB ADDRESS��N�'�•171��-!\ UNIT# --'LOT# PERMIT EXPIRES IF WORK OWNER V CONTRACTOR L (r- IS NOT.STARTED WITHIN INSPECTION DATE INSPECTOR INS ECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR.180 DAYS FROM FOUNDATION NOTE: LAST CALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED ' PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION- CUPERTINO STANDARDS. GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - t UNDERGROUND /SLAB off PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT. PLGj MECH El 11 El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION - WOOD FLOOR - vnwnnoN -sicT. PLUMBING MECHANICAL - - PERMIT TO ELECTRICAL � G�/ • FRAMING - I INSULATION 'I STORIES TYPE CONST.. OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF NOTE:NO FINAL INSP,SHALL BEM FORE so.rr Loon An Ea romL ACREAGE .� DIAPHRAGM` THE CONSTRUCTION.TAX IS PAID C BU DING USE ROOF SHEATHING RES MND• CON . PB- ' Dui • 7 APPLY NO ROOFING UNTIL ABOVEMAS BEEN SIGNED FINALS DATE INSP. ❑,1 ❑ ' ASSESSORS PARCEL NO. ROUGH SAN.N i PLUMBING .ELECT.ENERGY - rgncT NO. PARCEL No. TUBS&SHOWER PAN - PLUMBING ENERGY - MECHANICAL ' MECH.ENERGY ` ELECTRICAL BUILDING ENERGY , , ,ACC.DATE ACE.PILE NO FRAMING - ELECT.FINAL TEST zoNlNc ENc.SITE rvo. '.I INSULATION PLUMBING m_6_ I GAS TEST GAS - FIRE SPRINK ENERGY T-24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ . E:]., NSI FLOOD ZONE A V C. EXTERIOR SHEAR ELECTRICAL RELEASE v [:] N� � I] N❑� INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY i EXTERIOR LATH' BUILDING INTERIOR LATH - TEMPORARY APPROVALS BUILDING i SCRATCH COAT. ' ELECTRIC• _ - PLAN CHECK ' GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEENQ,$I„GNED OCCUPANCY SEISMIC FEE 1 OCCUPANCY.OF BUILDING IS NOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ' F ONE WORKING DAY. BEFORE REQUIRED INSPECTION. PLUMBING i Z� . PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! eONST.TAX PLEASE READ'REVERSE SIDE BEFORE_ TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY ,IPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY I! - BUILDING PROJECT I DENTIFICATION PERMIT NUMBER i BUILDING APPLICATION & PERMIT A C J AOOREssq I �4 6 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL ti.- , NER's PLAN CHECK VALIDATION VNAME QTY. ELECTRIC PERMIT FEE � PXONC CONTRACTOR. NAME rvpmE ^/ OUTLETS-SWITCHES-RECEP 10.00/1.00 GU LIc.N . O LIGHTING FIXTURES 10.00/1,00 • CONTkACrDRs PPLIANCES-RESIDENTIAL 4.00 ADDRESS / p PANELS 10.00 DATE OF APPLICATION AR W PANELS(OVER 200 AMP) '20.00 PLAN CHECK FEEP.c.No. DR ENGINEER LIC.rvD. ISIGNS TRANS. 3.00 ARCH.OR DRESS ENO'. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APORE55 PLICANT'S AD ' MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 - 9 w o o LICENSED CONTRACTORS DECLARATION ¢u u I hereby affirm that I am licensed under provisions of Chapter 9 IS/NCE DATE ,¢-z In (commencing with Section 7000)of Division 3 of the Business and y¢N - BLDG. ELECT. PLG. MECH. r y Z Professions Code nd , license is in full or n O O ❑ , r� ❑ o i m o License C ss Lic.Number r m F w Date- Contract-. ¢ r f � � BUILDING PERMIT ¢ rc ¢ OWNER-BUILDER DECLARATION Saw t- REFER TO ORD INFORMATION K n ,e I berth afOrm That I am exempt fwm the Contractor's License MISC.-' an 3 0,A y P _ VALUATION SIFT. F 1. 0 ¢ Law for the nycit following ountyreason,ch e.requires aermit to Professions PERMIT ISSUANCE 10.00 Q ,A 2 Code:Any city or county which structure permit to consua ce,also Q Q improve,demolish,Or repair any strntlnlC,pflnr tO itsissuance,aISO ELEC.CONTR. LIC.NO, ELEC. ' 0 LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO e" x$ he is licensed pursuant to the provisions of tire Contractor's License - wiw Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe �48 � z a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT IEEE ¢ H the basis for the alleged exemption.Any violation of Section 7031.5 V STORIES TYPE CONSTR. i3 - by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) AO of not more than five hundred dollars($500).1: ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4. OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not - _ intended or offered for sale (Sec, 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON 0 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER.TRAP 5.0 SO,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. ments are not intended or offered foreale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6. or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- . RES IND CON PB Omer prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSE55OKS PARCEL NO., and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to SEWER-SAN V-STORM EA.200ftl10.00 the Contractors License Law. TRACT NO, PARCEL NO. ❑ I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM -6.00 ACC.DATE ALC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of Consent to self-insure. - - ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereaf(Sec.3800,Lab.C.). e Policy No. Company Z Z ❑ Certifie �y is hcrtebyf / y p FIRE$PRINK ENERGY T24 B,Cerlili co 1 d t the it ins terror division. O Applicant �+ �Gy-�- - MISC.- REFER TO ORD. Y❑ N❑ y ❑ N[]~ rn EXEMPTION FROM WORKERS' PERMIT ISSUANCE FLooD ZONE CC CERTIFICAI'H OF A.L.u.c. 1 - 11J _ COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLO. CL O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑ LD Z hundred dollms(SI0()or less.) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F- out is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. y Date Applicant ALTER OR ADD TO MECH. - 5.00 FELECTRIC } to NOTICE 1'0 APPLICANT: If,after making this Certificate of fix- _ F Z emption,you should become subject to the Workers'Compeasution APPLIANCE 5.00 - provisions of the Labor Code, you must forthwith comply with. - V such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT ITO1Q000C.F.M.) 4,00 CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER t0p00GFM.) 6.00 .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. HEATING'UNIT(TO 100,000 B.T.U.) 6.00 3097,Civ.C.). Lenders Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address 1 certify that 1 have read this application and state that 0se 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-OOMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Misc.- REFER TO ORD. .per tian against liabilities,judgments, costs and expenses which CONST.TAX may any way accrue agar said City in consequence of the � PERMIT ISSUANCE 10.00 ran Ofe ,L� MECH,CONT. - LIC.N0. MECH. TOTAL �e TOTAL YJnatuT p nl/Contractor Dale OFFICE COPY