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16572 POST THIS CARD NEAR FRONT OF BUILDING PF.RM1IIT NUMBER CITY OF CUPERTINO INSPECTION DIVISION S- JOB INSPECTION RECORD - PER_MIT•�ETIRATION {® JOB ADDRESSI K� �� V UNIT# LOT.# y � ' / rf T - - PERMIT EXPIRESIF WORK , OWNER `� `V 1, I/\ I/ CONTRACTOR - `SIS 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 STA ED —j, 7CALLED INSPECTION. PREGUNITE TO COMPLY WITH THE APPROV PLANS OF PERMIT VALIDATION 1 . CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - UNDERGROUND /SLAB / —�- PLUMBING ELECTRICAL - ISSUANCE DATE MECHANICAL BLDG. ELECT. PEG. Meo, ❑ ❑ ❑ - DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION-911 SIFT. - PLUMBING O } ` o_rv!I` ' MECHANICAL l _ b. ✓J_(X "TAID { ELECTRICAL Peunurro - ,[ FRAMING lg7J En� 1" INSULATION 1 $9 1 1988 STORIES YPE CONSTR, 3 CRY of C • - upertinn Occ.GROUP Res UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' SR,� ROOF � - NOTE:NO FINAL INSP.SHALL BE MADE BEFOREE T.FLUOR" .A. REA TOTAL ACREAGE DIAPHRAGM - THE CONSTRUCTION TAX IS PAID ROOF SHEATHING ' _ 1 HES INUUIlDION USE 0 Oil- � APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ID ❑ ❑ ❑. • ASSESSORS PARCEL NO - - ROUGH SANA - - PLUMBING " ELECT.ENERGY' ' Fit 161? TRACT NO. PARCEL NO TUBS 8 SHOWER PAN - � '- PLUMBING ENERGY' MECHANICAL MECH.ENERGY qcc�OgrE qcc.FILE NO. ELECTRICAL BUILDING ENERGY - FRAMING ' F- -Q," ELECT.FINAL TEST • _ ZONING ENG.SITE NO. INSULATION � ' PLUMBING GAS TEST GAS MECHANICAL - FIRESPRINK ENERGY L]9 . ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING. Y ❑ 1 E) . ♦ ❑ . N0, FLooO rorvE A.L.uc -, EXTERIOR SHEAR ELECTRICAL RELEASE . ❑ N❑ N❑ INTERIOR SHEAR FIRE DEPT. - SHEETROCK - - _' GRADE - FEE SUMMARY ' EXTERIOR LATH - BUILDING BUILDING • ACJ INTERIOR LATH TEMPORARY PPROVA J ' SCRATCH COAT - - ELECTRIC 1 PLAN CHECKItz ', GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED, OCCUPANCY SEISMIC FEE E� OCCUPANCY OF BUILDING IS NOT,PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM ARRANGE FOR'INSPECTION BY,PHONING 252-4505, ELECTRIC Y^' Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING I� 0� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z —'SEE PERMIT FOR EXPIRATION DATE — MECHANICAL CONST.TAX IMPORTANT! , PLEASE READ REVERSE SIDE BEFORE' TOTAL CALLING FOR FINAL INSPECTION. I ' OFFICE COPY / AP/PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY +. - {JBUILDING PROJECT IDENTIFICATION PERMIT NUMBER „ ADDREu / APPLICATION.&PERMIT 16 5 7 S eGt lJ Pr t-Ml--� BUILDING - ELECTRICAL-PLUMBING -MECHANICAL U J I OWNER'5 PLAN CHECK VALIDATION NAME � o QTY. ELECTRIC PERMIT FEE PHONE( `4_/ CONTRACTORS a UTLETS-SWITCHES-RECEP 10.00/1.00 7 LIC,No. LIGHTING FIXTURES - 10.00/1.00 CTRAOTons ADDRESS APPLIANCES-RESIDENTIAL 4.00 PHONE PANELS _ 10.00 DATE OF APPLICATION j I. ARCHITECT PLAN CHECK FEE P.C:NO. oR PANELS_IOV ER 200 AMP) 20.00 t- ENGINEER/y�� '1- IY\E--E"tA❑ fC�uc.No.C��61'(5 ISIGNS TRANS. 3.00 ARCH. R ENG. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION I/ rG S ztPg512EMP. METER OR POLE INS. 20.00 APPLICANT'S MOTORS SEE FEE SCH. r ADOHESS , 1 � SERVICE CHANGE 20.00 omz �' . Foo LICIiN SYU CONTRACTORS DECI-ARATION AID a u E, I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE I H rt d (comntcncing with Section 7000)of Division 3 0l the Business and R DG. ELECT. PLG. MECH. F,w z Professions Coda,and my license is in Will force and effect. 11 U O i T a License Class' Li,.NumberEl El Date Contractor F N F J City of.Co BUILDING PERMIT { ¢ 0 w a rim th' -RUICDIiR DECLARATION ' 's O a- 0 .. INFORMATION w g m I hereby affirm thin 1 a...exempt from the Cunvacl or's License MISC.- REFER TO ORD u0 J, faw lnr the fallowing rcason.lSec.703 L5.Business and Professions • VALUATION §/FT. F - PERMIT ISSUANCE .10.00 D Caste:Any my or my whiny reqstructure, permit prior is construct,alter,also � ^//, < improve,Jmnolish,or repair any structure,prior to its issuance,afro ELEC.CONTE) - LIC.N0. ELEG ( ^ ca E w0 LL requires the applicant for such permit to file a signed statement that TOTAL FfERMIT TO he is licensed pursuant to the provisions of the Compactor's License rim Law(Chapter 9(commencing withSection 7000)ofl)ivision3ofthe s 4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE, ✓1 ILR/(� m F $ the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR. + s ; by any applicant for a permit subjects the applicant ton civil Penalty ALTER-DRAIN (EA.) '500 of not more - . . than live hundred dollars(S500).): -' ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 Oce.GROUP RES.urvlTs their sole compensation,will do the work,and the structure is not 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 builds or Improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 sa ET.FLOOR AREA TOTAL ACREAGE himself or through his own employees.provided that such improve- ments are not intended oroffered for sak.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or improvement is soW within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA ) 200 ` builder wcl have the burden of proving that he did not build or ice- . . . BUILDING USE is e for purpose of sale.). INDUSTRIAL WASTE I NTER. 30.00 RES IND CDN PB oihar 1,as owner of the property',am exclusively contracting with - ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. SE Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improv..thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractuds)licensed pursuant to the Contractor;License Law. SEWER-SANITARY-STORM EA.2008/10.00 . TRACT NO. PARCEL NO. ❑ I am exempt a der So .B.&P.C.for this WATER HEATER W/VENT .6.00 letesion is - '4 Owner - Date ACC.DATE 'ACC.FILE NO. ( WATER SYSTEM.' 5.00 WORKERS'COM PENSArill ON DECLARATION WATER TREATING EQUIP, 5.00 _ 1 hereby affirm that I have a certiticate ofcunsint to self-insure, or a certificate of Workers'C uirensution Insurance,or a certified ZONING + ENG.SITE NO. copy thenal(Sec.3800,I.A.C.). Policy No. Compmr, - _ - O ❑ Certified copy is hereby f ami shed. FIRE SPRINK ENERGY T-44 Z 2 C1 Certified copy is Filed with the city inspection division. MISC.- REFER TO ORD. O Applicant - _ Y❑ IN Y.❑ N❑ M,N ' CF RTI F ICA'rr OP FXFM 19]ON P ROM WORK ERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W �_ COMPENSATION INSURANCE - PLG.CONTE. - LIC.No. PLG. ' ❑ ❑ ❑ ❑ CL 0 (This section need not be complcteJ if the permit is fop one TOTAL ( Y N Y N Z hundred collars(5100)or less.) �( U O 1 certify that in the performance of the work for which this per OTV MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. O Ed Date A licant BUILDING �- } m NOTICE TO APPLICANT: If,after making this Certificate of Hx- ALTER OR ADD TO MECH: 5.00 J I F Z emptlon,you should become subject to the Worker'Compensation APPLIANCE 5.00 - PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE• U such provisions or this permit shall be domed revoked. - AIR HANDLING UNIT(TO 10SMCF.M.) 4.00 CONs'fRUcf1ON LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 3s Z9 1 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. MICROFILM 3097,Civ C.). H EATI NG UNIT ITO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 InPonances is stater la agreeticonmp b with.11 city county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING �- .. ordinances and state laws relating to building const rand ion, and hcrehy authmn,c representatives of this tidy to enter upon the above mentioned property for inspection purposes. gO1LER-COMP Ova,100,000 BTU)SEE FEE SCH. MECHANICAL �- (We) agree to save, mile nucfy and keep hamales,s the City of MISC.- REFER TO ORD. .vpertino against liuhilid ins,judgments, costs mrd expenses which PERMIT ISSUANCE 10.00 CONST.TAX • 4wy in any way accru• aga' st said City in consequence of the ranting ofh�is}}�1�'nm�� MECH.CONT. LIC.NO. MECH. - - O_� Itx,V �oIBIBB TOTAL TOTAL �/ ignaterc of Applicant/Contractor Uutc r OFFICE COPY