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16804 POST THIS CARD NEAR FRONT OF BUILDING PERMITNUMBER CITY OF CUPERTINO 16804 INSPECTION DIVISION JOB INSPECTION RECORD Y 197 /1�� ',.-{— PE�RM(IT EXPIRATION , JOB ADDRESS ` C ` � 1M ey-�( l &)� UNIT# _LOT# /PERMIT)E XPI ES IF OWNER GQ D k CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION NOTE: LAST CALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMLT VALIDATION PR EG UN I TE CUPIERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED A UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG ELECT I PLG. MECH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED auIL PERMIT INfORMRMA710N WOOD FLOOR VALUAnUN 11 SIFT, PLUMBING co MECHANICAL PERMIT TD ELECTRICAL FRAMING PAID 1 a eSTORIES TYPE C NSTR INSULATION NOV 15 _ UCG GROUP Hes UNITS, PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED City Of CupertinoSo IT aooH AREA TOT AL ACRCAce ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING - 'Es IND CON PB Om., Ll El El El El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. A SSLSSORS PARCEL NO ROUGH SAN.N PLUMBING ELECT.ENERGY TRACT NO PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC DATE ACL FILE NO ELECTRICAL BUILDING ENERGY FRAMING ' ELECT.FINALTEST ZONING ENc.SITE NO INSULATION PLUMBING / GAS TEST GAS I SPRINK ENERGY Tad MECHANICAL I El NE-1 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING � FLOOD LUNNEL 4l U C. EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. v ❑ NL Y L NL SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC FEE PLAN CHECK M-3S— GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE r OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILMLu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC I'_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING �-- • O� PLEASE GIVE JOB ADDRESS WHEN,PHONING. Z MECHANICAL �— ��I — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.TAX I PLEASE READ REVERSE SIDE BEFORE TOTAL 1, CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDI NG PROJECT I DENTI FICATION PERMIT NUMBER aNILDING n/ APPLICATION & PERMIT 16804 ADDRESS V =��/T V F UILDING - ELECTRICAL-PLUMBING-MECHANICALOWNER'S - PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE PHON CONTRACTORS NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 _ LIC.NO. LIGHTING FIXTURES 10.0011.00 �( S '-' ADDRESS CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 RE55 PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 Airl 20.00 PLAN CHECK FEE P.C.NO. o OR ENGINEER uc.NO SIGNS TRANS. 3.00 ADDRESS ENG SPECIAL CIRCUIT 5j.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 ADDRESS is ADDRESS MOTORS SEE FEE SCH. SERVICECHANGE 20.00 w O o LICENSED CONTRACTORS DHCLARA'TION a o U I hereby a0irm that I am licensed under provisions of Chapter 9 ISSUANCE DATE G m (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H o z Professions Code,and my license is in full force and effect. El El 11 M13 z o w- License Class Lie Number 9 z H w Datc Contractor F a u s 111 BUILDING PERMIT w u OWNER-BUILDER DECLARATION INFORMATION o A MISC.- R O ORD 1 herch flirt, and I an,exam t Gum the Contractor's License w 3 y a p VALUATION $/FT. L .. oa Law for Any, yOr iCoultyoa(Sec.703L5,Businessland sirofcszions PERMIT ISSUAN 10.00 � y� � Code:Any mulish coy Ny whiny structure p riot t ots issuance, alsoter, FLED.CONTR. LIC.NO. - lUrVIIII Q O improve,demolish,or repair any structure,prior to its issuance,also LEC. O u requires the applicant for such permit to Hle a signed statement that TOTAL PEg1MIT TO (''` a F m he is licensed pursuant to the provisions ol'the Contractors License �- // 0 ` l (Df--"� zi Law(Chapter 9(commencingwith Section 7000)of Division 3 of the V,./. l ' " ` lLvt - < Business and Professions Code)or that he is exempt Therefrom and QTY. PLUMBING PERMIT FEE it=$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. aby any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 r of not more than five hundred dollars(55001): "C I,as owner of the property,or my employees with wages az BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP BEs.urvrTs their sole conhpensatlon,will do the work,and the structure is'not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve. meats are not intended or offered for sale.If,however.the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of cnlnpletmn,tic owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or it,- RES IND CON PB other prove for purpesc of sale,). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct tire prnjeet(See 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 to am owner of property who build,or improves thereon,unit who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractorls)licensed pursuant to Rhe Contracmr's License Law. SEWER-SANITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Svc._,B.&P.C.for this WATER HEATER W/VENT 6.00 ( reason Owncr Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPE:N$A'IION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a eerti0eafe of Workers'Compensation Insurane ,or a certitled copy thereof(Sec.3800,Lab.C.). I'mie,No. Company Q ❑ Cenitiedcopyisherebyfurnizhed. FIRESPRINK ENERGY T24 Z Z Cl Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. p Applicant Y ❑ N v ❑ N❑ iry CERITFICA'1'E Of Fxi:mpTON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UC. LU > COMPENSWION INSURANCE PLG.CONTR. LIC.NO. PLC. C. ❑ This section need not be completed if the permit is for one TOTAL V❑ IN Y E] N❑ Z) Z hundred della..IS 100)or less.I U O 1 Certify that in the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued.I shall nut employ any person m any manner so as to U become subject to the Workers'Compensation Laws of California. D w Date A licant BUILDING 2 r1 6, Pp ALTER OR ADD TO MECH. 5.00 } w NOTICE TO APPLICANT': If,after making this Certificate of Ex__ F ? emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK ' -7 provisions of the Labor Code, you most forthwith comply with FEE QJ f U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,OWC.F.M.) 4.00 CONS'T'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10A00C.F.M.) 6.00 SEISMIC FEE r Q I hereby affirm that there is a construction lending'agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of(be work for which this permit is issued(Sec. MICROFILM 3097,Civ.C,). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's N. HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 _ information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating Dr building construction, and BOILER-CCA4P(3H.P.or100,000B.T.U.) 6.00 - hereby authorise representatives of this city to enter upon the BOILER-COMP Cars,100,000 BTU)SEE FEE SCH, MECHANICAL above-mentioned property for inspection purposes. (We) agree to save. indemnify and keep harmles the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ay in any way accrue against said City in consequence of the •ranting this pcnm it. MECH.CONT. LIC.NO. MECH. _, II�L��y� //-/(F,&x TOTAL TOTAL S�S� Signature of Applicant/Contractor Date OFFICE COPY