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16694POST THIS CARD NEAR FRONT OF, BUILD . ING ' e CITY OF CUPERTIN0 INSPECTION.DIVISION JOB INSPECTION RECORD ^ L//'� •. JOB ADDRESS rC �I Z6 ( 4_T C -(/-S D i' UNIT# _ LOT# OWNER t, [7 P. CONTRACTOR Q �� (ryf PERM IT NUMBER, 16694 .q PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 160 DAYS OF PERMIT ISSU=- ANCE OR 160 DAYS'FROM .LAST CALLED,INSPECTION,'" NSP CTION D&E INSPECTOR INSPECTION RECORD .FOUNDATION'NOTE: ALL GRADING AND DRAINAGE SHALL-BE:.INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CIT/ OF CUPERTINO STANDARDS. UFER '- PREGUNITE I -,-,,IT vALJOATION - - o!�� + ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -MARI 2.19ul.j UNDERGROUND /SLAB - PLUMBING - - - - ELECTRICAL - - MECHANICAL BLDG ELE rr. ❑ PLG. "c'❑ ID DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT - INFORMATION WOOD FLOOR . PLUMBING - " 3 VALUATION - S/FT. MECHANICAL ELECTRICAL - PERMIT To i � ' FRAMING INSULATION 'STORIES -. TYPE CONSTR. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED OCC. GROUP ,RES UNITS' ROOFNOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS, PAID " 'so FT.FLOORf.REA TOTAL ACREAGE ' DIAPHRAGM - ROOF SHEATHING - - BUILDING USE RIES IND CON PB 0m._ ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. • ROUGH SAN.# ASSESSORS PARCEL NO ' PLUMBING ELECT. ENERGY TUBS &SHOWER PANPLUMBING ENERGY - TRACT NO: PARCEL NO MECHANICAL - - - MECR ENERGY ELECTRICAL BUILDING ENERGY ACC DATE, AGO FILE NO FRAMING' ELECT. FINAL TEST INSULATION' PLUMBING " ZONING 1, ENG. SITE NO. . GAS.TEST GAS - MECHANICAL •EIRE SPRINK Y ❑ "❑ ENERGY T.za ° ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEARELECTRICAL RELEASE 'ELooD ZONE . _Y ❑ IN ALu.c. Yo No INTERIOR SHEAR FIRE DEPT. • SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING - BUICDwc' . INTERIOR LgTHTEMPORARY�APPROVALS SCRATCH COAT - ELECTRIC - - PLAN CHECK GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDI NG FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ~O� ONE WORKING DAY BEFORE REQUIRED INSPECTION., , PLEASE GIVE.JOB ADDRESS WHEN PHONING.' . Z —SEE PERMITEXPIRATION DATE - ELECTRIC ' PLUMBING " MECHANICAL CONST. TAX -I -IMPORTANT! PLEASE READ REVERSE SIDE BEFORE' CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 'BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT .PERMIT NUMBER RSS ADDE22126 Hibiscus BUILDING - ELECTRICAL- PLUMBING -'MECHANICAL 16694 OWNER'S NAME QTY, ELECTRIC PERMIT FEE PLAN CHECK VALIDATION 'Helen DickmeyenRDNE NAMERAcrGRs OUTLETS-SWITCHES-RECEP 10.00/1.00 - LIGHTING FIXTURES 10.00/1.00 Dial One Buffalowso. 961-75 R- CT ADDRESS DDES PPLIANCES- RESIDENTIAL 4.00 PANELS 10,00 1245 S ace Park wafy DATE OF APPLICATION' - OR ENGINEER LIC. NO. PANELS(OVER 200 AMP) 20.00 PANELS PLAN CHECK FEE P.C. NO, SIGNS TRANS. 3.00 ADDRESSS ENG' SPECIALCIRCUIT - 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 alp '1 -ZL 7_ A ADDRESS oREss MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 • T JI9� [ VV Vs'`vex� LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing will, Section 7000) of Division 3 of the Business and Professions Coal a =-1y I ase Is In fUIt fOr C' Ila BeCA UCCI ss Lie. Number � BLDG. ❑ ELECT, ❑ PLG. MECH.. ❑ DCI. Contractor Date Contractor n i a.1--4 f f a J O W S cup"Igp BUILDING PERMIT city Of OWNER -BUILDER DECLARATION I herebyaffirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Businessand Professions Code: Any city or county which requires a permit lP construct,alter, improve, demolish, or repair any structure, prior to its issuance, also Litotes lire applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License I... (Chapter 9(commencingwith Section 7000) of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 INFORMATION MISC. - REFER TO ORD VALUATION $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. TOTAL TOTA PERMIT TO eG s OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penally Proof more than five hundred dollars(5500).): ALTER -DRAIN & VENT -WATER (EA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered far sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5,00 Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work FIXTURES - PER TRAP 5.00 SO, FT. FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such improve- ments are not Intended uroffered for sole. If, however, the building GAS-EA.SYSTEM-I INC. 4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner builder will have the burden of proving that he did not build or im- prove for purpose of sale.). Cl 1, as owner of the properly, am exclusively contracting with licensed contractor to construct the project (Sec. 7044, Business GAS -EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON Pe Other INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS -I INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who LAWN SPRINKLERS - OVER 5 (EA.) 1,00 contracts for such projects with a contructoos) licensed pursuant IP the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 _ TRACT NO. PARCEL NO. WgTER HEATER W/VENT 6.00 ❑ tum exempt under Sei. ,B.&I'.C. for Ibis reason I Owner Date WATER SYSTEM 6.00 ACG -DATE ACC. FILE NO. WORK RRS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of newel 10 self -insure, or a Certificate of workers' Compensation Insurance, or a certified 20NING - ENG. SITE NO. - copy QQ Policy lNpkibyfi-amy.1. PaClfic Comp ❑ CeRilied copy is hereby furnished. O Certified pct is 11 '0 I trAspec ion division. Applicam /rrJ � FIRE SPRINK V N ENERGY T-24 V N MISC.- REFER TO ORD. CERTIFICATE OF EXEMPTION PROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if lire per is for one PERMIT ISSUANCE 10.00 FLOOD ZONE y� N❑ A.L.0 C. V❑ N❑ PLG. CONTR. LIC. NO. PLG. TOTAL QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or less.) 1 certify that in The performance ol'tile work for which this per mit is issued, I shut[ not employ any person in any manner so as to become subject to the Workers Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex amp mm, you should become subject to the Workers' Compensation ' provisions of the Labor Code, you must forthwith comply with such provisionsor This permit shall be dimmed revoked. BUILDING ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10=CF.M.) 4.00 AIR HANDLING UNIT (OVER 10)000 C - EM.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM I hereby affirm that there is a construction lending agency for The performance of the work for which this permit is issued (Sec. 3097, Civ.C.). HEATI NG UNIT (OVER 100,000 B.T.U.) 9.501 ELECTRIC Lender's Name _ Lender Address I certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to , indemnif and keep harmless the City of uperlinoyagainstbilines, ju ments, costs ;cod expenses which in acme ago' st said Cil i onsequcnce of the oil. d / K VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER H.P. or 100,000 B.T.U.) 6.00 - BOILER -COMP Cover, 100,000 BTU) SEE FEE SCH. MECHANICAL yn1 1 0 V MISC. - REFER TO ORD. CONST. TAXay ISSUANCE 10.00 �.pDranting ECH. CONT. LIC. NO. MECH. TOTAL/ 0U TOTAL OD Signet c Applicant/Conlraclo Date OFFICE COPY