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16438 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16438 INSPECTION DIVISION JOB INSPECTION RECORD �/j PERMIT EXPIRATION JOB ADDRESS `•1-'ay�-� ' ' "� 0/UT� GT UNIT# _LOT# PERMIT EXPIRES IF.WORK OWNER ��/�1— �" CONTRACTOR �� L p IS NOT STARTED WITHIN INSPECTIOh DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. - UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING , ELECTRICAL ISSUANCE DATE MECHANICAL RLOG I ELECT PLG. MECR ❑ ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION SIFT. P, MECHANICAL ELECTRICALVaw ryry �PERMIT /.TD FRAMING h� $ TYPE CONSTR INSULATION C,Uet a OCC GROUP R S UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO ET rLOOR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ouILDINc usE ROOF SHEATHING RES IND CDN PB omo, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ E] ROUGH SAN.q ASSESSORS PARCEL NO PLUMBING - ELECT.ENERGY TRACT NO PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ELECTRICAL ACC DATE ACC FILE NO BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING- ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE SPRINK ENERGY T24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "ID EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD LONE A.Lu c. INTERIOR SHEAR FIRE DEPT.. Y❑ N[] Y ❑ N❑ SHEETROCK - GRADE FEESUMMARY EXTERIOR LATH - BUILDING INTERIOR. LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT !GA ECTRIC - PLAN CHECK - SFEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED CUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUIL)ING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 1 AooREssVn4� ^ry[AjIS� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1 V T V S OWNERS NAME �V PLAN CHECK VALIDATION ` �\ DTV. ELECTRIC PERMIT FEE �. PHONE NAMERAcraRs UTLETS-SWITCHES-RECEP 10.00/1.00 uc.No. LIGHTING FIXTURES 10.00/1.00 ADDRESS rags PPLIANCES-RESIDENTIAL 4.00 ONTRAC Z PHONE Q PANELS 10.00 DATE OF APPLICATION ARCHITECT I PLAN CHECK FEE P`C.N0. OR PANELS (OVER 200 AMP) 20.00 ENGINEER LIC,NO, SIGNS TRANS. 3.00 noo ESS ervc. SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT's ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 t.NCE p(,o o LICENSED CONTRACTORS DECLARATION S/ �p 0C,wI hereby affirm that I am licensal under provleions of Chapter Y GATE N a t (commencing with Section 7000)of Division 3 of the Business and BLDG. I ELECT.I PLG. MECH. r w i ProfessionsCo Zn icense is in full force mKLrfIR.`4'o' - El ❑ ❑ o i w o License Class Lie.Number ��ll JJ J EE H m J Date Contractor a M BUILDING PERMIT ¢ ¢ a OWNER-BUILDIiR❑ECLARATI0 o a v INFORMATION E: ;LL I- I hereby affirm that 1 am exempt from the C actor's License MISC.- REFER TO ORD m VALUATION SIFT. F u O a Low for the following reason.(Sec.7031.5.Bus ess and Professions PERMIT ISSUANCE 10.00 Q Code:Any city or county which requires a permit to construct,alter, aAev 6 aa¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. x�D Ou requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO rsu a w m a he is licensed pursuant to the provisions of the Contractor's License r x a Law(Chapter 9 Commencing with Section 7000)of Division 3 oflhe 3 4 O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE 11 ¢ o the basis for alleged exemption.Any violation of$ection 703 L5 STORIES TYPE CONSTR. rt u;tO by any applicant for u permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.1 5.00 of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4,00 OCC,GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and dProfessions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve- renis are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I1NC.40UTLETS 6,00 or improvement is.sold within one year of completion,the owner- GAS-EA.SYSTEM•OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Otha. ❑ 1,as owner of the property,am exclusively contracting with 0 0 ❑ ❑ ❑ licensed contractors to construct the project(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 , 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 contractor(s)licenses)pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,B.&P.C.for this WATER HEATER WIVENT 8.00 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 certlfreale of consent to self-insure, ZONING ENO.SITE N0. or a certificate of Workers'Compensation Insurance,or a certified copy Ihereof(Sec. 00,Lab.C.).... Policy N Company O ❑ ertified c y is hereby fur fished. ❑ ertified o f FIRE SPR INK ENERGY T29 Z_ 2 pY is filed h th y inspection division. MISC.- REFER TO ORD. Ap icmt y F] N y ❑ N� ~ oa PERMIT ISSUANCE 10.00 CC .C FICATE SATION ION FROM WORKERS' FLOOD ZONE A.L.U.C. W � COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG; d O (This section need not,be completed if the permit is for one TOTAL V❑ IN Y ❑ IN Z hundred dollars($100)or less.) U O 1 certify that in the performance of Re work for which this per- GTY f MECHANICAL PERMIT FEE FEE SUMMARY IL 1- mit is issued,I shall not employ any person in any manner so as to - O L) become subject to the Workers'Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING >_ N. NOTICE TO APPLICANT: If,after making this Certificate of Ex- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK V provisions of the Labor Code, you must forthwith comply with FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000C.P.M.) 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. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) Lender's Name Lender's Address HEATING 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 information is correct. I agree to comply with all city and county PLUMBING ordinances and'state laws relating to building construction, and BOILER,COMP 13 H.P.Or 100,000 B.T.U.) 6.00 ll hereby authorize representatives ec this city to enter upon the BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL p(/ aereby inion properly forinsp ofth i 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 ISSUANCE CONST.TAX ay in any w accrue against Said City in cons uence of the a ndngo(tl' lrinit' ECH.CONT. LIG NO. MECH. aelii Z2, / TDT TOTAL Si c of Applicanl/Contractor Datc OFFICE COPY