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17525 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO . X525 INSPECTION DIVISION JOB INSPECTION RECORD (, PERMIT EXPIRATION JOB ADDRESS_I (1 J L ^1�s�MiW� UNIT# _LOT# �t 4-•.T PERMIT,EXPIRES IF WORK G OWNER , CDNTRACTAH 1 IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU FOUNDATION - ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED' PREGUNITE - TO COMPLY.WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION ,GARAGE SLABS CUPERTINO STANDARDS. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB �11 PLUMBING ELECTRICAL - - - iSSUANCEDATE - MECHANICAL BLDG, ELECT I PLG. I MEC. DO NOT POUR'FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL . ELECTRICAL - - PERMIT TO FRAMING - INSULATION S �57� OA! SruRIEs TYPE coNsrR - px- —/ OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.I Floory ARIA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAXIS PAID BUILDING USE ROOF SHEATHING O 11- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 ASSESSOR PARCEL NO ROUGH SAN.N - • PLUMBING ELECT,ENERGY TUBS 8 SHOWER PAN - PLUMBING ENERGY ' TRACT NO. PARCEL NO MECHANICAL MECH.,ENERGY ACC DATE ACC,FILE NO. ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST M T• INSULATION PLUMBING - ZONING ENG.SITE NO. GAS TEST GAS^ ' ' MECHANICAL - FINE SPRINK .ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATINGY ❑ ' N� "n EXTERIOR SHEAR ELECTRICAL RELEASE c_090 ZONE ALUC._ INTERIOR SHEAR - FIRE DEPT. v❑ N❑ v ❑ N SHEETROCK .' GRADE FEE SUMMARY EXTERIOR LATH BUILDING - INTERIOR LATH. TEMPORARY APPROVALS BUILDING SCRATCH.COAT . ELECTRIC . PLAN CHECK - - - - GAS - FEE' NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BU ILDING FINAL ISSIGNED BY BUILDING'INSPECTOR. MICROFILM ' ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION'. PLUMBING /jEQD PLEASE GIVE JOB ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION'DATE -' MECHANICAL IMPORTANT!' CONST.TAX' -\ PLEASE READ REVERSE SIDE BEFORE TOTAL 7f fj�LQJ� CALLING FOR FINAL INSPECTION: OFFICE COPY APP`tICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER aUIEGING APPLICATION & PERMIT ao :• 17525 UILDING-ELECTRICAL-PLUMBINGDRESS ' / 7� u •&VDBMECHANICAL - OWN ER'S J NAM //`nI]JAj1 'PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE PHONE coNT ACT .y- Uyt [100.1101OUTLETS-SWITCHES-RECEP 10.00/1.00 NAM 7 rT LIGHTING FIXTURES 10.00/1.00 no T ACTOR '�F�, I PPLIANCES-RESIDENTIAL 4.00 . o �WAU�HON v7 PANELS 10.00 DATE OF APPLICATION ARCHITECT / PLAN CHECK FEE P.C.NO. OR ' , 1 _ a0 PANELS (OVER 200 AMP) 20.00 ENGINEER Cy W / L SIGNS TRANS. 3.00 ARCH OR ENG PERMIT VALIDATION A Q /� „Ir , 1--� f� �'�- SPECIALCIRCUIT 5.00 ^'y, T� 3 n �_A m c✓1�. iIP�]-1, • EMP.METER OR POLE INS. 20.00 vc , A4, APPLICANT'S A DREs 1 a AA _ [](�� MOTORS SEE FEE SCH. rtU� r� SERVICE CHANGE 20.00 ` QQ m a o LICENSED CONTRACTORS DECLARATION _1 . a Z w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (sem....rucing with Section 7000)of Division 3 of the Busines and ti a cBLDG. ELECT. P MECH. r w i Professions Co m 'cense is in full fo n tC ❑ ❑ o Z u,o License CI Lie.Number J H w Uafc _Contract - < e s BUILDING PERMIT ¢ ¢ a OWNER-BUILDER DECLARATION o g u INFORMATION X3: w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD w w VALUATION $/FT. HUN J Law for the following reason(Sec.7071.5,Business Professions PERMIT ISSUANCE 10.00 Code Any City oT county which requires permit to construct,alter, ¢ rt < improve demolish,Or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO LL w m m he is licensed pursuant to lire provisions of Ore Contractor's License r z Law(Chapter 9(commencing with Section 7000)of Division 3 of the i q o Business and Professions Code)or than he is exempt therefrom and QTY. PLUMBING PERMIT FEE w I-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. ag � byway applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 500 of not more than five hundred dollars($500).1: ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 00 OCC.GROUP RES.UNITS le their socompensation,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 Q Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who doesimsuch work FIXTURES-PER TRAP S.OD 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended oroffered for sale.IL however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or improvement is sold within rote year of Completion,the owner- GAS-.EA.SYSTEM OVER 4 IEA) 200 builder will have the burden of proving that h - . . e did not build or un- BUILDING USE prove for purpose of sale.). RES IND CON PS Other ❑ Las owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSOR 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 IEA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to SEWER-SAN ITARV-STORM EA.200ft/10.00 the Contractors License Law. • TRACT NO. PARCEL NO. ❑ I am exempt Linder Sec..,BAP.C.for this reason WATER HEATER W/VENT 6.00 _ Owner Date WATER SVSTE 5.00 rDv1�O ACC.DATE ACC.FILE NO. WORKERS'COMPENSAT10N DECLARATION WATER TR AT 5.00 I hereby affirm that I have a aertiNcute i fe nsew to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lah.C.). of Policy No. Company O j ertifc copy is hereby furnished. FIRE SPRINK ENERGY T24 Z Z ant ifle copy 's I'd I he 'ty inspection division. PMISC.• REFER TO ORD,p v ❑ N❑ ❑v N ❑ O va PERMIT ISSUANCE 10.00 fY - CIi RTIFICATE OF EXEMPTION FROM WO S. FLOOD 20NE A.L.U.C. LU COMPENSATION INSURANCE PLG.CONTR. ❑C.NO. PLG. v❑ N❑ Y❑ N❑ CL Z (This section need not be completed if the permit is for one TOTAL hundred dollars(Stool or It.) L) 0 I certify that in the performance of the work for which this pm- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,1 shall not employ any person in any manner so as to O w become subject to the Workers'Compensation laws of California. BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 } W NOTICE*1'0 APPLICANT: IL after making this Certificate at Ex__ Fz emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK' provisions of the Labor Code, you must t'orthwith comply with FEE U such provisions or this permit shall he deemed revoked. - AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONSTRUCT ION L17NDING AGENCY AIR HANDLING UNIT(OVER 10=r-F.M.) 6.00 SEISMIC FEE 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 3051 HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lcndcrs Name HEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC Lender's Address 1 certify that I have read thisapplication and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP (Over 100.000 BTU)SEE FEE SCH, MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. .penin. against liabilities,judgments, costs and expenses which CONST.TAX may.in any way a crue a�.couseiuienccinst said City in of the _ PERMIT ISSUANCE 10.00 mn .(this er t QMECH.CONT. LIC.NO. - MECH. - 3�/g l TOTAL TOTAL CJ1 OD Slgnat re of Apphcan[/ConU e OFFICE COPY