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17126' POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD Q% u1% �j1�.(� WT13 JOB ADDRESS 1�,o I'�q1I'�•`�� •"^' UNIT# _LOT# OWNER \ �/ ��W Q CONTRACTOR PERMIT NUMBER 17126 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLEDINSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS.Ems'. LEER PREGUNITE PERMIT VALIDATION I --)L� ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLABa PLUMBING ELECTRICAL MECHANICAL BLDG I ❑ ' ELECT I PLL. MECI, ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT, PLUMBING MECHANICAL PERMIT TO ELECTRICAL FRAMING INSULATION' STORIES TYPE CONSTR. occ GROUP RES UNITS ' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID i. SO IT TLOOH AREA TOTAL ACREAGE DIAPHRAGM Bu n.OINc USE Irvu coN vu Om,•, E ❑ ❑ 11ASSESSORS 54APPLY ROOF SHEATHING NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. PARCEL NO ROUGH SAN.# PLUMBING ELECT. ENERGY TRACT NO PARCEL NO TUBS & SHOWER PAN PLUMBING ENERGY MECHANICAL MECR ENERGY ncc Ohre ACC FILE No ELECTRICAL BUILDING ENERGY FRAMING ELECT, FINAL TEST ZONINGI:Nc',. SITE No. INSULATION PLUMBING GAS TEST GAS - FIREBPRWK ❑ N❑ ENERGY ila . ❑ NE MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING cLooO zoNE Y0 N nL.0 c.� ❑ No EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEESUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, I" ONE WORKING DAY BEFORE REQUIRED INSPECTION. O� PLEASE GIVE JOB ADDRESS WHEN'P ONING. Z - SEE PERMIT FOR EXPIF D DATE - ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL �y�5 OFFICE COPY Ll D¢i Foo QUU yZi 0Nz 0 ¢QWV w3A F u o a s M 0 ou ¢ 0 O ou Q 6 W 0 � z a Bio � � o d 3 m U Z2 F O c W _ ao 0 z UO LL U Ow } N F � A - APPL-ICANT TO FILL IN INF09MATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT IDENTIFICATION APPLICATION &PERMIT PERMITNUMBIER - q I� r�C EDLDiNG ADDRESS BUILDING a:ELECTRICAL- PLUMBING - MECHANICAL I 1 (, 0 OWNERS NAME / PHOrvE� �E -�G�i� OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION oNTRacTons NAME UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 LIC. No, CONTRA Des ADDRESS PPLIANCES-RESIDENTIAL 4.00 PANELS 10.00 Qp PHdrvE GATE OF APPLICATION ARCHITECT OR ENGINEER Sec. No. PANELS (OVER 200 AMP) 20.DD PLAN CHECK FEE P.C. NO, SIGNS TRANS. 3.00 ARCH. OR ENG.PERMIT ADDRESS SPECIAL CIRCUIT 5.00 VALIDATION TEMP. METER OR POLE INS. 20.00 ZIP IL �` x APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONI' RAC'I'ORS DECLARATION ? .yael I hereby Set Ole that I ant licunsed under provisions of Chapter 9 (connnencin with Sec lion 7000) of Division 3 of the Business and g w' Professions Code, and my license is in full force and effect License Class Lic. Numher ISSUANCE DATE BLDG. ❑ ELECT. PLG. MECH. ❑ ❑ '�E upartjno Date Contractor BUILDING PERMIT OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5. Businessand Professions Code: Any city or county which requiresa permit to construct, alter, improve, demolish, or repair :my structure, prior to its issuance, also requires the applicant for such permit to the a Sighed Stalenient that he is licensed pursuant to the provisions of the Contractor's License INFORMATION MISC.- REFER TO ORD VALUATION $/FT. PERMIT ISSUANCE -}B.00 fsC70 ELEC. CONTR. LIC. NO, ELEC. ^ �`� TOTAL 1 PERMIT TO QTY. PLUMBING PERMIT FEE Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business mW 1'rol'cssions Code) or that he is exempt therefrom and STORIES TYPE CONSTR. the basis for the alleged exemption, Any violation of$ec(ion 7031.5 by any applicant for a permit subjects the applicant toa civil penalty of no'more than five hundred dollars (5500).y. ALTER -DRAIN -WATER IEA.) 5.00 ❑ 1, as owner of the property, or my employees with wages as their role compensation, will do the work, and the structure is rot BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA, COND- 5.00 intended Or offered for sale (Sec, 7044. Business and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or hllproves thereon, and who does such work FIXTURES - PER TRAP 5.00 50, FT, FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such improve- mentsarenotintendedoroffered for sale. H. lHowever. the build'mg GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one your of completion, the owner- builder will have the burden of proving that he did not build or On - prove for purpose of sale.). ❑ I, as owner of the properly, um exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RE Into cont PB Diner ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 licensed contractors to construct the project (Sec, 7044, Business ASSESSORS PARCEL NO. and Professions Cody. The Cdntmefo)s License Law dues mol 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 contractors) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO, PARCEL NO. ❑ Iamexemptunder Sea .B.&P.C.forthis reason WATER HEATER W/VENT 6.00 Owner Dane WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORK ERS'COMPENSAT ION DECLARATION WATER TREATING EQUIP. 5.00 I hereby olfirnt that I have a certilicate of consent to scl-insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof(See. 3800, Lab.C.). ]'miry No. Company ❑ Certified copy is hereby famished. FIRE SPRINK ENERGY T-24 ❑ Certified copy is tiled with the city inspection division. Applicant Y ❑ N ❑ Y ❑ N❑ MISC.- REFER TO ORD. CE R' I PICA' I OF 1 XEMpf1ON PROM WORKIi RS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG. COINED. LIC. NO. PLG. TOTAL COM111'I7NSATION INSURANCE (This Section need riot be completed if the permit is for one YE] N Y ❑ No OTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars (S 1001 or lessT I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any ..rammer so as to BUILDING e orkers' Contpon,smion Laws of Culitornia, become subject to tire W Date Applicant ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, alter making Ibis Cerlil'icate of 1,.- ,'option, you should become subject to the Workers' Compensation APPLIANCE 5.00 PLAN CHECK Provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked FEE AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 AIR HANDLING UNIT(OVER 10J=C.F.M.) 6.00 SEISMIC FEE CONSTRUCT ION LENDING AGENCY I hereby affirm that there is a construction lending agency for the pertorounce of the work I'or which this permit is issued (Sec. 3097, Civ.CJ, EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UN IT (OVER 100,000 B.T.U.) 9.50 ELECTRIC `2 Lender's Name Lenders Address VENTILATION FAN (SINGLE) 4.00 PLUMBING 1 certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building camHuction, and BOILER-COMP(3 H. P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEESCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX (We) agree to Save, indemnify and keep hornless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against Said City in consequence of lire PERMIT ISSUANCE 10.00 MECH. CONT. LID, NO, - MECH. •ranting of Ibis rennit. TOTAL TOTALz 1 C S' natured Appicanf/ ntractor Date OFFICE COPY