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17488 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER • CITY OF CUPERTINO 1748$ INSPECTION DIVISION JOB INSPECTION RECORD • /�v ,, PERMIT,EXPIRATION IIT� JOB ADDRESS /9 �"D dS��L�- k-d UNIT# _LOT# ' ' PERMIT EXPIRES IF WORK OWNER e e- � C�`!'�-I CONTRACTOR4-e - Com,. IS NOT STARTED WITHIN INSPECTION DATEINSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNITE, TO COMPLY WITH THE APPROVED PLANS AND CIN OF T PERMIT.VALIDATION CUPERTINO STANDARDS. .� GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED- 3 - 2 4 t [ UNDERGROUND /SLAB PLUMBING • " u p�� D� �" "-C%/ ELECTRICAL (Lil�y of � elo ISSUANCE DATE MECHANICAL BLDG. ELECT. vLc. MECR ❑ �L El ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION ' PLUMBING VALUATION SIFT. � u�-/ MECHANICAL 2�0 ELECTRICAL 8 T TSB _ 0 - PERMIT TO FRAMING INSULATION d"'1Cd- /��'" Si NIERS iYPEC NSTR, �jr,�sc,2J b!Z rJ/zu��ejiS. c / - _ IOCC_GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED $O ET LLOOR AREA TOTAL ACREAGE _ ROOF NOTE'NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING Res IND - CON PIT O,I,,., APPLY NO ROOFING UNTIL ABOVE HAS BEEN,SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.N PLUMBING - ELECT.ENERGY TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO -PARCEL NO MECHANICAL MECH.ENERGY ELECTRICALBUILDING ENERGY ACC.DATE ACO-FILE NO FRAMING - ELECT.FINAL TEST - INSULATION PLUMBING - ZONING ENG SITE NO. GAS TEST GAS MECHANICAL EIRE SPEAK ENERGY T2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE _ L FLOOD ZONE A L U C INTERIOR SHEAR FIRE DEPT. I °❑ N❑ °❑ N❑' SHEETROCK GRADE • FEE SUMMARY EXTERIOR CATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK NO TAPE OR PLASTER UN I IL'ABOVE HAS BEEN SIGNED OCCUPANCY • SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL IS SIGNED By BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-45' ELECTRIC . LU WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB-ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE ' TOTAL CALLING FOR FINAL INSPECTION. ,. , OFFICE COPY. APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 'D11.1,11.0111i PROJECT I DENTI FICATI ON -PERMIT NUMBER .U,LDING APPLICATION & PERMIT I1 7 A ADDRESS f1 / I I I/ 88 e-",d P BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 4 CaVNIER'S PLAN CHECK VALIDATION NAE 4, f O QTY. ELECTRIC PERMIT FEE �� P/1 V&•�.1� PRDNE CONTRACTORS 14 OUTLETS-SWITCHES-RECEP 10.00/1.00 .DU r .CIeU "C LIC.NOZ ?"Id CZ LIGHTI N G F I X T U R ES 10.00/1.00 ( yo ADDRESS PP LI ANC ES-RESIDENTIAL 4.00 AOORE55y su.✓-�YV.1Le, /-'wNV�� l 8il 6�-2 PRONE PANELS 10.0D ,•VV DATE OF APPLICATION " OR PANELS PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.CANO. ENGINEER is uc.No. SIGNS TRANS. 3.00 ARCH.Ess ENc. SPECIAL CIRCUIT $,00 PERMIT VALIDATION zlv TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS s 1� - SERVICE CHANGE 20.00 ,00 LICENSED CONTRACTORS DECLARATION F i c I hereby afOnn that 1 am licensed under provisions of Chapter') ,- ISSUANCE PATE Q (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H w i Professions Code,and my license is in full force it Il' V- ❑ F-1 ❑ o i m o Licence•Clays '/ _Lie Numbe /r Dute /��"- Comnctor p M M w st OWNER-BUILDER DECLARATION Cly Ol COpeRlo BUILDING PERMIT MISC.- REFER TO ORD INFORMATION R u m I hereby aft'inn that I un,exempt from the Contractors License VALUATION $/FT. ac o j Law for the following reason.(Sec.703 L5,Businessand Professions 12. O - PERMIT ISSUANCE 10.00 IL Code:Any city or county which requires a permit to construct,alter, M 4 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. .�-/y 0¢ requires the applicant for such permit t0 Oh'a signed statement that ,)��11 p 2, TOTAL Q V A w es u. he is licensed pursuant to the provisions of the Contractors License Ad&r N PERMIT TQ H z a Law(Chapter 9(commencing with Section 7000DI'Division 3 ofthe E D Business and Professionshm Code)or thus he is exempt erefroand OTY. PLUMBING PERMIT FEE (:!( ¢ H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. u ; � by any applicant for a permit subjects lite applicant to a civil penalty of ALTER-DRAIN& VENT-WATER (EA.) 5.00 not more than five hundred dollar,0500).): ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or oRered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND, 5.00 Code:The Cim tmetor's License Law docs not apply to an owner of property who builds or Improves hereon,and who does Suet,well FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mustsare not intended oroft-cmd for sale.If,howeveL the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- builder will have the burden of proving hal he did not build or hit- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER30.00 RES IND CON PB Omer . ❑ 1,as owner of the properly,am exclusively conlracting with 11 ED El ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 8.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply V.B. to un owner of property who builds or improves hereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ sen exempt under Sec. ,B.�P.C.for his WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM ' ,5.00 ACC.OATE ACC.FILE NO. WORKERS'COMPF:NSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm hal I have a certificate(ifemisent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO, copy thereof(Sec.3800,I.A.C.). Policy No. Company Q ❑ Certified copy is hereby furnished. FIRE BPRINK ENERGY T24 Z Z De Certified y Is tiled w,t��,,1�h�e city inspection division. F-' 0 ApplicantMISC.- REFER TO ORD. Y ❑ N❑ Y 1:3 NE] Cr CERTIFI ATE( IiXES ONFROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.uc. W J COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. IL o (This section need not be completed if the permit is for one TOTAL Y❑ N❑ y❑ N❑ 0 Z hundred dollars IS 100)or less U O I certify that in the performance of the work for which this per- QTV MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not employ any person in any untrue,so as to Q U become subject to the Workers'Compensation Laws of California. Dr. Date-Applicant I ALTER OR ADD TO MECH. 5.00 BUILDING } to DNO]ate S 'f0 AI'I'LICAN f: If,after nuking this Cert ificatc of Ex- f" ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall be occulted revoked. AIR HANDLING UNIT(TO 10=47-F.M.) 4.00 FEE CONSI'RUC'I'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10fMC.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the perhmnance of the work far which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lcndcr's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read this application and state Ilion the above VENTILATION FAN (SINGLE) 4.00 information is correct I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COUP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. above-mentioned property for inspection purposes. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX ay in any way accrue against said City in consequence of the PERMIT ISSUANCE - 10.00 mn/ti�J/y�1'Ihis pem,iL MECH.CONT. LIC NO. MECH. [ (/ 3 TOTAL Sign u l Appheam4tfijorlor Date TOTAL OFFICE COPY