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14585 v POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 14585 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDR'EEJSSSSS �UB6 �i LC/ 1 .P•UNIT# - _LOT# PERMIT EXPIRES IF WORK OWNER " `"QS 7'c0 - CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. 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 I' PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG ELEcI, PLG. MECR ❑ o a ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT - WOOD FLOOR , INFORMATION V4LUATION SIFT. PLUMBING MECHANICAL " ELECTRICAL - nom^ PERT TO FRAMING INSULATION (�, STORIES TYPE CONS TO {I OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF so.FT.FLOOR AREA TOTAL ACREAGE. NOTE'NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING BUILDING USE - RES INo CON Pp Ou,„, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ED E] ROUGH. sAN.a ASSESSORS PARCEL NO PLUMBING ELECT,ENERGY TUBS&SHOWER PANPLUMBING ENERGY _ TRACT NO. PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL - - BUILDING ENERGY ACC DATE ACC FILE NO FRAMING ELECT.FINAL TEST INSULATION -M ZONING” ENG.SITE NO. GAS TEST FIRE SPRwrc ENERGY LP4 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED Y ❑ N❑ ` ❑ No EXTERIOR SHEAR ELEASE FLOOUZONE A U.c, INTERIOR SHEAR Y❑ N❑ Y ❑ N❑ SHEETROCK FEE SUMMARY EXTERIOR LATH 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 BUILDING IS NOT PERMITTE D'UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC k T o� 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 CALLING FOR FINAL INSPECTION. OFFICE COPY rAPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY I. BUILDING PROJECT IDENTIFICATION PERMIT NUMBER "' BUILDING APPLICATION & PERMIT 14585 A�aDDRESs CJI 2 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL , 'S PLAN CHECK VALIDATION �• -ESN p,r i �� hAPPLIANCES LECTRIC PERMIT FEE '-I PHONE NamERacI ITCHES-RECEP 10.00/1.00 LIC.NO. XTURES 10.00/1.00 CONTRACTOR DDRESS rolls -RESIDENTIAL 4.00 , ,PHONE 10.00 DATE OF APPLICATION - ARCHITECt PLAN CHECK FEE P,C.NO, on ER 200 AMP) 20.00 ENGINEER NO. S. 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP. METER OR POLE INS. 20.00 ADORESS s MOTORS SEE FEE SCH. �> SERVICE CHANGE 20.00 / w O o LICENSED CONTRACTORS DECLARATION P,u L, I hereby affirm that 1 am liecowd under provisions of Chapter 9 GGG y Z n ISSUANCE ¢ (commencing with Section 7000)of Division 3 of the Business and R H i Professions Code,and my license is in full force and effect ❑BLDG. ELECT. PLG. MECH. ❑z o m - License Class Lic.Numhcr 2 w r°w Date Contractor - E�ppp El�� ¢ a fe a OWNER-BUILDER DECLARATION CUP" BUIL NG PERMIT a o P, ° INFORMATION X ; y I hereby affirm that 1 am exempt from the Contractor's License MISC.- RE ER TO ORD w o a Law for the following reason.(Sec.7031.5,Businessand Professions _ VALUATION - g PERMIT ISSUANCE 10.00 a S/FT. ,4 Code:Any molty or countywhich structure permit rots issuance.also ♦[" ¢ 2 ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. Oma o O¢ requires the applicant for such permit to file a signed statement that o u TOTAL a w m he is licensed pursuant to the provisions of the Contractor's License ��P;-C/,TO REQ Buw(essand9(cosions Codeng )or Section is 00)exempt therrorl the G 1 o Business and Professions cant of IAn he is exempt thcreGn0 and QTY. PLUMBING PERMIT FEE ¢ I-pm the basis for the alleged exemption.Any violation of"8ection]031.5 STORIES TYPE CONSTR. a. i - by any applicant for a permit subjects the applicant to a civil penalty o1'not more th an five hundred dollars($500).). ALTER-DRAIN&VENT-WATER (EAJ 5.00 ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4,00 their Sale 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 an owner of property who buddy or improves thereon,and who does such work FIXTURES-PERTRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- . meats are not intended or offered lot sale.If.however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 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(it im- BUILDING USE prove for purpose afsele J. RES IND CON PIS Other ❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 licensed contractors In construct tern project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0. and Professions Code The Contraclnr's License Law docs 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 a contractor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. _ ❑ Iamtxyno d•r Se . ,B.&1tC.lin this WATER HEATER W/VENT reason D M 6.00 Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WOR I iRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent to selhinsure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(See.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnislled. z Z ❑ CUN iIicJ copy is Filed with the city inspcction'diviaion. FIRESPRINK ENERGY T-24 Applicant MISC.- REFER TO ORD. Y ❑ No v E] IN ~ O PERMIT ISSUANCE LU w CE R'I'IFI (70 OF PROMW'ORRIiRS' 10.00 FLOOD-ZONE a.L.u.c. W . COMPENSATION INSURANCE PLG.CONTR. LG.NO. PLG, CL0 (This section need not be completed if the permit is for one TOTAL v N Y N U O hundred dollars IS 100)or less.) I certify that in me performance of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,1 shall not employ any person in any nl etoer m us'to 0 W become subject to the Workers'Compmisation Laws ofCalifornia, C_ Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE TO APPLICANT: If,after making this Certificate of Ex- F - emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MOC.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10=C+F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a Construction lending agency for EXHAUST HOOD(WITH DUCT) 500 the performance of the work t..whidh this perm . it is issued(Sec. MICROFILM 3097,Civ.C.r HEATING UNIT(TO 100,000 B.T.U.) 8.00 Leaded,Name Lender's AddressHEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC 0, 1 certify Rat I have read This application and ,are Ilial the above VENTILATION FAN (SINGLE) 4.00 information is correct 1 agree 10 comply with all city and county PLUMBING , ordinances and state laws relating to building construction, and BOILER-DOW H.P.or 100,000 B:T.U.) 6.00 hereby aullum-oc representatives of this city to enter upon the BOILER-COMP above-mentioned Property for inspection purposes. (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (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 in consequence of the PERMIT ISSUANCE 10.00 - mnlin ofthisp mit. MECH.CONT. LIC.NO. MEGH. d�M✓ ,A , 2/3`pP TOTAL TOTAL Signature APPhcanOContractor Dale OFFICE COPY