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16742 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PERMIT NUMBER 6742 INSPECTION DIVISION �� JOB INSPECTION RECORD �. �Y" 1J� JOB ADDRESS_d__[�� _ '� P"� JO UNIT# _LOT# PE NIITJEXF pAT10N� JJ�� cQ PERMIT EXPIRES IF WORK OWNER B e5 J d� ' CONTRACTOR L IS NOT STARTED WITHIN I SPECTION DATE INSPECTOR INSPECTION RECO D 180 DAYS OF PERMIT ISSU- FOUNDATION �" NOTE: LASTANCE AL 780 DAYS FROM UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. TO COMPLY WITH THE APPROVED PLANS AND CITY OF PElAMIT VAI.II)A TION PREGUNITE p gTINO STANDARD5. GARAGE SLABS ]C t� L r POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED p(7WCC , UNDERGROUND /SLAB \. ,, _ 3 qI q / PLUMBING pQvv V L O � /�E� /'} V� ELECTRICAL cityISSUANCE DATE BLDG ELECT' PLG. MICR MECHANICAL ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION 5/F T. PLUMBING MECHANICAL , 0 ELECTRICAL - PEHrv�n►Ijo ft- FRAMING O 1/�.�f STORIES TYPE CONSTR INSULATION F occ CHOUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 50 FT FLOOR DHEA IOi AL ACPEAGE • ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING HES IND' CON PH CO' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El 1:1 ❑ El ❑ nSsessOHs Pa¢eL No ROUGH SANA PLUMBING ELECT.ENERGY TRACT NO PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY acc GATE ACC FILE No. ELECTRICAL - BUILDING ENERGY FRAMING ELECT,FINAL TEST ZONING. ENG.SITE NU. INSULATION PLUMBING GAS TEST GAS FIRE SPRINK ENERGY 1 44 MECHANICAL v ❑ N❑ � [—] N[]COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED 'HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZONE ALuc INTERIOR SHEAR FIRE DEPT. v❑ N❑ L, N❑ SHEETROCK GRADE Eft FEE SUMMARY EXTERIOR LATH BUILDING [7 8/— ' f BUILDING INTERIOR LATH TEMPORARY APPROVALS "v SCRATCH COAT ELECTRICPLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I I SEISMIC FEE ' OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM �0 ARRANGE FOR INSPECTION BY PHONING 252-4505ELECTRIC, Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. ' Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. � ' .f OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER ), RDILDING APPLICATION & PERMIT 16 7 2 ADDRESS 2�7 � r,\" �� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1 _ Ow"ER5 PLAN CHECK VALIDATION "AME OTY. ELECTRIC PERMIT FEE �.o,.. �i f9sAzt-. PRDNE 2.53 -b'Sj ad CONTRA R'$ NAME `(jrse.�`r.Gor2s,E•�J GS3 UTLETS-SWITCHES-RECEP 10,00!1.00 10 ,� Li v<-,p.r LJa rt1Gt/ILc No.I�/T2-7`7b - LIGHTING FIXTURES 10.00/1.00 •� T CONTRACTORS Sr•._^e.� PPLIANCES-RESIDENTIAL 4.00 ADDRESS rn OR 2(r3,1;i Spe W�1 �� PHONE Wf6Z-017L) PANELS IO.00 Z ,V DATE OF APPLICATION r ARCHITECT PANELS (OVER 200 AMP) 20.00 PLANCHECKFEE P.C.NO. ENGINEER - sec.NO. ISIGNS TRANS. 3.00 aooaesR ENG, SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 ADDRESSI �/) AMOTORS SEE FEE SCH. 9,00 T ADDRESS SERVICE CHANGE 20.00 `1 ac oD LICENSED CONTRACTORS DECLARATION v L I hcrcby affirm fiat I am licensed under provisions of Chapter 9 kyr, ISSUANCE DATE ,HA¢ H (commencing APR with NUCHoO 7000)of Division]of the Business and BLDG. ELECT. PLG. MECH. F y z Professions Code,mud my license is in full fo{{c�e and effect. z i u,o Licen Clas Lic.Num ber_ryY7�'1b CS1 p�� aContractor city �cop lLLLpi BUILDING PERMIT ¢w e OWNER-BUILDER DECLARATION INFORMATION 0 0_ U MISC.- REFER TO ORD I hereby a0irm that I um exempt from fire Contractors License uois Law for life following«ason.(Seo 7031.5.I3minessunJ Professions pERM1T ISSUANCE 10.00 VALUATION S/FT, � - Code:Any city orcounly which requires ape r...iftnconslrucl,alou. �� oimprove,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. o��ffff as O u requires the applicant for such permit to file a signed statement that TOTAL 1• ERMIT TO a w m he is licensed pursuant to(lie provisions of the Contractor's License Uzi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe- a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE V Der-ft the basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES TYPE CONSTR. d � by any applicant for a permit subjects fire applicant toa civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more Lha.five hundred dollars 15500).1: ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEV ICE 4.00 OCC,GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered I'or sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Conl .clot s I-icensc Law docs not apply In an owner of properly Who builds'of In.pro,cS the con,and wit,dOW such work FIXTURES-PER TRAP 5.00 $0.FT.FLOOR AREA TOTAL ACREAGE mentsfor ethuntende own rofferdfors. le.preened however, the ibuildig GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 mems arc not intended or offered for sale.❑',however,the building or improvement is sold within one year of completion,lite Owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have(be harden of proving that hmi-did not build or .- RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ El El El E]❑ I,as owner of the property,am esclusively contracting with licensed contractors 10 construct the project!Seen 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:1'he 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 u contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ I am creep!under see ,B.&I'.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a cerliflcale of consent to selhinsure, ZONING ENG.SITE NO. or ertificate of Workers'Compensation Insurance,or a certified copthereof(Sec.3800,Lab.C.I � PolicyNo. Company O C1 Sin�E FMCICN ,y3 -gtr FIRE SPRINK ENERGY T 24 ❑ Cert d o y is Bled with fir' city inspection division. z � Applicanti�' Cwre.�a....� MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ crN CER'HFICA'❑i OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > COAIPL'NSWION INSURANCE PLG.CONTR. LIC.NO. PLG. Y N Y N CL O (This section need not be completed if the permit is for one TOTAL ❑ ❑ ❑ ❑ 0 Z hundred dollars(5100)or less,) U O 1 certify that in the performance of.lic work I'or which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not eGwloy any person in any manic,eo as fo Ow become subject to the Workers'Compensation Lawsof California. BUILDING Dee Applicamf ALTER OR ADD TO MECH. 5.00 } y NOTICE.TO APPLICANT; 11',after making this Certificate of Ex- ? emption,you should become suhject to fire Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed awaked. AIR HANDLING UNIT(TO 10SMC.F.M.) 4.00 ^ CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE aLZ I hereby affirm that there is a Construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 fire performance of the work for which this permit is issued IS,,.. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Co,C.). Lender's Nan.e HEATING UNIT(OVER)00,000 B.T.U.)9.50 ELECTRIC VV Lender's Address f I certity that l lueenud thisapplicalioi and sate that tire above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county BOILER-COMP13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and sate laws relating to building construction, and hcrcby autlmrive representatives of this city fo enter upon the BID ER (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE10.00 CONST.TAX may in any way accrue against said City in consequence of life •rantiv ff this permit. MECH.CONT. LIC.NO. MECH. l'Z C I(-3-y5 TOTAL TOTAL 336,7 Signature of Applicant/Contractor Dale OFFICE COPY