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11655 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO ' PFRMIT NUMBER INSPECTION DIVISION 1.1655 JOB INSPECTION RECORD ` p W�� K� PERMIT EXPIRATION JOB ADDRESSj( 11rl/� Yx / 'I' ` UNIT# LOT# `/ PERMIT EXPIRES IF WORK OWNER 'y CDNTRACTOR sl IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR MSPECTION RECORD 'i 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION 'POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' UNDERGROUND /SLAB ` "y/ PLUMBING ELECTRICAL ISSUANCE OnrE MECHANICAL - 6LUG ELECT. PLG. MECH. 11 � � ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT PLUMBING , WOOD FLOOR �� ' INFORMATION:'' ' - A 1. •l �U tl � U iION� 5/FT. MECHANICAL '3 b ELECTRICAL PER I To FRAMING N • :p_( INSULATION STORIES TPE CONSIA. I i OCC.GROUP HES.UNITS 'PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF , SO.FI.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE HES IND CON PB Olt,,, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED . ❑ ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO, PARCEL NO. MECHANICAL ELECTRICAL FINALS DATE r INSP. ACC.DATE ACC.FILE No. FRAMING SAN S INSULATION PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ Nol Y ❑ N❑ LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.00. LATH-EXTERIOR FIRE DEPT. .. Y❑ N❑ Y 0 N❑ SHEETROCK GRADE - ' SHEAR INTERIOR FEE SUMMARY BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE UCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED By BUILDING INSPECTOR. MICROFILM Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC I-� ONE WORKING DAY BEFORE REQUIRED INSPECTION.• PLUMBING ,4 Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANTI CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL i CALLING FOR FINAL INSPECTION. POST THIS CARD NEAR FRONT OF BUILDING PFRMIT'NUMBER' I; = ' CITY OF- CUPERTINO . 1.1655 INSPECTION.DIVISION 'JOB•INSPECTION.RECORD — - . / 1y' 1.1 PERMIT EXPIRATION '. JOB ADDRESS, `��D` `1 �✓Ol Y�:A ; , UNIT# LOT* - PERMIT EXPIRES-1 F WORK DwNER '� CONTRAciOR - -IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR ` SPECTION RECORD 180 DAVS.OKPERMITISSU- _ FOUNDATION ' - ANC E OR 180 DAYS FROM UFER - - - - LASTCALLEDINSPECTION: PREGUNITE ' - PERMIT VALIDATION T �f POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED fi UNDERGROUND /SLAB . " r' •` �' / PLUMBING' ELECTRICAL _ - - - ISSUANCE DATE- MECHANICAL ! ELECT, PLG. MECH.. " 10 El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT .. WOOD FLOOR _ INFORMATION PLUMBING,'- slFr. MECHANICAL _ ' 71 ' ,PERMIT TO • ELECTRICAL _ ♦' lz FRAMING _ 4 RI L � STORIES TYPE CONSTH, - INSULATION + ' -- ' OCC GROUP RES.ONITS, PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED •ROOF SO,FT,FLOOR AREA TOTAL ACREAGE DIAPHRAGM + _ euILOlNc USE RES', IND CON PB O1M1Y, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ❑ ❑ ❑ El ❑ ASSESSORS PARCEL NO, ,'ROUGH PLUMBING GAS TEST - rnACT:NO. PARCEL NO MECHANICAL ' I' -ACC,DATE - ACC.FILE NO. ELECTRICAL p .I FINALS DATE INSP. FRAMING. _ SAN.# •, ZONING.:, ENG.SITE NO. A INSULATION '" -u-• A�" - � PLUMBING - - - GAS L , • .. , - MECHANICAL FIRE SPRINK ENERGY 72 COVER NO WORK-UNTIL ABOVE HAS BEEN SIGNED - HEATING Y ❑ N❑ `-❑ N❑ ELECTRICAL FLOOD zorvE AIL.u.c ._ATH—' INTi_R_l0FV . LATH-EXTERIOR - FIRE DEPT, �,.`,. • Y❑ -N❑ 10 No SHEETROCK GRADE " - FEE SUMMARY ' SHEAR INTERIOR � � BUILDING '. + •,.,, � ' SHEAR EXTERIOR TEMPORARY APPROVALS eulLDwc / 3, . FIREWALLS _ -,. ELECTRIC ,. „ .PLAN CHECKT " GAS' FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' SEISMIC FEE w j) OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED'BY BUILDING INSPECTOR. 'MICROFILM ' ARRANGE.FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE,WORKING'DA'Y BEFORE REQUIRED INSPECTION. PLUMBING o'� . PLEASE GIVE;JOB ADDRESS WHEN PHONING. Z I ' . 'MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! coNsr.TAX 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 - 1' PERMIT NUMBER mat.mml - APPLICATION & PERMIT I ��� AnOREss - 7630 IkWI BUILDING—ELECTRICAL—PLUMBING—MECHANICAL OWNER'S V / / PLAN CHECK VALIDATION Na.E AQI ;WIF SI IUpN W,JrS�—`�p�G QTY. .ELECTRIC PERMIT FEE , .�� hhQIJArJ coNTRAcroRs UTLETS-SWITCHES-RECEP 10.00/1.00 NAME LIC.No. LIGHTING FIXTURES - 10.00/1.00 . I , CONTRACTOR'S - APPLIANCES-RESIDENTIAL 4.00 AOORESS PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) .20.00 PLAN CH CK FEE P.C.NO. OR ENGINEER - 'LIC.N0. ISIGNS TRANS. 3.00 AR H.OR ENG. - SPECIAL CIRCUIT S.00 PERMITVALIDATION AOORS - ZIP TEMP.METER OR POLE INS. 20,00 ) APPLICANTS I MOTORS �� SEE FEE SbH. `n Q'v-'„a/�� AOORE55 - - - - - - SERVICE CHANGE 20.00 y,�[ .w o o LICENSED CONTRACTORS DECLARATION , - �p�" u w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE w (commencing with Section 7000)of Division 3 of the Business and _ r D i Professions Cotte,and my license is in full force and effect. ' BLDG. ELECT. PLG. MECH. z O — License Class Lic.Number 0 ❑ 1 - 13 O z Doe Contractor ' < ef c BUILDING PERMIT a w OWNER-BUILDER DECLARATION - - INFORMATION MISC. REFER TO ORD w ;' r I hereby affirm that I am exempt from the Contractor's License VALUATION S/FT. u04 Law for the following reason,(Sec.7031.5,Businessand Professions PERMIT ISSUANCE - 10.00 ( D�� �. w N Code:Any city or county which requires a permit toconslruct,alter, ' Q improve,demolish,or repair any structure,prior to its issuance,else ELEO CONTR. LIC.N0." ELEC. —o S,. requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO A w m he is licensed pursuant to the provisions of the Contractor's License H z r Law(Chapter 9(commenoing with Section 7000),,fDivision 3 ofthe �A-�'o �V f 4 4o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT -FEE C r the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER'(EA.) 5.00 of not more than five hundred dollars($500).): 0 1,as owner of the property,or my employees with wages as IBACK FLOW PROTECT.DEVICE --4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044; Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The'Contractor's License Law does not apply 10 an..net of - property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenotintendedoroDcredfo,sale.l L however,the building GAS-EA.SYSTEM-I IN C.4 OUTLETS 6.00 or improvenlent,is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or iRES IND_ CON E Other prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 O 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. and Professions Code:The Contractor's License Law docs 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 conimchms)licensed pursuant to the Contriclor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. 0 lam exempt under Sec.—,B.&P.C.for this WATER HEATER W/VENT 6.00 - reason Owner - Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE No, WORKERS'COMPENSATION DECLARATION' / WATER TREATING EQUIP. 5.00 I hereby affirm that I.have a certificate of consent to self-insure, or a certificate of Workers Compensation Insurance,or it certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. aCompany 0 0 Certified copy is hereby furnished. - FIRE SPRINK ENERGY T24 Z Z 0 Certified copy is filed with the city inspection division. - - O Applicant misc.- REFER TO ORD. Y ❑ N❑ .v ❑ N❑ ~ rn - PERMIT ISSUANCE 10.00 CERTIFICATE OI'.CXIiMPTION FROM WORKERS' 'FLOOD ZONE A.LU.C. LL > COMPENSA'T'ION INSURANCEI PLG.CONTR. ,LIC.NO. PLG. - (L o (Phis section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑ D Z hundred letters(S 100)o,less.) - U O 1 certify that in the performance ol'the work for which this per. CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,I shell not employ any person in;my manner so as to - Qw become subject to the Workers'Compensation Laws of California. y Date • Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } m NOTICE TO APPLICANT: 11,after making this Certificate of Ex- _ - - � Z emption,you should become subject'to the Workers'Conwitsation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit that be deemed revoked AIR HANDLING UNIT(TO 10)0000.F.M.) 4.00 CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER IO,OWC.F.M.) 6.00 SEISMIC FEE I 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,CP.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lenders Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that Lhave reed this application and state that the above VENTILATION FAN (SINGLE) 4.00 Information is correct.f agree to Com Ply With all Cry and county PLUMBING ordinances and state laws refiling to building construction, and BOILFA•COMP(3 H.P.or 100,000 8.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP 10 Yer100,000BTU)SEEFEESCH. MECHANICAL ohave nscntimi d property far inspection purposes. - r (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 may in any way'acerue-:against said City in consequence of the PERMIT ISSUANCE 10.00 grantingufthispernit. r MECH.CONT. LIC.NO. MECH. - ha44020, / u�st[4 1 p—/,300 TOTAL TOTAL Signature a1 Applicant ontracior Data j --� OFFICECOPY,