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16393 POST THIS CARD NEAR'FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16393 INSPECTION DIVISION � \ JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS�Q'!1 T 7 L!y',/�zt}- (/LS / @- !�/L UNIT _'LOT# ^ I _ PERMIT EXPIRES IF WORK' OWNER V vte C 4e°9 O CONTRACTOR �' '.G.d(r IS ,NOT,STARTED WITHIN' INSPECTION DATE INSPECTOR INSPECTION REC RD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION NOTE: LASTCALL60 INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL,BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY'.OF PERMIT VALIDATION - PREGUNITE CUPERTINO STANDARDS. GARAGE SLABS - � — •-�-"•" POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 'UNDERGROUND /SLAB , - _ t. ttf% 5 vIY, • - PLUMBING - - ELECTRICAL - - .ISSUANCE.DATE Bloc ELECT. PLG. MECR. MECHANICAL •� ❑ 0 El Q DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED euILDING PEaM1T INFORMATION WOOD FLOOR - VALUATION SIFT. PLUMBING . MECHANICAL '� PERMIT TD ELECTRICAL - �f �•� FRAMING- s*uRles TYPE CONSTR. . INSULATION ' CC:GROUP, RES.UNITS " I CAI °. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED so.Fr.FLOOR AREA TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE f% THE CONSTRUCTION TAX IS PAID .•I� - DIAPHRAGM — BUILDING USE RES''„IND CON PB 011", r'dt'I. ROOF SHEATHING ❑ ❑ EEl ' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSOR S PARCEL NO ROUGH SAN.N PLUMBING ELECT.ENERGY - TRACT NO. ' PARCELNO - TUBS 8$HOWER PAN PLUMBING ENERGY ,. MECHANICAL, MECH.ENERGY - ' ACC.DATE ACC.FILE NO,' ELECTRICAL - BUILDING ENERGY 77b FRAMING ELECT.FINAL TEST ZONING ENG SITE NO, INSULATION PLUMBING GAS TEST U 1TGAS -- FIRESPRINK ENERGY TBE MECHANICAL YE] NE 1 , ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING o0o ZONE AL U C. EXTERIOR SHEAR." ELECTRICAL RELEASE - - INTERIOR SHEAR FIRE DEPT, YD NYLN❑ SHEETROCKGRADE. - FEE SUMMARY EXTERIOR LATH• - BUILDING TEMPORARY APPROVALS BUILDING INTERIOR LATH - - ELECTRIC - �_ PLAN CHECK I SCRATCH COAT GAS FEE NO TAPE OR PLASTER UNTIL'ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. 4,9 ' � PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. ZMECHANICAL — SEE PERMIT FOR EXPIRATION DATE — ' IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR.FINAL INSPECTION. OFFICE COPY j APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY DING PROJECT IDENTIFICATION IPEBMIT NUMBER.- . ' D� APPLICATION U PERMIT q'63.(]3 ADORE. � I J O BUILDING —ELECTRICAL—PLUMBING—'MECHANICAL tavola a PLAN CHECK VALIDATION '#_77, NAME QTY. ELECTRIC PERMIT FEE PONE •fMV E NAME AA , OUTLETS-SWITCHES-RECEP 10.00/1.00 c.ND. LIGHTING FIXTURES 10.00/1.00 ., CONTRACTOR'S ADDRESS � APPLIANCES-RESIDENTIAL 4.00 1F1�L, WA FHONE&S7 IC6Cf PANELS 10.00 DATE OF APPLICATION ARCHITECT -- PLAN CHECK FEE OR PANELS (OVER 200 AMP) 20.00 ENGINEER UC.NO. - SIGNS TRANS. 3.00 - ARCH.ORENG. 'PERMIT VALIDATION - ADDRESS SPECIAL CIRCUIT 5.00 ,. ZIP TEMP.METER OR POLE INS. 20.00r ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 //S7p'y Woo LICENSED�CONTRACTORS DECLARATION [[' IFL,W I hereby affirm that I,am licensed under provisions of Chapter 9 ISSUANCE DATE J' •.' am (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F y z Professions Code,and my license is in full for c. ❑ ❑ O o i.,D License Class Lic.Number Date �� Contractor - ., BUILDING PERMIT IS a w'uy y arm.OWNER-BUILDam exempt ER DECLARATontractors ,- INFORMATION w 0 u I hereby that I from the C ' License MISC.— REFER TO ORD - LL 0 Q Law for the following mason.(Sec.7031.5,Bmanessand Professions PERM IT'ISSUANCE. VALUATION $/FT. rw Code:.Any city or county which requires a permit to construct,alter, 10.00 R —aa ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE, LIC.NO. ELEC. n wo), requires the applicant for such permit to file a signed statement that - TOTAL PERMIT TO wt he is licensed pursuant to the provisions ofthe Contractor's License FiQ Law(Chapter 9(eommencing with Section 7000)of Division 3 ofthe - 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE - ¢ H o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. ' d '''? by any applicant fora permit subjects the applicant toacivil penalty ' of not more than five hundred dollars($500).) ALTER- _DRAIN&VENT-WATER (EA.) 5.00 ' -`•`, 0'+I;as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE OCC.GROUP RES.urvITS 91 their sole compensation,will do the work,and the structure is not - intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00 ` Code:The Contractor's License Law does not apply to an owner of - I 1 property who builds or improves thereon,and who does such work FIXTURES-PER TRAP ID JAD SO,FT,FLOOR AREA rOTAL ACREAGE - himself or through his own employees,provided that such improve- ments are not intended or offered for Sale.If,however,the bui Wing GAS-EA.SYSTEM-11NC.4OU or improvement is sold within one year of completion,the owner- GAS:EASYSTEM-OVER 4(EA) lI BUILDING USE - builder . . will have lire burden of proving that he did not build or im- RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 C3 1,as owner of the property,am exclusively contracting with .❑ ❑ ❑ ❑ ❑ licensed contractors to construct the projuct'(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply - x 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 contractors)licensed Pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. x - ❑' l am exempt under Sec.—,BAP.C.for this WATER HEATER W/VENT 6.00 reason . Owner Date WATER SYSTEM ' _ ACC.GATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0. I or a certificate of Workers'Com 9� ryI a certified .r� copy thereof(Sec.3800,Lab,Ce!l! ��r�'/' •D,- /. _ Policy ere Company ieu' feyfE�7AY L�{RRIh/ ' O : ❑ Certified cc y ishereby furnished. FIRESPRINK ENERGYT-24 - Z Z ❑ Certifie c py is filed wy�/ere city insp nation division. MISC.- REFER I ORD: ❑ ❑ ❑ ❑ ', OT Applicant /a`7wv� Y N V N H +n PERMIT ISSUANCE FLOOD ZONE - A.L.U.C. cc CF. TIFICAT' XEMPiION FROM WORKERS' . . �a LU > _ COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. PLG. d 0 (This section need.not be completed if the permit Is for one TOTAL Y❑ N❑. Y ❑' N❑ :) Z hundred dollars(S I00)or less.) - U O 1 certify that in the performance of the work for which this per" QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I— mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. �.6 Date - Applicant ' ALTER OR-ADD TO MECH. ' 5.00 BUILDING ' }W NOTICE TO APPLICANT: If,after making this Certificate of F,x- F 2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwithcomply with , FEE V Such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 - CONSTRUCTION LENDING ACGNcv AIR HANDLING UNIT(OVER 10=C.EM.) 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. HEATING UNIT(TO 100,000 B.T.U.) '8.001MICROFILM 3097,CN.C.). - Lender's Name Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) ',4.00 / .z information is correct. I agree to comply with all city and county - PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.Dr 100,000 B.T.U.) 6.00 hereby amhorize representatives of this city to enter upon the BOILER-COMP IOJer 100,000 BTUI SEE FEE SCH. MECHANICAL shove-mentioned property for inspection purposes. (We) agree to save, indemnify and keep'harmless the City of MISC.- REFER TO ORD. , xCaper tino against liabilities,judgments, costs and expenses which - CONST.TAX is, ay in y wit accrue, gainst said City in consequence of the PERMIT ISSUANCE ..10.00 anf t i ermiL. ECH,CONT. LIC.NO. MECH.TOTAL TOTAL go lure of is of/Contractor Date OFFICE'COPV .