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16735POST THIS CARD NEAR FRONTOF_BUILDING PERMIT,NUMBER CITY OF CUPERTINO 16735 INSPECTION'DIVISION JOB INSPECTION IIN'(S�PEECTIcO}•1N7 RECORD I 0--b3k GEt�(ZR�r. \1�� PERMIT EXPIRATION JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK! OWNER CONTRACTOR Pf•LV�t IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU. ANCE OR 180 DAYS FROM INSPE TION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE:' ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF LAST CALLED' INSPECTION. UFER PREGUNITE PERMIT VALIDATION CUPERTINO STANDARDS. , F f ISSUANCE DATE. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - - UNDERGROUND IISLAB PLUMBING ELECTRICAL MECHANICAL - - BLOC ❑ ELECT ❑ PL( ECR 1 t ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING - MECHANICAL ELECTRICAL PERMIT TO FRAMING INSULATION ' STORIES TYPE CONSTR. - •'' •MADEBEFORE OCC. GROUP RES, UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' ROOF NOTE NO FINAL INSP. SHALL BE THE CONSTRUCTION TAX IS PAID so,PT FLOOR AREA *orA¢uceeaeE. DIAPHRAGM BUILDING USE ROOF SHEATHING ❑ coN PB onr� 1 '' E APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.a ASSESSORS PARCEL NO, - PLUMBING - 'ELECT. ENERGY TUBS &SHOWER PAN - PLUMBINGENERGYIf,. THACTNO, " PARCEL NO . MECHANICAL MECH.ENERGY ELECTRICAL .. BUILDING ENERGY S, + ACC DATE, ACC. FILE NO, FRAMING - ELECT. FINAL TEST INSULATION - PLUMBING ZONING ENG SITE NO� GAS TEST - GAS FIRE SPRINK ENERGY T.24 MECHANICAL Y ❑ No Y 0 N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASEL OOD2ONE �❑ IN A:L.Uc YL N❑ INTERIOR SHEAR FIRE DEPT. ,• SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING' - BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC - PLAN CHECK FEE GAS - NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY- SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED.UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. ' MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC PLUMBING F ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. z —SEE PERMIT FOR EXPIRATION DATE — MECHANICAL consT. rnx ' IMPORTANT! TOTALjLD PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY'. 10 0 Z_z N Cr W _ ao UD LL V Ow )r la I- ? ,a. APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL ;PERMIT NUMBER z , 16735 BUILDING -,- ADDRESSD OwNEWs NAME DTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION - PHONE 2S _ NOAMTRACTOFs 1 LIC. No.362- UTLETS- SWITCHES -RECEP 10.00 :00 LIGHTING FIXTURES 10 /1.00 DDNTHACTO 's '� ADDRESS APPLIANCES 4.00 PANELS 10.00 p p� 77 PHONEp 6.T. - DATE OF APPLICATION v ARCHITECT OR ENGINEER LIC. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C,NO. SIGNS TRANS.- 3.00 AARCH. OR DDRESS ENG. zip SPECIAL CIRCUIT 5.00 PERMIT VALIDATION - Er�q EMP. METER OR LE INS. 20.00 APPLICANT _ ADDRESS ADDRESS - MOTORS SEE FEE SCH. SERVICE CH GE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cot �y�my license is in full for a pf�t. License Class S-!/1_ Lin. Number) ISSUANCE DATE BLDG. ELELT. ❑ ❑ PLG. EC . ❑ Date �. Contractor � . BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION License 1 hereby el firm that 1 ng Gatso exempt from the mess ma Professions Code:aw Any the Code: Any city or roubty whiny countywhichn. c. requires a permit to construct, atleo permit / ISG.- REFER TO ORD VALUATION $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIG NO. TOTAL Eo1 r improve, demolish, or repair any structure; prior n its issuance, also structure: its Mourn requires the dp araant for such permit to file ir signed statement that he is licensed pursuant to the provisions of the License PERMIT TO DTV. PLUMBING PERMIT FEE Lew (Chapter 9 (Commencing with Section is) of exe of Division 3 of the Business and Professions Code) or that he isexempt therefrom and STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation ol'Section 103 T.5 by any applicant for a permit subjects the applicant toa civil penalty of not more than five hundred dollars (55001.): ALTER -DRAIN & VENT -WATER IEA.) 5.00 ❑ .I, as o wner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (See. 7044, Business and Professions Code: The Conlmclor's License Law does not apply to an owner of property who builds or improves theremr, and who docs such work himself or through his own employees, provided that such improve- mentsarenotintendedoroffered for sale. If, however, the building F IXTUR ES - PER TRAP' 5.00 GAS - EA. SYSTEM - I INC. 4 OUTLETS 6.00 60. FT. FLOOR AREA TOTAL ACREAGE - or improvement is sold within one year of completion, the owner- builder will have lhe''burden of proving that he did not build or im- prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 IEA.) 2.00 BUILDING USE RE IND CON PB -Omer El ❑. C1 ❑" INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business 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- 1 INC 5 V.B. 6.00 LAWN.SPRINKLERS -OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. , contracts for such projects with a cmdmctor(s) licensed pursuant to the Contractor', License Law. SEWER -SANITARY -STORM EA. 200ftI10.00 TRACT NO. PARCEL NO. reason lam exempt under Sec.-, B.&P.C, for this, WATER HEATER W/VENT t 6.00 Owner Date WATER SYSTEM ' 5.00 ACC. DATE ACC. FILE NO. WATER TREATING E WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a Certificate of consent to self -insure, or is certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy a 3800, Lab.C.). Poli Company i-��••-of ❑ Certified copy is hereby furnished. ,JikCertinqty is filed will ;,e city inspection division. Applicant' L�I- At I FIRE SPRINK y ❑ N ❑ ENERGY T-24 Y ❑ N❑ MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE - A1.U.C. PLG. CONTH. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one y� N❑ y❑ N❑ hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per. mit is issued, I shall not employ any person In any manner s0 as t0 DTV MECHANICAL PERMIT FEE FEE SUMMARY BUILDING , become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex- ALTER OR ADD TO MECH500 . . APPLIANCE 5.00 PLAN CHECK emption, you should become subject to the Workers'Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 FEE AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE .CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DU 5.00 the performance of the work I'or which this permit is issued (Sec. 3097, Civ.C.). MICROFILM HEATING UNIT (TO 100,00 .U. .00 �� Lender's Name HEATING UN IT (OVER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Address I certily that I 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 ordinances and stale laws relating to building construction, and PLUMBING BOILER-ODMP(3 H.P. Or 100,000 B.T.U.) 600 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. .MECHANICAL' I LW hereby authorize representatives of this city to enter upon IhC operty for ins ct ion purposes. shove-7yay MISC. - REFER TO ORD. (Weve, indem y and keep harmless the City of uperl'line - d encs, costs and expenses which may inrue 1 aid City in conseyuence of therantin CONST. TAX - PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL 111 L TOTAL � 11 rL IxQD Signature of ApplicantfConlractor Date OFFICE COPY