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14918 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 1491 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS' / Lyl'L y UNIT#' _LOT# LL c' PERMIT EXPIRES IF WORK OWNER �- �� /J oAiy)G(.p� CONTRACTOR 'k-4, /'D �h .J« � IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNI?E TO COMPLY WITH THE APPROVED PLANS AND CITU OF Pe{+nul VALIDATION GARAGE SCABS' CUPERTINO STANDARDS. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB pt �7 PLUMBING ELECTRICAL ISSUANCP DATE MECHANICAL - oux; ELecr - Pu.. MEC{+ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL ELECTRICAL op PERMIT To FRAMING •" '•'1` TORIES TYPE CONSTR, INSULATION' P P GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED C,a ROOF NOTE'NO FINAL INSP.SHALL BE MADE BEFORE So.FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM I THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING I HES IND CON Pe 0"", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH SAN.N AS5E550R5 PARCEL NO ' PLUMBING ELECT:ENERGY TUBS&SHOWER-PAN PLUMBING ENERGY TRACT NO PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO, FRAMING - ELECT.FINAL TEST ZONING ENG SITE NO. INSULATION PLUMBING • S GAS TEST GAS ARE SPRL INK ENERGY T20 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 'F ❑ ` I' NE]FLOOD ZONE ALUC. EXTERIOR SHEAR ELECTRICAL RELEASE O N❑ - N❑ INTERIOR SHEAR. FIRE DEPT. L SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC - PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ME ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F 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. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY IYW WILDING PROJECT IDENTIFICATION PERMIT NUMBER So,LOING APPLICATION & PERMIT oNEss .*/&/ ?AAN L-2- BUILDING -ELECTRICAL-PLUMBING -MECHANICAL 14918 OW EHIS PLAN CHECK VALIDATION NAME V /,i �/I Orn"s PHONE QTY. ELECTRIC PERMIT FEE �'" l CONTRACTORS NAME144UTLETS-SWITCHES-RECEP 10.00/1.00 f AO %aka 5ea�vb uc.No. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ADDRESS ,foil L �'/j/.�S 77a PPLIANCES-RESIDENTIAL 4.00 y1b .QM0�1trf PHONE (J�p PANELS 10.00 DATE OF APPLICATION OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER - - LIC.No. ISIGNS TRANS. 3,00 ARC"ORRESS ENG SPECIAL CIRCUIT S.00 PERMIT VALIDATION :,F TEMP.METER OR POLE INS. 20,00 APPLICANTS (//�J_'f-��"�� ADDREss MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 tG/ /pG o o LICENSED CONTRACTORS DECLARATION / OO Fiw 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE a n (commencing with Section 7000)of Divi,mo 3 of the Business sod - BLDG. ELECT. PLG. MECH. Hn i Professions Code,�0hm license is in full force' effgg�� / Z O m- License Class Ly Lic.Number 9 y Dale Con[mclor ZLJ-,rte BUILDING PERMIT ¢ ¢ a OWNER-BUILDER DECLARATION o i v INFORMATION w ; y I hereby affirm that 1 am exempt from the Contractor's is License MISC.- REFER TO ORD r u0J Law l'or the following rcason.ISec.7031.5,Business and Professions PERMIT ISSUANCE - 10.00 VALUATION Code:Any city or county which requires a permit to construct,alter, ac ea Q Q Improve,demolish,or repair any structure,prior to its issuance,31W ELEC.CONTR. LIC.NO. ELEC. u requires the applicant for such permit to file a signed statement that TOTAL n w o m he is licensed pursuant to the provisions of the Contractors License PERMIT TO Hii Law(Chapter 9fcommencingwith Section 7000)ofDivision 3 of the ?4_8 9. f 4 o Business and Professions Code)or that he is excmpl therefrom and QTY. PLUMBING PERMIT FEE ¢ H $ the basis for the alleged exemption.Any violation of Sect on 7031.5 STORIES TYPE CONSTR. n3 � by any applicant fora permitsubjects file0licuntloacivil penalty ALTER-DRAIN -WATER (EA.) 5,00 of not more titan five hundred dollars(55(500).0).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 Dec.GROUP RES.UNITS sole compensation,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 does not apply to an owner of • property WlW builds or improves thereon,and who doe ssuch work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- Rentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden at proving that h -e did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ I,as owner of the property,am exclusively contracting with0 El C1 11 0 licensed contractors to construct the project(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 an owner of property who builds or improves tmreon:and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ [am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.0q ACC.DATE ACC.FILE No. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. I hereby affirm that I have a certificate ofcomenl to self-insure, or a certificate of Workers'Compensation Insurance,or a Certified ZONING ENG.SITE N0, copy there Sec.380 ,Lab.C.l. pe Policy No. ,ompany_ - Q ❑ Certified cop is hereby furnished. FIRE$PRINK ENERGY TZ4 Z Z '4-Certified copy is filed with the city inspection division. F O Applicant MISC.- REFER TO ORD. Y L] N Y [:] IN Cr m CERTII'ICATF:OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 - FLOOD ZONE A.L.U.C. lL COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. _ 0- O (This section need not be completed if the pen.it is I'.. one TOTAL 6 Y[] N� Y 0 NE3 D Z hundred dollars IS 100)or less.) U 0 I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY ly U mil is issued,I shall not employ any person in any manner so as to heconm subject to the Workers'Compemalion Laws of California. 0. DateApplicantBUILDING >_ N NOTICE TO APPLICANT; If,after making this Certificate of fix- ALTER OR ADD TO MECH. 5.00 F. Z emotion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10000GEM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued PSCC. MICROFILM 3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) A.00 Lenders Name H EATI N G UN IT(O V E R 100,000 B.T.U.)9.50 Lender's Address ELECTRIC 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) ' 4.00 information is correct. 1 agree to comply with all city and county PLUMBING _v ordinances and state laws relating to building [onsinactio0, and BOILER-COMP(3 H.P.of 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOI LER-COMP(Over 100,000 BTU)SEE FEE$CH. above-mentioned property for inspection purposes. MECHANICAL (We) agree to save, indemnify and keep harntess the Cily,of MISC,- REFER TO ORD. upertino against liabilities,judgments,costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ay,in nny way accrue against said City in consequence of[hc rami of ll''permi. MECH.DONT. LIC.NO. MECH. xE� �•ay yd/ TOTAL TOTAL fu sure of Applicant/Contractor Datc OFFICE COPY