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15395 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 15395 INSPECTION DIVISION JOB INSPECTION RECORD _ PERMIT EXPIRATION ,JOB ADDRESS /O �f3-� LL("7.n-7�C UNIT# _LOT# / PERMIT EXPIRES IF WORK OWNER d cs'TY. i / v'V CONTRACTOR - IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION 6- NOTE: _ ANCE OR 180 DAYS FROM UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGESLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED . ,UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE UATF MECHANICAL - - BLDG ELI-E-�CT. PLG- MECR El EI ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED IPPASW BUILDING PERMIT WOOD FLOOR nINFORMATION PLUMBING ALUATION SIFT. � � MECHANICAL « ELECTRICAL FL.M T TO FRAMING C�tY ai: ..� J�.�✓:�t INSULATION - - STORIES TYPE CONSTR. • OCL GROUP RES•UgtTS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn.Er FLOOR A�reA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAXIS PAID --------BUILDINC ON use ROOF SHEATHING - Res IND cve oiR., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH A55ESSORS PARCEL NO SAN.p PLUMBING - ELECT.ENERGY ` TUBS&SHOWER PAN PLUMBING ENERGY TRACT.No. PARCEL No MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC OATS ACC.FILE No FRAMING ELECT.FINALTEST INSULATION PLUMBING zomwG ENc.SITE No. GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING' Y ❑ N'❑ v ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A,LUC INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ N❑ SHEETROCK GRADE EXTERIOR LATH FEE SUMMARY BUILDING,#/v7 -j INTERIOR LATH BUILDING 4 TEMPORARY APPROVALS SCRATCHCOAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. • MICROFILM . . ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F_ 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 >s CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FICATION 'PERMIT NUMBER t BUILDING APPLICATION & PERMIT [ Q ADDRESS / S D J ��yaa2� EQS a G ✓:VG BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ,. J J OWNER 3. CiFr� PLAN CHECK VALIDATION OTY. ELECTRIC PERMIT FEE .+ t✓ L s.:: -rsoy,„°NE NAMERADTORs UTLETS-SWITCHES-RECEP 10.00/1.00 LIC.ND. LIGHTING FIXTURES 10.00/1.00 ADDRESS roR's PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ' On PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER LIc,No, ISIGNS TRANS. 3.00 ARCH.ss ENG SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 ADDRESS Ts MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 Daz Foo LICENSED CONTRACTORS DECLARATION D c u u I hereby affirm that 1 am licensed under provisions of Chapter 9 - y< y (Commencing with Section 7000)of Division 3 of the Business and SSUANCE DATE L10 LECT. PLG, MECH. H H z Professions Code,and my license is in full force and effect. ❑ ❑ ❑ oi m o License ClassLie.Number w H w Datc Contractor ¢ YE a a w a OWNER-BUILDER DECLARATION ING PERMIT o a " Cu - INFORMATION F ; u H 1 hereby affirm that I wn exempt,from the Contractor's License MISC.- _ REFER TO ORD a_ Law forthe following reason. 7031.5,Business and Professions VALUATION g/FT. - PERMIT ISSUANCE 10.00 m0 Code:Any city ormunty which requires a perrintto construct,alter, a re ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. n w m u requires the applicant for such permit m file a signed statement that TOTAL PERMIT TO Ile is licensed pursuant m the provisions of the Contractors License '/ Fii Law(Chapter 9(commencing with Section 7000)ofDivislon 3 ofthe � TQw�� 4 a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE F' (( a F $ by basis for the ally a exemption.Any violation applicant to a cion 7031.$ STORIES TYPE CONSTR. a ;_ by any applicant forapedledd.1ccts(hc0).) toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of nyt more Ihun five hundred dollars(my employees Ylyl� I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 L el sole Compensation,will do the work,and the structure i5 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 docs not apply to an owner of • property who hallds Sar improves tllareon,and who doe,Sllelt Wurk FIXTURES-PER TRAP 5.00 S°.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale.l f,however.the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) . 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE Prove for purpose cfsale.). RES IND CON P8 Other t❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construe( the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. 11 1:1 El El 11 and Professions Code:The Contractor's License Low does not apply. to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS.-OVER 5(EA.) 1.00 contracts for such projects with n contractor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORMEA.200ft/10.00 TRACTNO, PARDEL NO. ❑ lam cx erS B.&P.C.feel us v reasWATER HEATER W/VENT 6.00 P Owner L / WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK Ii RS'COMPEN'SATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm Dlat I have a certificate of consent to self-insure, or u certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof'(Sec,3800,Lab.CJ. Policy Nn. Company O ❑ Certified c.py'ia hereby furnished. ❑ Certified co is filed with the cit ins FIRE SPRINK ENERGY,T24 Z 2 PY Y' inspection Division. v N� v N� Applicant MISC.- 'n REFER TO ORD. ~ rn PERMIT ISSUANCE 10.00 LU CISRTIFICCOMOFEXEMPTINS FROM WORKERS' FLOOD ZONE A.L.U.C. W � % COMPENSATION INSURANCE PLG.CONTR. LIC.NO.` PLG. CL 0 (Phis section need not be completed if the pcnnit is for one TOigL YN Y ry Z hundHed dollars(4100)or lessf U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mil is issued,I shall not employ any person in any manner rat as to U w become subject to the Workers'Compensation Laws ol'California. 6 Date Applicant O ALTER OR ADD TO MECH. 500 BUILDING J } 0 N'OTICIi 'I' APPLICANT If, fter making th '. ais Certificate oGx- lif F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5PLAN CHECK .00 provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M,) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOWGEM.) 6.00 SEISMIC FEE SO 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 3097,Civ.C.). HEATING UNIT(TO 100,000 MICROFILM B.T.UF) 8.00 Lender's Name Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 1 Certify that I have read this application and stat Rlat the above V ENTI LAT I ON FAN (SINGLE) 4.00 inforneation is correct, I agree to calnPlY with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COIv1P(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representalives of this city to enter upon the BOILER-COMP IOva�100,000 BT SEE FEE SC above-mentioned property for inspection purposes. MECHANICAL (We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORDl s- Cupertino against liabilities,judgments, costs and expenses which ay in any y accrue a 'lost said ty int consequence of the PERMIT ISSUANCE 10.00 CONST.TAX r'intin" it. ECH.CONT. LIC.NO. MECH. a//f�' TOTAL �-rJC Ignalurc of ppllcant/Contractor Dat TOTAL V aJ OFFICE COPY