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17154 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 17154 INSPECTION DIVISION JOB INSPECTION RECORD - - d/PERMIT EXPIRATION t JOB ADDRESS (,Z(� 3 D �� AV� UNIT# _LOT# (pEA MT/EXP RES IF WORK OWNER �� CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180DAYS OFPERMITISSU- ' FOUNDATION _ ANCE OR 180 DAYS FROM NOTE: - LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLEDPREGU ' ITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF GARAGE SLABS PEvral noun noN CUPERTINO STANDARDS. GARAGE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED I�nR L �� .� . -���-� - UNDERGROUND /SLAB �11 {{u� ELECTRTE NCAL �V Isu VtCFU VLA' ( MECHANICAL - BLDG LDG ELECT I PLO. MEC. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING `,VALUATI SBFT. 0 MECHANICAL z 17OG ELECTRICAL - - PEHpiIT TO FRAMING DVI. SiU ES TYPE CONSTR, INSULATION OCC GROUP - RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED sa FT 1LOOF Fv F T.T.L FCAEAGF ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID -BUILDING USE ROOFSHEATHING RES IND CON PB -OT,­ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE f INSP. El ❑ ❑ ❑ ❑ ROUGH SAN.q ASSESSORS PARCEL NO '. ( - PLUMBING ELECT.ENERGY ' I!' �3--mayL', TUBS 8SHOWER PAN PLUMBING ENERGY. TRACT NO. PARCEL NO MECHANICAL MECH.ENERGY ' ACC GATE FCC FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT.FI NAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING ' GAS TEST GAS MECHANICAL- FIRE SPRINK ENERGY TQ< ' rS COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING I ❑ N1 10 _FLOOD ZONE A.LUC: EXTERIOR SHEAR EA ELECTRICAL RELSE ' INTERIOR SHEAR FIRE DEPT. `"❑ N❑ ❑ 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 I OCCUPANCY OF BU I LDING IS NOT PERM ITTED UNTI L BUI LDI NG F INAL IS SI GN ED BY BUI LDING.INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC �. • V-�l14 H ONE WORKING DAY BEFORE .REQUIRED INSPECTION:. ' PLUMBING 0,� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z [MEEHANICAL -SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! AX +�-+ PLEASE READ REVERSE SIDE BEFORE TOTAL �A CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU PERMIT NUMBER LDING PROJECT IDENTIFICATION ADING APPLICATION & PERMIT ADD RE • E 17154 ss BUILDING -ELECTRICAL-PLUMBING-MECHANICAL _ OWNER'S �G PLAN CHECK VALIDATION NAME -'JF�+O�J QTY. ELECTRIC PERMIT FEE HONE ZSZ NAME PEICcrORg _ UTLETS-SWITCHES-RECEP 10.00/1.00 1150 / 1 LIC.NO. LIGHTING FIXTURES 10.00/1.00 g /-( ` D CONTRACTOR's ADNTRASESSAPPLIANCES-RESIDENTIAL 4.00 CO PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE - .C.NO. NT EtmzU cp, PANELS (OVER 200 AMPI 20.00 _. ENGINEER sec.NO. SIGNS TRANS. 3.00 ADDRErnECIAL CIRCUIT 5.00 PERMIT VALIDATION iEIT� X I zI EMP-METER OR POLE INS. 20.00 (s "AlPPUCANMOTORS SEE FEE SCH.Faecs �/7 AOOREss ��� "' SERVICE CHANGE 20.00 1( , / 'o o LICENSED CONTRACTORS DECLARATION 1 V De A� Ilk VL ICU- a o rFj I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE m a vu (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H m z Professions Code,and my license is in full force and effect ❑ oi m o License ClassLic.Number - svl H y H J Datc Conlracmr a Ys BUILDING PERMIT a OWNER-BUILDER DECLARATION ao ea INFORMATION w 3 a H I for the gf llo that I so exempt from the Contractor's License MISC.- REFER TO ORD uo law forthefollowingremon.(Sec.7irsela BusinessanJ Profcsstons VALUATION S/FT. 1- - PERMIT ISSUANCE c1g9g Z, Code:Any city or county which sequinse 1prior t0construct, also 2 Z G aO improve,demolish,Or repair any rent to prior to il,u issoonce,also ELEC.CONTR. LIG NO, ELEC. I�' 5o dao ic ° he is tic the applicant for un'h permit to file a signed atatemenl that TOTAL I PERMIT TO Z m heir licensed pursuanten theprovisions of theComwacloar%)ofDilision 3ofthe HiQ Law(Chapter and Professions Code)lir Section is exempt and 4 o tare bass for Professions empt or that lie i is exempt therefrom and DTV. PLUMBING PERMIT FEE ¢ r the basis for the alleged eloah exemption.Any violation oiS,lived 703L3 STORIES TYPE CONSTR. i3 by unY appli cant foraundre dollars the 00.): sod tuacivil penalty ufn more than five hundred dolWrs(55001.1: ALTER-DRAIN&VENT-WATER (EA.) 5.00 ' 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 Ih i sole compensation,will do the work,and the structurt is not OCC.GROUP RES.UNITS intended of offered for to (Sec. 7044, Business and Profcasions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Lrw does not apply to'an owner of property who builds or improves thereon,and who does such work F IXTURES-PER TRAP 5.00 . , SO.FT.PLO NT A EA r0rALACREAGE himself or through his own employees,provided that such improve- ments are not intended oroffered for sak.If.however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00 219 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 ins BUILDING USE prove for porpose ofsala)' m INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pe Other ❑ I,as owner of lire property,am exclusively contracting with ❑ ❑ ❑ ❑ 13 licensed contractors to construct the project(See.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORSPARCELNO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 7-.310-2 l0_��_!1 contracts for such projects with a coutruclons)licensed pursuant In 7 the Cthdmcur's Liccnw Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under c. ,B.&PC.fur this WATER HEATER W/VENT 6.00 reason_ Owner _ WATER SYSTEM 5.00 ACC.DATE ACD.FILE NO. , wool:- 'COb1P13N'SATI DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-maim. Or a certificate of Workers'Compensation lasunnce.or a certified ZONING ENG.SITE NO. copy theomf(Sec.3800,Lahti.). Policy No. Company U ❑ Ccrlilied copy is hcrchy furnished. FIRE BPR INK ENERGYT44 Z Z '❑ Cenil icJ copy is IiIcJ with tllc city inspection division. �: O Applicant MISC.'- REFER TO ORD. YE] NE] Y [:] NQ i w CER I'IFICATE OIr EXEMPTION FROM WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.U.C. LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. Q d O 1his section need not he col.... led if the permit is for one TPLG.OTAL2©• V N v ry � Z hundred dollars(SI00)or lvY,) U O 1 certify that in the performance of tdw r which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY l.L Umit is usueJ,I shall not cmplo anmanner so as uhecome subject to the Worker sf California.ta' Datc Appllc ALTER OR ADD TO MECH. 5.00BUILDINGw NOTICE TO APPLICAN' If.after makCertificate of Ex- F Z emplion,you should become subject to the Workers'Comperution APPLIANCE 5.00 PLAN provisions of the Labor Code, you mel forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000C.F.NL) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10OKCC.F.M.) 6.00 SEISMIC FEE 'I x Icj I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the 3097 Civ Cance of the work for which this per-mil is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's NamAddress I "So LLeader',Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 1 certify that I have read this application and mate that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county BOILER H.P.Or 100,000 B.T.U.) 6.00 PLUMBING 2oe0 . ordinances and stale laws relating to building construction, and hereby aulhorixe repmsentutives:of this city to carer upon the above-mentioned property On inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) ogre, to save, indemnify and p amdess file City of MISC.- REFER TO ORD. upertino against liabilities,jud co and expenses which - CONST.TAX may in any way accrue a st cno cxy cnce of the PERMIT ISSUANCE 10.00 n "ng of "s NECH.CONT. LIC.NO. MECH. i TOTAL TOTAL 6 6 ignel of Applicant/Contractor Uate OFFICE COPY