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15065POST THIS CARD NEAR FRONT OF BUILDING CITY -OF CUPERTINO . INSPECTION, DIVISION . ` JOB INSPECTION RECORD ; •, • ''/ '//PERMIT JOB ADDRESS ' `��Len. i7 ✓� UNIT# - LOT# - OWNER CONTRACTOR �� PERMIT NUMBER . 5065 ' " 1 EXPIRATION PERMIT EXPIRES IF WORK'i IS NOT STARTED WITHIN 180 DAYS OF,PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. ' INSPECTYON I -DATE I INSPECTOR INSPEC I IN RECORD FOUNDATION- ' _ - NOTE: -� ALL GRADING AND DRAINAGE SHALL, BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. LIFER PREGUNITE- ' PERMIT VALIDATION + - . ,,, �• y' ISSUANCE'DATF. GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED � 'UNDERGROUND/SLAB PLUMBING - ELECTRICAL MECHANICAL - ELecr, PLc. MECR DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDUILDING -� PERMIT INFORMATION WOOD FLOOR VALUATION 7vUZI" .' / s/FT. PLUMBING MECHANICAL_ ELECTRICAL - •, veRMlr r�.o%`�I ^..`1J.9h'f3G`G 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 so Fi. FLOOR AREA TOTAL ACREAGE DIAPHRAGM - ROOF SHEATHING BUILDING USE RES IND CON va`. om+' ❑' ❑ I] ❑- 1:1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH" SAN.q ASSESWNS PARCEO NO. PLUMBING— ELECT: ENERGY weg5 SHOWER PA .;t 4w PLUMBING ENERGY TRACT NP. PARCEL NO. MECHANICAL + S� MECH.ENERGY ELECTRICAL IF—- BUILDING'ENERGY ACC. DATE ACC, FILE NO FRAMING, ELECT. FINALTEST ' .INSULATION -- - PLUMBING ZONING ENG; SITE NO. GAS TEST _ _ GAS - a MECHANICAL FIRESPRINK Y N',�. ENERGY T114 ' ° ❑ NE] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING +dp EXTERIOR SHEAR ' ELECTRICAL RELEA E F LORD 17ONE y N� A.L UC. , LL N� INTERIOR SHEAR FIRE DEPT. - SHEETROCK GRADE,- FEE SUMMARY _ EXTERIOR. LATH, BUILDING - - BUILDING ':,, i• INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC" PLAN CHECK FEE - GAS +% NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ..- SEISMIC FEE' 1 a OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION. ZPLEASEGIVE.IOBADDRESSWHENPHONING. - SEE PERMIT FOR EXPIRATION DATE - MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FOR FINAL INSPECTION., TOTAL OFFICE COPY 4' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY bUl LD1 NG PROJECT I DENTI FICATIONr-." APPLICATION & PERMIT BUILDING -`PERMIT NUMBER •. 1 [ O65 BUILDING I ml lle-R Ulzx DINNER S N ME QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHONE +'• . DATE OF APPLICATION CONTRA ORS f1 •s p f4ER.EV,�S uc.N L p 70 OUTLETS - SWITCHES-.RECEP, 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 R's o�tsi ,ON in ODREBS e'�1 /U.,� �( L /HANE -2M PPLIANCES- RESIDENTIAL 4.00 PANELS' 10.00 HCHIiECT OR ENGINEEP�p�'+� , 1 LIC. No. PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO.' ISIGNS TRANS. 3.00 ARCH Ess ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION YVI Oo IZ f iIP EMP. METER OR POLE INS. 20.00 . , ((�l APPLICANTS ADDRESS MOTORS SEE FEE SCH. / Q I*Z.� SERVICE CHANGE •20.00 9� ' LICENSED CONTRACTORS DECLARATION .��Q/r 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Businessland professions OOd,� 1pd my becose is in IWI fOICe and Eff' License Class -.,p Lie. Ist be Dale Contractor ISSUANCE GATE Y . PLO ELECT. PLG. -MECH. �IYX�1 . I DING PERMIT INFORMATION. TION S/FT. v- _ I OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit To construct, alter, improve, demolish, Or repair any structure, prior to it, Issuance, also requires The applicant for such permit to file a signed statement hist he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and MISC.— - REFER TO ORD PERMIT ISSUANCE A449 ELEC. CONTR. LIC. NO. - ELEC. TOTAL p( PERMIT TO QTY. PLUMBING PERMIT FEE STORIES ' TYPE CONSTR. the basis for file alleged exemption. Any violulion of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars (S500L): ALTER -DRAIN -WATER IEA.) 5.00 ❑ I, as owner of the property, or my employees with wages as (heir sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS7FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions " Code:LThe Contractor's License Law does not apply to an owner of FIXTURES - PER TRAP GAS -EA. SYSTEM - i INCA OUTLETS 6.00 sU. PT. PLooR AREA TOTAL ACREAGE property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- ments are not intern icel moffered for sale. lf, however, the bmlding or improvement is sold within one year of completion, the owner- builder will have 0 1e burden of proving that he did not build or im- prove for purpose ofse.)' Lth[h ❑ I, as owner of property, um exclusively contacting wills . .. GAS , EASYSTEM -OVER 4 (EA.) 200 BUILDING USE RES IND CON P9 Clio, ❑ ❑ 0 INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. - contracts for such projects with a contractors) licensed pursuant to the Contractor's License Low. " SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO, -❑ I am exempt under Sec. ,B,&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Dace WATERSYSTEM 5.00 . ACC. DATE ACC. FILE NO. - WATER TREATING EQUIP. - 5.00 - WORKF-RS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure. or a certificate of Workers' Compensation Insurance, or a certified - ZONING ENG. SITE NO. ' copy thereof (Sec. 3800, Lab Policy No. Company�yYIETU-!lA ❑ Cerlifi hereby fur shed. 211f Certifi Is s f city inspection division. Applicant __�f w'� FIRE gPRINK Y[:] N� ENERGY RZa Y❑ N[3 MISC..- '. REFER TO ORD. ' CERTIFICA EOF IiXEMPTION FROM WORKERS' ' COMPENSATION INSURANCE '1This section need not be completed if the'permit is for one PERMIT ISSUANCE. ^34,96 '0]r— FLOOD ZONE V E] N� A.L.U.C. Y [:]NEI PLG. CONTR, ,LIC. NO, f PLG. TOTAL 46 hundred dollars 1$ 100)or less. -1 1 certify that in the performance of the work for which this per. mit is issued, I shall not employ any person in any manner s0 as To QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California.' Date Applicant - NOTICE TO APPLICANT: If, after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00OU APPLIANCE, 5.00 - AIR HANDLING UNIT (TO 10MC.F.M.)' ,4.00 PLAN CHECK FEE emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (OVER 10=1C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY lending agcy for I hereby affirm that there is a construction en tlle performance elf the work for which this p 3097, C's.CJ. - ermit is issued (Sec. EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM - HEATING UNIT ITO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC (IV Lender's Name Lender's Address - VENTILATION FAN (SINGLE) 4,00 I certify that I have read this appliciuk a and slate lbal IIIc above information is correct. 1 agree to comply with all city and county Ordinances and state laws relating to building consNu,I and PLUMBING 6 •�� BOILER-COD/P 13 H.P.or100,000B.T.U.) 6.00 BOILER -COMP IOvnr 100,000 BTU) SEE FEE SCH. MECHANICAL / rice representatives of this city To enter upoq the above-mm�tto d properly tori feelino purposes. MISC. - REFER TO ORD. (We) agree t save, indem y and k ep hmmless the City of upertino agai t iia hies, 'mems, Osls and expenses which may in any y d ag yin consequence of the oaring o is L CONST. TAX PERMIT ISSUANCE .70-001 01 _ MECH. CONT. UC. NO. MECH. Q ' TOTAL It41kJ1 ' TOTAL /f os Signator of Applicant/Contact r Dam OFFICE'COPY