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15238- POSTTHIS CARD NEAR FRONT OF BUILDING - - PEPM1IIT NUMBER CITY .OF CUPERTINO , 15238 INSPECTION DIVISION JOB INSPECTION RECORD l _ PERMIT E%PIRATION UNIT# LOT#t JOB ADDR ES �, ��'-" PERMIT EXPIRES IF WORK ,�y�/(yJ{l�r _ ` VFW OWNER CONTRACTOR V I IS .NOT STARTED WITHIN 180' DAYS OF PERMIT ISSU ANCE OR 180 DAYS FROM INSPECTION DATE INSPECTOR .INSPECTION RECORD FOUNDATION - - NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED' TO COMPLY WITH THE APPROVED PLANS AND CITY OF LASTCALLED INSPECTION. UFER PR EGUNITE PERMIT VALIDATION CUPERTINO STANDARDS. Q; /J, ./•' ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED pqr, 14. ^r jc5t5 5 ,� UNDERGROUND/SLAB PLUMBING � .�/3 ELECTRICAL MECHANICAL' - BLDG 0 ELECT] El PLG. MECO. '.A ? DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - _ BUILDING PERMIT INFORMATION . - -WOOD FLOOR '. VALUATION / SIFT. • PLUMBING. ('1 17 MECHANICAL ELECTRICAL CUPe PERnuT TO , 1l\OUD/7/,"+'V FRAMING y- - INSULATION - STORIES TYPE CONSTR- i OCC GROUP RES. UNITS - T PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INS°. SHALL BE MADE BEFORE THE CONSTRUCTION TAX. IS PAID _ - SO, FT IDJUP AREA —p U TOTAL ACREAGE DIAPHRAGM ROOF SHEATHING - BUILDING USE RES IND CON PB OIh. ' _Cl 1:1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ' ,ROUGH SAN.# ASSESSORS PARCEL NO PLUMBING ' ELECT. ENERGY---- TUBS BSHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO MECHANICAL -/6- MECH. ENERGY - - ELECTRICAL- BUILDING ENERGY' ACC, DATE ACC. FILE NO FRAMING - ,ELECT. FINAL TEST - - INSULATION 1 �� - PLUMBING - ZONING ENO. SITE NO. GAS TEST _ GAS MECHANICAL FIRE SPRINK ENERGY T.?4 v O; "E ` ❑ NO - t COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERfOR'SH EAR - ELECTRICAL RELEASE FLOOD LUNE A.L. U.C. INTERIOR SHEAR FIRE DEPT. SHEETROCK _5- ,GRADE _ FEE SUMMARY EXTERIOR.LATH - BUILDING - .� INTERIOR LATHBUILDING TEMPORARY APPROVALS SCRATCH COAT - ELECTRIC PLAN CHECK FEE , GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY - - SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL B UILDING FINAL'ISSIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o�,. ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING -PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL CONST, TAX BQ Z SEE PERMIT FOR EXPIRATION DATE.*-' .IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL' CALLING FOR FINAL INSPECTION. - OFFICE COPY VA 1 o ¢ FOO9 QVU yzw r 'n zo Z 2 O,w-O- 0' H N � ¢ IS rt w u X ; a HLL0 sw>s ¢ ¢ o 0 u d w � " ? a s¢o Ow WA O Z_ z? O CC N LU CL ❑ Z) z UO LL U OW � a H � U APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT —ELECTRICAL— PLUMBING —MECHANICAL -PERMITNUMBER J 15238 BUILDING ao DRE UTBUILDING OwNER'S "q�' - i PHONE DTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION Q Q m NAMTRAcro s A, LIC. No. Q J761 OUTLETS - SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTR ADDHE croR's PPLIANCES- RESIDENTIAL 4.00 12�ADDRESS R PRO DATE OF APPLICATION PANELS 10.00 ARCRITECT OR ENGI A LII. No. - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P,C. N0. ._ SIGNS TRANS. 3.00 El ADDRESS SPECIAL CIRCUIT 5,00 PERMIT VALIDATION zlv TEMP. METER OR POLE INS. 20.00 APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 e ,r/�� ' 7 LICENSED CONTRACTORS D12CLARATION 1 hereby affirm that 1 am licens<•d unJcr provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, d my license is in full fa c-' .( Licen. Cla hic. Number DJll' Croton, ISSUANCE DATE BLDG. I. ELECT. -0LG. MECH. O DING PERMIT BUILORMATION INFORMATION VALUATION S/FT. OWNER-BUILDERDF ARATIO' 1 hereby aUlrm that I am exempt from rhe Contract 's Licetnse 1e Law for the followingreason. (See 703 L5, Business and Professions Code Any oily .r county my which requires punnet to construct a MISC. — REFER TO ORD PERMIT ISSUANCE ELEC. CONTR. LIC. NO. - ELEG 30 (}� TOTAL ..� ra tr structure,also also t rci prior m els issuance. statement improve, demolish, or repair any permit rc is tic the applicant for such permit to lila a signed statement (hal he u licensed pursuant the provisions of the Contractor's License �p PER IT TO QTY. PLUMBING PERMIT FEE Law(ChapterdProfosionsCde)or Section 70001.. D ivision3of the en ) 3 Business nod Professions Code) or that he is txempt and STORIES TYPE CONSTR. ection70 the basis for the alleged exemption. Anyviolation ac oil penally fora permit dollars S500),licant tuaeivil penalty he t to by any more of not more than five hundred dollars (55 /f�/v ALTER-DRAIN-WATER(EA.) ❑ t as ..per of Inc will do t or my employees with wages as employees inter sole r offered will (S the work, and the and Pr re is not or offered Int rale (Sec. for Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES UNITS DRAINS -FLOOR, ROOF, AREA,CON D. 5.00 de: T Code: The doe motion's Licenses does not apply to an owner of FIXTURES -PER TRAP -6:B0 �— sa. FT. vL00R AREa s, (�/ (/YJ fel' rorgL geREACE who then d who touch im work who huih his improves employees, himself himself re through his own employees, provided (hat such improve- provided me not or chowever, me building I GAS - EA. SYSTEM -11NC. 4OUTLETS 6.00 onefor impromentien old yearsale.l or improvement is sold within one year of completion, Inc owner- builder will have the harden of proving thus he did nut huild or Ser -RES prove for purpose of the.l. ❑ as owner of the property, contracting with GAS - EA. SYSTEM - OVER 4 (EA:) 2.00 BUILDING USE IND CON PS Onher ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 d licensed contractors to construct the project (Sec. does Business he projectSc and n owner of Code: The who builds s License Law Jots not apply to owner of property who hoilds and who improvesensed LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 (EA.) 1:00 gSSE550R5 PARCEL NO. tr tr p, contracts for such projects with a mntmemrl sl licensed pursuant to the Contractor's License Law. - SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT No. PARCEL NO. ❑ I um exempt under Sec. , B.&P.C. for this reason WATER HEATER W/V ENT 6.00 Owner' Dam WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO, WATER TREATING EQUIP. 5.00 WORK I. RS'COMPENSA"PION DECLARATION ' 1 hereby affirm that I have a certifcu« of a ry cpt to sclf-insure, or a certificate of Workeri Compensation Insurance, or a certified copy thereof (Sec. 3800. LaINC.L Policy No. Company— - ZONING ENG. SITE NO. U C,rIi,)dc.Pyishe by. he ❑ Cc copy f copy is Ii c t c ity Ilion di stun. npplicun FIRESPRINK Y ❑ N ❑ ENERGY T -N Y ❑ N❑ MISC. - REFER TO ORD. TI PICAI'li OP IiXIiM N FROM W'O KERS' PERMIT ISSUANCE FLOOD ZONE A.L,u U.C. COMPENSAI'I INSURANCE 1'I'he, action need not be plctad if the permit is for one Y❑ N❑ Y N❑ PLG.CONTR. LIC. NO, TOTAL hundred dollars IS 100) or Zeas ) - I certify that in the performance of the work for which this per- not is ivaed, I shall not employ any person in any manner so as to CITYMECHANICAL PERMIT FEE FEE SUMMARY BUILDING p become subject to the Warkers Compensal ion Laws of California. Date Appli"ml ALTER'OR ADD TO MECH. 5.00 NOTICE 'f0 APPLICANT: If, alter making this Certificate of Ex- 5.00 - AIR HANDLING UNIT (TO 10=CF.M.) 4.00 PLAN CHECK FEE onption, you should become subject to the Workers CompensationAPPLIANCE provisions of the labor Code, you must lorthwllh comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (OVER 10=C.FM.) 6.00 SEISMIC FEE CONSTRUCT ION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the pcl-onnunce, of the work .or which er this pmit is issued (Sec 3097, Civ.C.). MICROFILM t HEATING UNIT (TO 100,000 B.T.U.)• Lender's Name Lenders Name HEATING UNITE (OVER 100,000B.T.U.)9.50 ELECTRIC .3 Q I certify that l have read this application and slate that the ulwve iincnnition is correct. 1 agree to comply with all city and county ordinances and stale laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00 hereby authorise representatives of this city W enter upon the uhove-mentioned property for inspection purpo.. BOILER -COMP Over 100,000 BTU( SEE FEE SCH. MECHANICAL (We) agree to ave, indemnify and keep harmless the City of MISC. - REFER TO ORD. - Cupertino against liabilities, judgments, costs and expenses which anyw may in aco(sy way attru 'rut sa- Ciry in 'I'm ncc of the PERMIT ISSUANCE �� CONST. TAX :,,I g It MECH. CONT. LIC. NO. MECH. TOTAL �0'd TOTAL �S7.3s more of can /Co ra r at ' / OFFICE COPY