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17453 POST THIS CARD-NEAR FRONT OF BUILDING' PERMIT NUMBER CITY OF CUPERTINO 17453 INSPECTION DIVISION JOB INSPECTION.RECORD I �.� ,'1}} PERMIT+EXPIRATION Y � JOB ADDRESS-I 37 C�d CS TsIn 'Ue - UNIT# LOT# PERMIT EXPIRES IF WORK ' owrvER �A,l�pil .� W e CONTRACTOR c�e - C'p (,(y� - IS.NOT STARTED WITHIN' I SPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU FOUNDATION ANCE OR,180'DAYS FROM NOTE: - IASTCALLEDINSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB MAR 2 1 1Iso? PLUMBING ^ u G( v . 1 , 7 � I ELECTRICAL ISSUANCE DATE, MECHANICAL BLDG I ELECT PLG. MECR ❑ V ❑ ❑. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUa noN SIFT. PLUMBING . . ' i MECHANICAL - - ELECTRICAL - PERrsrt ro FRAMING rl 4 INSULATION - "STORIES -TYPE CONS R. OCC GROUP RES UNITS 1 PLACE NO SUBFLOOR UNTIL'ABOVE HAS BEEN SIGNED ' ROOF NOTE:NO FINAL INSP.SHALL-BE MADE BEFORE $O.FT.EI.01F AREA - 70TAL ACREAGE DIAPHRAGM - - THE CONSTRUCTION TAX IS PAID - BUILDING USE ROOF SHEATHING - HES • IND- • CON PB Omr- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El El El 1:1 ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING TELECT.ENERGY TRACT NO. PARCEL NO. TUBS&SHOWER PAN PLUMBING ENERGY, - MECHANICAL MECH.ENERGY ' ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO FRAMING ELECT,FINAL TEST INSULATION PLUMBING ZONING ENG SITE NO. GAS TEST GAS 'I MECHANICAL . FIRESPRINK ENERGY T24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A,Luc. INTERIOR SHEAR FIRE DEPT. .Y❑ N❑ Y ❑ N❑ SHEETROCK - GRADE FEE SUMMARY - EXTERIOR LATH BUILDING - A A INTERIOR LATH - TEMPORARY APPROVALS - BUDDING SCRATCH COAT - ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. ,MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Z -SM H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB.ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE-BEFORE TOTAL 61 CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN REDLINES -USE BALL POINT PEN ONLY'. BUI LD1 NG PROJECT 1 DENTI FICATION '. PERMIT NUMBER Bmunrvc APPLICATION & PERMIT '. /�„[ aoOREae 11 �y� BUILDING—ELECTRICAL—PLUMBING—MECHANICAL �e /'r''• `I'iJ . OWNER'S /V /'{Pp• PLAN CHECK VALIDATION .. NAME M -S'r T1��/,�+- ]' { .OTY. ELECTRIC PERMIT FEE : Tomml r/111Y.� P.mNE -J— CONTRACTORs O'OUTLETS-..SWITCH 10.00/,1.00 .DD. NAME . tt ,(� : G ITI/ uc.No.413* 9/ IGHTING FIXTURES 10.00/1.00 7•-r CONTRACT 5�1� APPLIANCES-RESIDENTIAL 4.00 ,D a AooREas - _ Q �nl t PHONE ' O � PANELS 10.00 DATE OF APPLICATION' ARCHITECT PANEL$ (OVER ZOO AMP) 20.00 PLAN CHECK FEE PC NO. OR 41—S - ENGINEER LUN SH' uc.No. SIGNS TRANS. � 3.00 ' ARCH,OR ENG SPECIAL CIRCUIT -•' 5,00 -PERMIT VALIDATION'+' � R r S'D;$- EMP.METER OR POLE INS. . 20.00 _ zIP APPLICANT Sqsp MOTORS SEE FEE SCH. _�?7 Arnm E55 SERVICE CHANGE 20,00 `I woo LICENSED CONTRACTORS DECLARATION _ 'V UP 7-7 ��” ���- Ix u u " 1 hereby affirm that I am licensed under provisions of Chapter 9 MAR 21 1 ISSUANCE GATES ' a, rt i (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT: PILO r MECH. . - D i Professions Code nd my license is in full force License Class Le.Number e e L zo ® ❑, 11o r w Dare Contractor -3� City of cgpQ, — ❑ ` a Y BUILDING PERMIT ac a w a OWNER-BUILDER DECLARATION - - -- INFORMATION woa ° MISC. REFERTO ORD ;LL H I hereby affirm that I um exempt from the Contractor's License VALUATIONS SIFT. ca LL w J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00' 'Z - Code:Any city or county which requires a permit to construct,alter, ac improve, or repair any structure,prior to its issuance,.also ELEC.CONTR. LIC.NO. ELEC: o u requires the applicant for such permit to file a signed statement that - TOTAL b,J ✓ , ., PERMIT TO 'a w m he is licensed pursuant to the provisions of the Contractor's License ' H z i Low(Chapter 9(commencingwith Section 7000)ofDlviaion 3 ofthe a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ! �- $ the basis for the alleged exemption.Any violation of Section 703 1.5, 1 STORIES TYPE CONSTR.v by any applicant for a permit subjects the applicant lou civil penalty - ALTER-DRAIN -WATER (EA.) 5.00 . of not more than five hundred dollars($500).1: r' ❑ 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,AREA,GOND. 5.00 I' 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 SQ FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- 1 I NC.4 OUTLETS 6.00 ' ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-„ or improvement is sold within one,year of completion,the owner GAS-EASYSTEM r OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that h .e did not build or ire- 'RES IND CON ' PB Other. r—�'-'- prove for purpose of sale.). INDUSTRIALWASTE INTER.- 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to coretract the project(Sec.7044,Business LAWN SPRINKLERS-11 INC 5 V.B. 6.00 ASSESSORSPARCEL 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 IEA.)" 1.00 "M: the Cots ctor'shcene Lwithacontruclor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACTNO. ' PARCEL NO. the Contractor's License Law. ❑ Iamexemptundersee: ,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner __— Date WATER SYSTEM ' . 5.00 ACC.DATE 'ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. ,5.00 I hereby affirm that I have a certificate of consent to set Ginsurc, 'ZONING ENG:SITE NO. Y or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800, pangLab.C. T—c— Policy No. Company �31L✓ 0 ' ❑ Certified copy is hereby furnished. ••FIRE BPRINK ENERGY T-24 Z Z }� Certifi copy is d with t ii iLpe tion division. MISC.- REFER TO ORD. - O Abplicmi - - e.Y ❑ N❑ V'❑ N❑', ~ h PERMIT ISSUANCE . 10.00 __FL ZONE A'.L.u.c. = L, CE TIFICA E OF F.XEMP ION FROM WORKERS' LI _ C MPENSATIO INSURANCE PLG.CONTR. LIC.NO. PLG. - 1 (Thi 0 ' s section need not be co pleted if the permit is for one TOTAL Y❑ N❑ Y❑ N❑ 0 Z hundred dollars($100)or less.) U OI certify that in the performance of the work for which this per- DFEE SUMMARY TV. MECHANICAL PERMIT FEE ' LL F mit is issued,I shall not employ any person in any manner so as to OU become subject to the Workers'Compensation Laws of California - BUILDING ' UJ Date Applicant ALTER OR ADD TO MECH. 5.00 - ' NOTICE TO APPLICANT: If,after making this Certificate of Ex- , ? eruption,you should become subject to the Workers'Compensation APPLIANCE 5,00 PLAN CHECK- )- provisions of the-Labor Cade, you nwsLforthwith comply with .FEE V such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10/10DC.F.M_.).6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCTI 5.00 _ the performance of the work for which this permit is issued(Sea MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC G Lender's Address �VI,�5—bs V I certify that 1 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 - I" 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 - above-mentioned property for inspection purposes. I (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City co equence of the PERMIT ISSUANCE 10.00 raOhO f this permit MECH.CONT. -LIC.N0. MECH., 1 _ TOTAL - TOTAL ,3 D Sigriature of A plican/Conlrac r OFFICE COPY.