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15275 POST THIS CARD NEAR FRONT OF BUILDING ' CITY OF CUPERTINO PF.aMIT NUMBER15275 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB A D DRE SS LUNIT# _LOT# � • p PERMIT EXPIRES IF WORK OWNER l CONTRACTOR CG Lp 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 .Penn+rt VALIDATION - CUPERTINO STANDARDS. GARAGE SLABS - 12 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Lift TO � UNDERGROUND /SLAB. PLUMBING . •P T_ ,Li f. ELECTRICAL IssuArvcE DATE ` MECHANICAL - BLDG ELECT, PLG. MECR. ❑ ❑ © ❑ 1 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION SIFT, PLUMBING MECHANICAL (j ELECTRICAL - PERMIT 6- RnI FRAMING c'j O —^-"�` INSULATION sroH IFS ,.TYPE CONSTR. - • C:GRDUP RES UNITS ,PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED rAL ACREAGE ROOF NOTE:NO FINAL INSP.SHALL B DE BEFORE so,Pr PLooH AREA ro 46-1 DIAPHRAGM THE CONSTRUCTION TAX IS PAID B W LDI USE ROOF SHEATHING HES IND CON PB omr, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH ASSVGHS PARCEL NO SAN.# - _ PLUMBING - ELECT.ENERGY - ' THACT NO, PARCEL NO , . , TUBS 8 SHOWER PAN PLUMBING ENERGY • MECHANICAL ' MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC.DATE Act PILE rvo FRAMING - - ELECT.FINAL TEST ZONING ENG.SITE NO. ' INSULATION � PLUMBING � � ' GAS TEST GAS ' - - FIRE SPRINK ENERGY L1a MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NF]NY ❑ 'H❑ EXTERIOR SHEAR ELECTRI CAL.RELEASE PLooD ZONE .A.L uc. N❑ Y ❑' N❑ INTERIOR SHEAR FIRE•DEPT. V❑ SHEETROCK .- GRADE - E2XPIR 91- 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 OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 2524505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING e. O PLEASE GIVE JOB ADDRESS WHEN PHONING: + Z — SEE MECHANICAL PERMIT FOR EXPIRATION DATE -' IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE- TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY ' w APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY. - .,F.WN FolliLD1NG PROJECT 1DEN71FICATION PERMIT rvUMB ER so APPLICATION & PERMIT - 5 Z'1 5 J, x'` - BUILDING-ELECTRICAL-PLUMBING-MECHANICALR'6K� " �`•L � ' 'V_ PLAN CHECK VALIDATION - !"'-•�- -" OTY. ELECTRIC PERMIT FEE ` CONTRACTORS " 'NAME OUTLETS�./ .y �J UTLETS-SWITCHES-RECEP 10.00/1.00 (/l'✓�/ / rc.N 0���/ LIGHTING FIXTURES - 10.00/1.00 .. r, DRESSRASTONS' PPLIANCES-RESIDENTIAL 4.00 ADDRESS Sal O -Q GATE OF APPLICATION OR CHITECT PANELS (OVER 200 AMP) 20.00 ENGINEEfl PLAN CHECK FEEP.C.NO. - LIC NO SIGNS TRANS. 3.00 ARCH.OR ENG' SPECIALCIRCUIT 5,66 PERMIT VALIDATION SS zlv rrEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. \(J/C''I'1-.•C.• ADDRESS OONE66 SERVICE CHANGE 20.00 �j/"q��j .. r o8 LICENSED CONTRACTORS DECLARATION / - u w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE va aP(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I.G. MECH. H y,o Professions C nse is in full fyw.odic l6ct. ❑ ❑ Z i a C License Clas Lie.Numbed..-' 7 Oate Contractor P L BUILDING PERMIT 2 ¢ ' OWNER-BUILDER DECLARATION amu,O INFORMATION wO y I hereby affirm that I am exempt from the Contractor's License MISC.- _ REFER TO ORD �+u_ VALUATION - $/FT. u o 4 Law for the following reason.(Sec.7031.5,Business and Professions � - Code:Anycity orcounty which requires a permit to construct,alter, PERMIT ISSUANCE 10.00 ELEC.CONTR. LIC.NO. Se M 4 p improve,demolish,or repair any structure,prior to its issuance,also ELEC. O u requires the applicant for such permit to file a signed statement that TOTAL PER -- n w m he is licensed pursuant to the provisions of the Contractor's License •� - 1 H Z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the 7�LdG s z O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE W r$ the transfer the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR: by anyapplicant fora permit subjects file applicant ton civil penalty ALTER- DRAIN (EA.) '5.00 of not more than five hundred dollars(5500).1: - ❑ I,as owner of the property,or my employees with wagesas BACK FLOW PROTECT. DEVICE4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and lire structure is not intended or offered for sale (Sec. 7044,Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.0 eg - Cade: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 5.66 60.FT,FLOOR AREA TOTAL ACREAGE himself re through his own employees,provided that such improve- ments mselfonorintendcdot offered for nemployeesarovided that such hulloing GAS-EA.SYSTEM-1INC.4'OUTLETS fi. '�0 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OV E. 4.(EA.) 2. 0 builder will have the burden of proving that he did not build or im- BUILDING USE RES IND prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 1 'CON PB omen ❑ I,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 ASSESSORSPARCEL NO. 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 - contracts for such projects with a contractor(s)licensed pursuant to , the Contractors License Law. SEWER-SANITARY-STORME .200ft/10.00 TRACT No. PARCEL NO. ❑ I am exempt under Sec. k,B.&P.C.1'ar this WATER HEATER W/VENT •(fU reason I Owner Data WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPHNSAT1ON DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that l have a Certificate of consent toseff-insure, ZONING - ENG.SITE NO. or a certificate of Work W Compensation Insurunc'e,pr a certified copy t 800,Lab.C.). L!V-"nV9�r Policy Co any 0 ❑-C N copy is he by furnished FIRE SPRINK ENERGY T2A Ccr co is I with the city inspection division. Z p r plicch MISC.•- REFER TO ORD. Y❑ N❑ Y ❑ N❑ ccy CERT -CATS OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE - 1 FLOOD ZONE ' A.L.U.C. W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 'l C Cl (This section need not be completed if the permit is for one TOTAL ,DD' Y❑ N❑ Y ❑ N❑ D Z hundred dollars($100)or less.) U O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to D become subject to the Workers'Compensation Laws of California. Of Dme Applicant ALTER OR ADD TO MECH. 5.00 rFEE } UO NOTICE TO APPLICANT: If,after making this Certificate of fiemption,you should become subject to the Workc,,Compensation APPLIANCE - 5.00 provisions of the Labor Code, you must forthwith comply with AIR HANDLING UNIT such provisions or this permit shall be deemed revoked. (TO 10MC.F.M) 4.00CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is-issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.003097.Civ.C.).Lender's Name HEAT]NG UN IT(OV ER 100,000 B.T.U.)9.50 Lender's Address . I certify that I have read this application and slate that d county VENTILATION FAN (SINGLE) 4.00 ./RJ information is correct.1 agree to comply with all city and county PLUMBING I!V ordinances and state laws relating to building construction, and BOILER•COMP(3 H.P.Or 100,0008.T,U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100.0008TU15EE FEE$CH. MECHANICAL above-mentioned property for inspection purposes. - (We) agree to ave, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against 'abilities,judgments, costs and expenses which CONST.TAX ay any way 4cree against said City in consequence of the PERMIT ISSUANCE 10.00 mO or, f litper it. MECH.CONT. LIC.NO. MECH. TOTAL TOTAL N00 Sig:aF Applicant/Contractor Data - r OFFICE COPY