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16798 • � � POSTTHIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16798 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOBADDRESS�y ` / 'V�1/[�H/3�'r�L UJKI UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER L CONTRACTOR LI�L f� UO IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION,RECORD 180 DAYS OF PERMIT ISSU. ANCE OR 180 DAYS FROM FOUNDATION B -� 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 NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - PLUMBING --- UNDERGROUND /SLAB ELECTRICAL c�tEC ISSUANCE DATE MECHANICAL a BLDG ELECT PLG. MEC. El S— LDING PER DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED /-�-h' �oeL 'L.'7"t /3,�- 1 1,`I 1 'j98 UN ORMAT ONIT WOOD FLOOR VALUATION SIFT. PLUMBING 1�p� MECHANICAL Clty Ot A'WU ' ELECTRICAL p PET To FRAMING STORIES .,TYPE CON$TN INSULATION 76 OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO FT'r CODrIAREA TOTAI.ACREAch * 'ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ,`. ROOF SHEATHING RES IND col PB a:., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. nasessons PnncEL No ROUGH SAN.N , PLUMBING ELECT.ENERGY LRnCI NO, PARCEL NO TUBS 8 SHOWER PAN - PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC GATE ACC FILE NO ELECTRICAL BUILDING ENERGY FRAMING - ELECT.FINAL TEST ZONING ENG sIrE.No. INSULATION PLUMBING GAS TEST GAS FIRE SPR INK ENERGY TQE MECHANICAL i' Y ❑ N[:] . Y ❑ NE] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE a000mrvE ALuc INTERIOR SHEAR'. FIRE DEPT. Y ❑ N Y ❑ NE] SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING (�0 INTERIOR LATH TEMPORARY APPROVALS BUILDING d�a SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING �4b, 0.0 PLEASE GIVE JOB ADDRESS WHEN PHONING. �1 Z V V — SEE PERMIT FOR EXPIRATION DATE MECHANICAL — IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL D,{"4 CALLING FOR FINAL INSPECTION. OFFICE COPY • APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATI ON .PERMIT NUMBER BUILOING APPLICATION & PERMIT 16798 j �j p ? ADDRESSO /� 1 J U Y BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S /w /)_ PLAN CHECK VALIDATION NAME Y /YOB. OTV. ELECTRIC PERMIT FEE NAMRAG Rs EOUTLETS-SWITCHES-RECEP 10.00/1.00 r /I c.No. LIGHTING FIXTURES 10.00/1.00 f C4;!Gi s ADD s lw� PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPL ICATION - LARCHTECi PLAN CHECK FEE .C,NO. w/ PANELS (OVER 200 AMPI 20.00 on EER C uc.No. SIGNS TRANS. 3.00 SS E'G. SPECIAL CIRCUIT S.OD PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 APPucarvrs AD s MOTORS SEE FEE SCH. p,,,,� �� s'ffQy� SERVICE CHANGE 20.00 '02 LICENSED CONTRACTORS DECLARATION X o w I hereby affirm that I am licensed under provisions of Chapter 9 • Cyt ISSUANCE DA(((TE wz (connnengng wnh�$ecYr 7000)of Division 3 of the Busl DG. ELECT, PLG. MECH. wProlusions CoAI/anJT_ .1c is in full fl�xdaeff z o o� License Class---- Lie,.Number CC�� O O Uale Contractor a Y E ILDING PERMIT Ic ¢ w OWNER-BUILDER DECLARATION ' INFORMATION Z Go LL H I hereby affirm that I am exempt from the Contrac Contractor's License MISC.- REFER TO ORD P. o¢ Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE ION SIFT. Cods:Any city or wanly which requires a psnnil to construct,alter, UOWG'wl ¢ ¢G 0 inprrove,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO. ELEC. ic O¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO n w m he is licensed pursuant to the provisions of lire Contractors License HiQLaos(Chapter 9(colnmcncing with Section 7000)of Division 3 ofthe s((f(f•//y 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE at o the basis for the alleged exemption.Any violation of-Section 7031.5 STORIES TYPE CONSTR. dam by any applicant for a Permit subjects the applicant m a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 ,ef not mora than live hundred dollars($500).): ❑ 1,as owner of the property,or my employees with wages as /A BACK FLOW PROTECT. DEVICE 4,90 _7'-- OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is Sol intended or offered for sale (Sec. 7044, Business and Professions r DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law docs not apply'to an owner of properly who builds or improves thereon,and who does such work F I XTUR ES-PER TRAP 5.00 SC.FT.FLOOR AREA TOTAL ACREAGE meats re of ugh intended ownemployees.lots provided howcrosoch improve- GAS-EA.SYSTEM-I INC.4 OUTLETS himself are not innm des or empld ee sale.1f ed that s chs building or ilnprovament is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have tits burden of proving that he did not build or un- prove for purpose of su1cJ. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ I,as owner of the property,am exclusively'contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:'I'lie Contractor's license Law does not apply to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contruclons)hernud pursmml to the Commclor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO. ❑ tum exempt under Sec.-,B.&P.C.tiro this WATER HEATER W/VENT 6.00 reason Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK E.RS'COMPHNSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that l have Bcerlificam of cnmem tosslf-iaaurL r a ccnifwam of Workers'Com pe,"Ail Insures c,or a uurtfZONING ENG.SITE NO. copy thoord IScc.3SOq I-ah.CJ. __�b PoOcy No. Company O ❑ Cortilied copy is hereby famished. FIRE SPRINK ENERGY T-24 Z Zertified copy is filed with file city inspection division. MISC.- REFER TO ORD. O pp ice at Y [DN❑ V ❑ IN E] CC T CIi R'1'll'I CA r[117 OF EXF.MPIAON FROM WORKERS' PERMIT ISSUANCE FLOOD ZONE AC.U.C. LJ > COMPENSATION INSURANCE PLC.CONTR. LIC.NO. L.G.P CL 0 (This section need not be completed it the pennit is lir one TOTAL .. Y ElN❑ Y[:] N❑ U Z hundred dollars($100)or less.) U O 1 certify that in the performance of the work for which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY LL F mil is issued,I shall nor employ any person in any manner so as to U become subject to the Workers''Compensalinn Laws of California. -� U a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING d } m NOTICE 'I'O APPLICANT': If,afar making this Certificate,of F. ? smption,you should become subject to the 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 revoked. AIR HANDLING UNIT(TO 10MCF.M.) 4.00 CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 - SEISMIC FEE I hereby alfrm that there is a construction landing agency for EXHAUST HOOD (WITH DUCT) 5.00 the pertornwnce o1'lire work for which this permit is issued IScc. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,CIv.C1. Lender's Name Lenders Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 14 C ELECTRIC a�0 I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 �l infornmtion is correct m I agree io coplY with all cB,and county PLUMBING ordinances and stare laws relating to building construction, and BOILER-WMPI3 H.P.or 100,000 B.T.U.) 6.00 /O •/ hereby authorize representatives of this city to enter Inion the BOI LER-COMP(Dow,100,000 BTU)SEE FEE SCH. MECHANICAL pop 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 CONST.TAX may in any way cele against City in consequence of the PERMIT ISSUANCE 19.98 railing of thi: it. MECH.CONT. LIG NO. MECH. \^ TOTAL D TOTAL 0,5-� W Sig e o ApficarnJeortioncto, Date OFFICE OFFICE COPY