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17663 POST THIS CARD NEAR FRONT OF BUILDING`, PERMIT NUMBER CITY OF' CUPERTINO 1'7663 INSPECTION DIVISION JOB INSPECTION RECORD, - PERMIT EXPIRATION JOB ADDRESS-/_/�7cv/ PERMIT EXPIRES IF WORK OWNER >L CONTHACTOR r IS NOT STARTED WITHIN • INSPECTION DATE I INSPECTOR INSPECTION ECORD '180 DAYS OF PERMIT ISSU- FOUNDATION I. ` I ANCE OR 180 DAYS FROM -- NOTE:" LASTCALLED INSPECTION. LIFER - - ALL GRADING AND DRAINAGE'SHALL BE'.INSTALLED PREGUNITE TO'COMPLY'WITMTHE APPROVED"PLANS'AND CITY OF' : PERMIT VALIDATION CUPERTINO STANDARDS. v:'y�'J GARAGE SLABS- - - r POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB —✓ ✓ PLUMBING ' R - -- - j., ' R - 'ham . ELECTRICALWvCi�SunrvcED ('-� � M' P - B�LU5y' .ELECT - PLL; MECR. ,MECHANICAL - y LJ .�, 1 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION •• - VALUATION• 11slPr. PLUMBING. MECHANICAL ELECTRICAL - •. PERr.+rr�o - FRAMING . , -R Rf INSULATION S10RIES TYPECONSTR. ' ' �' �� .. � • ,' - , 4 .. . . OCC GROUP. RE S,UNITSS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED +' $U.fl FLUUN AREA TOTAL ACH F.AGf - ROOF NOTE:NO FINALN T BE•MADBEFORE DIAPHRAGM THE CONSTRUCTION TAXX IS IS EPAID. ' BUILDING USE ROOF SHEATHING _ RES- IND CON PB 0"'. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED. FINALS' DATE INSP. E El 0 ' 1:1 11, ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY rrRncT No; PARCEL No. . TUBS&SHOWER PAN''= - Li PLUMBING ENERGY - MECHANICAL MECH..ENERGY ELECTRICAL BUILDING ENERGY •ACC:DATe ACC EIDE No, FRAMING'- - ELECT.,FINALTEST ZONING ENG.SITE NO: -. INSULATION PLUMBING � � - GAS TEST, - GAS MECHANICAL , FIRE.SPRINK ENERGY T.24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING . - Y'❑ ' N Y I] N[ R - ELECTRICAL RELEASE - .FLOODZONE A,hUC ' EXTERIOR SHEAR � � ' INTERIOR SHEAR ! h FIRE DEPT. Y❑ N❑ Y L N❑ SHEETROCK - GRADE . ; - FEE SUMMARY EXTERIOR LATH- BUILDING i ' INTERIOR LATH � CDTEMPORARY APPROVABUILDING LS : �.)J t3• SCRATCH COAT. - ELECTRIC PLAN CHECK ' GAS - FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY• i;-i SEISMIC FEE 4 OCCUPANCVOFBUILDINGISNOT PERMITTED UNTIL BUILDING FINgLIS SIGNED By BUICDINGINSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, j ELECTRIC j : .�& " ONE WORKING DAY BEFORE REQUIRED INSPECTION.% PLUMBING O 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. z,. SEE'PERMIT FOR EXPIRATION DATE = ' MECHANICAL' ti IMPORTANT!' coNsr.TAX, y. . PLEASE READ REVERSE SIDE BEFORE TO IL CALLING FOR FINAL INSPECTION. R. �7• jL • ..OFFICE COPY • APPL`ICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUILDING LD1 NG PROJECT IDENTIFICATION - - ., - PERMIT NUMBER B ILOINc APPLICATION & PERMIT 17663 ADDREss d� v BUILDING—ELECTRICAL—PLUMBING—MECHANICAL OWNEN'S , PLAN CHECK VALIDATION NAME POL HONE _ DTV. ELECTRIC PERMIT FEE - CONTRACTOR'S ' - NAME �y�[ OUTLETS-SWITCHES-RECEP 10.00/1.00 Lau,NO.J,7s,Jto� LIGHTING FIXTURES 10.00/1= CONTRACTOR'S ; ADDRESS PPLIANCES-RESIDENTIAL 4.00 Q 2�J - VC0#'., u PHONE 7/-��WZ PANELS - 10.00 DATE OF APPLICATION 0. ARCHITECTPLAN(OVER 200 AMP) 20,66 PLAN CHECK FEE P.C.N0. ENGINEER yy Opo + LIC.NO. ISIGNS TRANS. 3.00 ARCH.OR ENG. - PERMIT VALIDATION ADDRESS SPECIALCIRCUIT • - "5.00 V� 6 ZIP TEMP.METER OR POLE INS. 20.00 1. 20�0 ('•; APPLICA"aoDR /J/ - ..J,-I /71 MOTORS - SEE FEE SCH. �- 4•'tl S�D//1' F76��� ' SERVICE CHANGE' 20.00 J3 , woo LICENSED CONTRACTORS DECLARATION ¢ is w 1 hereby affirm that I am licensed under provisions of Chapter 9 I- < n (enmmencing with Section 7000)of Division 3 of Ula Boomess a0d ,. BLDG CT. 41 LG. MECH. t- D i Professions Co and myli ense is in full fnre�.Sn�sfleet./ AW ' o,�o License Class J Lic.Number 3.I Sb/W , - Data T �. Contractor—O-t — N J T a m 2 U BUILDING PERMIT a o It sc a o owNER-BuiLDISR DecLAan'noN MISC.— F •PRD .INFORMATION X g r _ 1 hereby of firm that I am exempt from the Contractor's License - m Om - / '.VALUATION $/FT. ¢ Law for the following reason.(Sec.703L5,11tisiness and Professions PERMIT ISSUANCE }Qs60 Code:Any city orcounty which requimsa permit to construct,alter, QQ ¢ p II11prove,demolish,.,repair any StNCtme,prior to Bs Issuance,also ELEC,CONTR.- LIC.NO. ' ELEC. DO� an No u requires the applicant for sucGpermit to file a signed statement that TOTAL PERMIT TO is m he is licensed pursuant to the provisions of the Contractor's License i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ¢ Business and Professions'Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT •FEE IGndir11AAS4r $ ¢ f $ the basis for the alleged exemption.Any violation of Section 7031.5 - TORIES TYPE CONSTR. i'3 _ by any applicant for a pe nn it subjects the applicant Ino civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 • of nal more tlmn five hundred dollars „ - ❑ .L as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044;Business mid Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00 .. I Code', The Con Daclor's Lirense Law does not only to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 0180 SO,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve" - martsarenotintendedInoffered for sale.If.howeveq the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- ' GAS•EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have ilia br Nemof proving that he did nor build or int- r BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND.. CON PB Omar CII,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business. LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO. - and Professions Code:The Contractor's License Law does not apply - - 1. t0 an owner of property who builds or improves Ibercon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 - + contracts forsueh projects with a contractoAs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/1400 the Contractor's Licence Law. TRACT NO. PARCEL No. ❑ lam cxuanpt mtdnr Sec -,Is.&P.C.fnr Ibis • ension WATER HEATER W/VENT [6.00 t - ��• Owner - Data WATER SYSTEM 5.00 - ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATERTREATINGEQUIP, 5.00 I hereby affirm that I have a certificate of consent to self-imus, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). - Policy No. - Crnnpuny , Q• Certified ropy is hereby furmsl d. - FIRE SPRINK ENERGYT24 Z 2 Certified copyiled will the city inspeelion division. FO licam a - MISC.- REFER TO ORD. - .Y❑.. .N❑ v ❑ N❑ C/ �'- PERMIT ISSUANCE ,10:0 -� y CER'I'IP CATI:OI'F.XIiM 'PION IrNOM WORKIiRS' FLOOD ZONE A.L.UIC. W > COAL I'IiNBA'I'IONINSURANCIi PLO.CONTR, LIC.NO. 'PLG. / V❑ 'N v❑ [:1Z (This section need nm riot be completed if the permit is for one TOTAL N hundred dollar.,($100).,,lcssJ U O 1 certify that in the performance of Him work for which this par- DTV MECHANICAL PERMIT FEE FEE SUMMARY LL F- mil is issued,I shall not employ any person in any manner'so as to O w become subject to the Workers'Compensation Laws of California. Dam Applicant BUILDING �• 6 yr } N NO] TO APPLICANT: If,uNcr making this Ccrlil icnte of fix' ALTER OR ADDTO MECH. 5.00 Fz emption,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK provisions of the Labm'Codc, you most forthwith comply wit II FEE U such provisions or this permit Shall be deemed revoked. AIR HANDLING UNIT(TO 10P=MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIRHANDLING UNITIOVER 10=C.EM.) 6.00 SEISMIC FEE - . "• (y'O I hereby affirm that there is a construction lending agencyfor EXHAUST HOOD (WITH DUCT) 5.00 l the performance of the work for which this permit is issued(Sec. MICROFILM 3897,C,.C.). HEATING UNIT(TO 100,000 B.T.U.) .8.00 Lender's Name lA HEATING UNIT(OVER 100,000 B.T.U.19.50 Lender's Address ELECTRIC 2• So 1 certify that I have read'-this application:md'sone that the above VENTILATION FAN (SINGLE) 4,00 q. information is correct. I agree to comply with all city and county. - BOILER•OOMP I3 H.P.Of 100,000 B.T.U.1'B.00 O PLUMBING " ordinances and slate laws relating to'building construction, roll hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL !�^ Ame-mentioned property fanlnspection purposes. - 0 (We) agree to save, indemn' y and kcep•Imrmless the City of MISC. REFER TO ORD. • - Cupertino against liabilities;j gments, costs and expenses which PERMIT ISSUANCE 1&90 CONST.TAX may in any way a true :jsq said,City in conttquence of the mnlin Ih' it.• yyy MECH.CONT. LIG NO. - " MECH: - 4)/' TOTAL TOTAL ' Signature of pplicant C ntraCIO, .Date 6• ©r OFFICE COPY "