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16681 POST THIS CARD NEAR FRONT OF BUILDING, PER&IITNUMBER CITY OF CUPERTINO 16681 INSPECTION DIVISION JOB INSPECTION RECORD • .r p PERMIT EXPIRATION JOB ADDRESS �Q.;/ F,�,�„�-<-d�L�F UNIT# LOT# PERMIT EXPIRES IF WORK OWNER ,� L 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 PEHn+n VALIDATION, CUPERTINO STANDARDS. GARAGESLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED " UNDERGROUND /SLAB PLUMBING + R /•'- l.. ' / ��, !• ' . ELECTRICAL• ISSUANCE DATE - MECHANICAL - - LDGI ELECT I PLG MECR. X ' DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED t'1 - BUILDINGEPERMIT INFOR ATION WOOD FLOOR VALUATION SIFT. PLUMBING - ,{ry MECHANICAL - ELECTRICAL - PERIO T TO FRAMING INSULATION - c� 7vap at, STORIES TYPE CONSTT+ occ m+OUP HES uwTs PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 5O-IT FLOOR AI,cA TOTAL ACREAGE. DIAPHRAGM THE CONSTRUCTION TAX IS PAID B W.: LONG USE ROOF SHEATHING Res Irvn ON Pe oln., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 ❑ 0 0 ROUGH # ASSESSORS PA14CEL NO SAN. _ PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO. TUBS BSHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY .A=DAlE ACC FILE NO ELECTRICAL - BUILDING ENERGY FRAMING ELECT.FINAL TEST ].ONiNG ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS ' - MECHANIC FIRE SPRINK ENERGY TOA COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y L] NO Y 0 N[]� EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE -A.LUC. INTERIOR SHEAR FIRE DEPT. ` "❑ - "❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR.LATH BUILDING II INTERIOR LATH - - TEMPORARY APPROVALS BUILDING SCRATCH COAT . . ELECTRIC PLAN CH ECK GAS FEE . I NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY_ SEISMIC FEE OCCUPANCY OF BUI LDING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ELIARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC C � ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING I Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL S U , IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE 'TOTAL v ' CALLING FOR FINAL INSPECTION. ---�- -OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 16681 ADDREss BUILDING-ELECTRICAL-PL _ UMBING 'MECHANICAL ' 10' O /•c, )1zo ki � OwrvER'S PLAN CHECK VALIDATION AME D- //A 'a //�� L OTY. ELECTRIC PERMIT• FEE /• V�/��•-1�' PHONE /� -�L Q i NTRACTOR'S / (- . UTLETS-SWITCHES-RECEP 10.00/1.00 3 "� V1 C-A NO. S6 q✓/ _9_ LIGHTING FIXTURES 10.00/1.00 ADDRESS ORa APPLIANCES 4.00 ADDREss _ S �PHONE�? � PANELS . s 41�13710.00 DATE OF APPLICATION (... OR ORT PANELS (OVER 200 AMP) 2.0,00 PLAN CHECK EEEP.C.No. ENGINEER LIC.NO. SIGNS TRANS. 3.00 AOGRi'ESS ENG' � SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 1 Arvrs MOTORS SEE FEE SCH. ADDRESDDRESS Oft! SERVICE CHANGE 20.00 e• w o o LICLNSIiD CONTRACTORS DECLARATION P t vJ� U,L~i I hereby of ria that l am licensed under provisions of Cha pmr 9 7 ISSUANCE DATE Z "' (commencing with Section 7000)of Division 3 of the Business and G ¢ y BLDG. ECT. PLG. MECH. ,o In r W Profession,Code,gpyamy nL C. in f all ford�� z o H- License ss_G__�(s Lie Numbe Dote Gust meter ��sMf ¢ Y ¢ a OWN[i R-BUILDF,R DECLARATION \s.' BUILDING PERMIT a o v INFORMATION X ; LL I- I hereby affirm that I am exempt from the Contractor's License MISC,- REFER TO ORD I- ooj Law for the following reusnn.lSec.7031.5.Business and Professions PERMIT ISSUANCE VALUATION E/Fi. m0 Crede:Any city orcounty which myuires a permit to construct,alter, ¢ ¢o improve,demolish,or repair any structure,prior to its issuance also ELEC.CONTR. LIC.NO. ELEC. o - O ¢ requires the applicant for such pemlil to Pit,a signed statement that TOTAL w 9 m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO Fz > Law(Chapter 9(commencing with Section 7000)ofDivision3ofthe _ �• ¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ t the basis for the alleged exemption.Any violation of-Section 7031.5 STORIES f TYPE CONSTR. a ; by any applicant for a permit subjects the applicant to acwil penally0)-) ALTER-DRAIN -WATER (EA.) of not more than five hundred dollars(550 : ❑ 1,as owner of the property,or my employees with wages as BACKFLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole eompenation,will do the work,and the structure 6 not intended or offend for sale (Sea 70,L4, Business and Protessions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:'Fla,Contractor's License Law does not apply to an owner of O property who builds or Improves thereon,and who doessuch work FIXTURES-PER TRAP - rOrb SD,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such approve- Hunts are not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- bit wner- GAS-EA.SYSTEM OVER 4 IEA.) 200 builder will have the burden of proving that he did not build or ire- - . . BUILDING USE prove for purpose of mlc')' INDUSTRIAL WASTE INTER. 3000 RES IND CON PB Omer ❑ 1,as owner of the prnpcny:ani uxclusivcly contracting with ❑ ❑ ❑ '❑ ❑ licensed contractors to construct the pokes(See 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:l'he Contractor's License Law dun not apply to an owner of Property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5IEA.) 1.00 contracts for such pmjccts with a contractor(,)licensed pursuant to the Convector's License Law. SEWER-SANITARY-STORM EA.200ft/10:00 TRACT NO. PARCEL NO. ❑ lam exempt under See ,BSP.C.for this WATER HEATER W/VENT 6.00 - reason 0w'ner Pate WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby alflrm that 1 have a cenific is id-consent to wfiNnuue, -ZONING ENG.SITE NO. or a artm.1 cu W'orkcrs'ComlprS5gqinion Inwralke,orcertified I ropy thereof)Sac_3800.Wb.C.)SJ Y `/g' P ' Policy No. Com wry //�C�E q- Z ❑ Certified P by Tum FIRE SPRINK ENERGY T 24 Z 2 )IC Certif s file frI��'tion division. MISC. REFER TO ORD. O/' Appla,", of Y ❑ N❑ Y ❑ N❑ MN CF.RTIFICA :Of EXEMPTION FROM WORKERS' PERMIT ISSUANCE lr FLOOD ZONE A.L.U.C. LU > COMPIMATION IN'SURAN'CE PLC,CONTR. LIC.NO. PLGCIL . ❑ ❑ ❑ ❑ Z (This 5eeticip aced not he completed it the permil is lir one TOTAL V N V N hundred dollars IS 100)or less.) V O 1 certify that in the performance of the work for which this per. DTV. MECHANICAL PERMIT FEE mFEE SUMMARY EL U mit is issued,1 shall not empty any proton in any manner so as to becoe subject to the Workers'Compensutiun Laws of California. / O 2Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING pQ` } res NOTICE '10 APPLICANT: If,after making this Certificate of Ex- H ? c,nption,you should become subject to the Workeri Compensation APPLIANCE _ 5.00 PLAN CHECK Provisions of the Labor Code, you Most forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.)' 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000C.F.M.) 6.00 SEISMIC FEE I hereby afroo that there is a construction Racing agency for EXHAUST HOOD (WITH DUCT) 5.00 ' the perfammnce of the work for which this Per,nit is issued(Sec. MICROFILM 3097,Civ.CL HEATING'UNIT(TO 100,000 B.T.U.) ' 8.00 Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC . 1 certify Ihat I have read this application and ,are that the above VENTILATION FAN (SINGLE) T? �"y�1. information R correct.1 agree to comply with all city and county PLUMBING 4G — ordinances and slate laws relating to building co..for.mm, and BOILFA-CCMP(3H.P.or100,0D0B.T.U.) 6.00 .i hereby authorRe representatives of this-city m ..oleo upon tire BOILER-OOMP IOwr 100,000 BTU)SEE FEE SCH. above-mentioned property for irespectionprumse,, MECHANICAL 6 (We) agree to save, indemnif and keep hamucv the City of MISC.- REFER TO ORD. Cupertino ' St li' 'lines,j no rets, costs and expends which PERMIT ISSUANCE .}g-00 ` CONST.TAX may i ny a msl ily in cpnsequenct,of the - yi_ \ n of cit JU 2e MECH.CONT. LIC.NO. MECH TOTAL S`= . TOTAL Igniture of cant/Contractor Date - OFFICE COPY