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17553 POST THIS CARD NEAR FRONT OF. BUILDING PERMIT"umRER CITY OF- CUPERTINO 17553 INSPECTION DIVISION, JOB INSPECTION RECORD PERMIT.EXPI RATION JOB ADDRESS " '-UNIT# _LOT# "'4_SS0�f_• PERMIT EXPIRES IF WORK OWNER T��WCsr l�1 CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU, FOUNDATION ANCE OR 180 DAYS FROM NOTE; LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED - PREGUNITE, TO COMPLY WITH THE APPROVED PLANS AND CITY-OF PERNIn`VAIJDATION GARAGE SLABS CUPERTINO STANDARDS. � � POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB p 10 PLUMBING - ELECTRICAL APR 2 ISSUANCE DATE MECHANICAL _ - L� ELECT, PLc. mecR @CIIY.QL �. ' DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUIL%% PERMIT WOOD FLOOR IN RMATION PLUMBING' VALUATION SIFT. � - MECHANICAL TO ELECTRICAL � PERMI'T FRAMING STORIES TYPE CONSTR. INSULATION DEC,GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO PT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID -BUILDING USE ROOF SHEATHING RES NO CON PB on... APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 El ❑ ❑ ❑ ROUGH ASSES CUTS PAR CEL NO � SAN.k PLUMBING. - ELECT,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 ZONING eNc.SITE No., INSULATION PLUMBING GAS TEST GAS ' -FIRE SPRINK ENERGY T-24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ElN[] ' EXTERIOR SHEAR ELECTRICAL-RELEASE FLOOD ZONE AL U,C, INTERIOR SHEAR FIRE DEPT. Y[] IN Y ❑ 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 JOCCUPANCY - SEISMIC FEE OCCUPANCY OF BUILDINGIS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC IW— ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z (LLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT,FOR EXPIRATION DATE = MECHANICAL ' IMPORTANT! CONST.rax PLEASE READ REVERSE SIDE BEFORE I TOTAL CALLING FOR FINAL'INSPECTION. I OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU PL DING PROJECT IDENTI FICATION PERMIT NUMBER BUILDI APPLICATION & PERMIT AOD6G IIf� 1 17553 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL �!I OwNER'S PLAN CHECK VALIDATION � NAME�1}`y� r\��EA{�'fyy OC• QTY. ELECTRIC PERMIT FEE rO�ICCONTRACTORS TORS NAp7�� \ x 4 /�^ UTLETS-SWITCHES-RECEP 10.00/1.00 ✓e CON Z a LIC.NO. 1432 / LIGHTING FIXTURES 10.00/1.00 ADons PPLIANCES-RESIDENTIAL X DRESS 4.00 PHONEWVA36 PANELS 10.00 ' DATEOF APPLICATION " ARCwrECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. sec.No. SIGNS TRANS. 3,00 AARCH OR DDRESS ENG. SPECIAL CIRCUIT 6.00 PERMIT VALIDATION • ZIP EMP.METER OR POLE INS- 20.00 ADDDRESSDRESS -7^ 1•y�^ AMOTORS SEE FEE SCH. AN�NL�-� SERVICE CHANGE 20.00 w00 LICENSED CONTRACTORS DECLARATION 0u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE Z ea (commencing with Section 7000)of Division 3 of the Business and DG. ELECT. PLG. MECH. r�i I'uofcssions Co�d• (aaDnn��/11((Cyyyy yII�p nu is in full foreq)�7}ff�i a i m I] License ClassT Lic.Number f`� I ❑ ❑ Date Contractor a L s UILDI NG PERMIT Scwu OWNER-BUILDER DECLARATION ORMATION w g e- N I hereby affirm that I am exempt from the Contractor's LiINF cense MISC.- REFER TO OR NIF $/FT. r u o J Law for line following unison.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.0 ATION PeRw ww Code:Anycity or county which requires a permit to construct,alter, Q improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. , w-DLL requires the applicant for such permit to file a signed statement 11mt TOTAL PERMIT TO m he is licensed pursuant to the provisions of the Contractor's License Hza Law(Chapter 9(commencing with Section 7000)of Division 3 offle - 4 D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Ie H the basis for the alleged exemption.Any violation of Section 7031,5 STORIES TYPE CONSTR. aS - by any applicant for a permit subjects the applicant to a civil penuhy ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($5001). ❑ 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,AREA,COND. 5.00 , Code:The Contractor's License Law does not apply to as owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP - 5.00 g0,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve, , �., meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I1NC.40UTLETS 6.00 or improvement is sold within one year Of completion,the owner- GAS EASYSTEM-OVER 4 (EA.), 2.00 builder will have the burden of proving that h - . e did not build or ice- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER, 30.00 RES IND CON PB Omer ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contract.,, m construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,land who ILAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200111/10.00 TRACT NO. PARCEL NO. ❑ Iamexemplunder Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 VACC.OATEACC.FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1hereby affirm that I have acerlilicme ofconsent toselGin sure, ENG.SITE NO. ora certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab.C.). I'o¢ No. Company 0 G Certified copy is hereby furnished. ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.O Applicant• Y.❑ NN CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 AL.u.C. LLI COMPENSATION INSURANC17 PLG.CONTR, LIC.NO. PLG.d 0 (This Section need not be completed if the permit is for one TOTAL Y ❑ N❑ D Z hundred dollar,IS 100)or less_) U O 1 ecrlily that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL P mit is issued, I shall not employ any person in any manner so as to oV become subject to the Workeri Compensation Laws of Gdiforma. Go0. Dote Applicant ALTER OR ADD TO MECH. 5.00 BUILDING >_ Go NOTICE 1`0 APPLICANT: II',after making this Certificate of Ex- F ? empton,you should become subject to Ole Workers'Compensatmo APPLIANCE 500 PLAN CHECK provisions of the Labor Code, you must forthwith comply with - r- FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) CONS'fRUC"FION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.RM.) 6.00 SEISMICFEE -I hereby affirm OUR there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 _ the performance of the work fo which tis pennil is issu-d(Sec. MICROFILM 3097,Civ.C.), f�' �J 1J,1,� /y;Z�'y�-- HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Nam- ` ", "'�k; ` Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC . 1 eerily Ihat I have read this application and state that the above VENTILATION FAN (SINGLE) 4. 4.00 • information is correct.1 agree to comply with:dl city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorise representatives of this city to enter upon the BOILER-COMP Over 100,000 BTU)SEE FEESCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. ertino against liabiliti judgments, costs and expenses which o + CONST.TAX a in any wa a r ainsl Said City in consequen a of the PERMIT ISSUANCE 12 x.16:60 a gof this n �t. MECH.CONT. LIC.NO. MECH. IL - TOTAL TOTAL Si lure Df Apple nt/Contraclor Date �c�Con3 T� PC) 5j OFFICE COPY