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15064 POST THIS CARD NEAR FRONT OF BUILDING I •r - ��� PERMIT NUMBER CITY OF CUPERTINO ��� INSPECTION DIVISION i:Z_: JOB INSPECTION RECORD �/'" PERMIT EXPIRATION For, JOBADDRESS /0/6 - Y'd"9K-�-9-'� �/'�C- UNIT# _LOT# PERMIT.EXPIRES IF WORK OWNER CONTRACTOR E L IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD ISO DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. LIFER - 'ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE PPROVED PLANS AND CITY OF PERMIT VALIDATION . CUPERTINO STANDARD . GARAGE SLABS ---"s' yr POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED u: UNDERGROUND /SLAB PLUMBING ELECTRICAL 41119A ISSUANCE DATE, MECHANICAL �� R ELec r,- PLG. MECR ❑ � , ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $TFT. PLUMBING • MECHANICAL PERMIT TO ELECTRICAL FRAMING STORIES - TYPE CONSTR, INSULATION I UCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.ET aooR aReq TOTAL ACREAGE DIAPHRAGMTHE CONSTRUCTION TAX IS PAID y y BUILDING USE \\ ROOF SHEATHING I Res IND CON' PB om.. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 0 ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.N PLUMBING ELECT.ENERGY 1RAC1 NO PgRCE L'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 s 1 .pj PLUMBING GAS TEST GAS 'FIRE SPRINK . ENERGY T2 MECHANICAL Y ❑ No Y ❑ NE COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEARELECTRICAL RELEASE FLOOD ZONE ALL Uc. N ❑ ❑ ❑ ❑ - INTERIOR SHEAR � FIRE DEPT.. NY SHEETROCK - - GRADE FEE SUMMARY EXTERIOR LATH -{j BUILDING BUILDING INTERIOR LATH TEM Y APPROVALS SCRATCH COAT E LECTR I C PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - - SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL.ISSIGNED BY BUI LDING INSPECTOR. MICROFILM .�• , ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ! F ONE WORKING,DAYBEFORE REQUIRED INSPECTION• PLUMBING . O PLEASE GIVE 309 ADDRESSWHEN PHONING, Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX .' PLEASE READ REVERSE SIDE BEFORE TOTAL T' CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY _ • BUILDINGPROJECT IDENTIFICATION .PERMIT NUMBER BUILDING APPLICATION & PERMIT 15064 ADDRESS FI �- BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWN R PLAN CHECK VALIDATION NAME Ll QTY. ELECTRIC PERMIT FEE PHONE ( CONTRACTORS NAME I` NOME OUTLETS-SWITCHES-RECEP 10.0011.00 TT_-' rL LIC.NO, 73 - LIGHTING FIXTURES 10.00/1.00 comraacroR's APPLIANCES-RESIDENTIAL 4.00 CONTRACTORS ' 7 _ HON PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE ?.C:N0. OR PANELS (OVER 200 AMP(. '20.00 ENGINEER LIc.NO. SIGNS TRANS. 3.00 ARCH,OR ENG. PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 /� ZIP EMP.METER OR POLE INS. 20.00 APvucarvrs � - MOTORS SEE FEE BCH. \/�//J(L\P�J, ADDRESS H0 - SERVICE CHANGE 20.00jd/�}pp o o LIC17NSED CONI'RACTOIIS DECLARATION A "0 a z w I hereby offs....that I am licensed order provisions of Chapter 9 V ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and rn G 2 r� V✓ Lia Nmnber .�rL� �- BLDG i ,I CT. PLG. MECH. H7'Hz PoessonsC.dedmylcenseisinfullft 0 License Clau --L-� � © 1-�e"" ❑ ❑ 4 � r uQa- Dated •Contractor 1 A)rrssr wa V .--. _ m s ��T�T�i-L FfIC p �IJ� ING PERMIT tc w u OWNER-BUILDER D17CLARATION y1II'C'Isl�`�RMATION w3.A.y 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD r u o J Law for the following reason.(Sec.7031.5,Busin,ssgnd Professions PERMIT ISSUANCE 10.00 VALUATION U $/FT. w 0 4 Code:Any city or county which mcluiresu permit toconslrucpaheq 4 900o..- ¢ Le ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO. ELEC. I i w m LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO he is licensed pursuant to the provisions of the Contractor's License Hzi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ' a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE [C 1- the basis for the alleged exemption.Any violation of Section 7031,5 STORIES TYPE CONSTR. Lu 3 m by any applicant for a permit subjects the applicant to a civil penalty - ofnot more than five hundred dollars(55001.): ALTER-DRAIN"&'VENT-WATER (EA.) 5.00 ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Oce,GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,CON D. 5.00 Code:The Contractor's License Law does not apply to an owner of ' property who builds or improves(hereon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale,If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 �"- or Improvement is sold within one year of completion,the owner. GAS EASYSTEM-OVER 4 IEA ( 200 J builder will have the burden of proving that he did not build or sin- - . . . BUILDING USE 7 prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB 'Other C1 1,as owner of the properly,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: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 suchprojects with a conlractor(s)licensed Pursuant In ` the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ Iamexemptunder Sec. ,B.&P.C.Iortbis WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0. WORK1iRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby infirm that I have a cenific.be.fcomsent toself-in sure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy(hereof 1Sec.3800, a .�.i`F_�kNF'RK..,/• Policy No. CompDanyny(p' Q ❑ CertilicJ copy is here by farm!@IIeJ. FIRE SPRINK ENERGY T20 Z 2^ CF ✓Sc ti- J ory is filed wit the cit inspection divi5iml. H �•- t MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ N Applicant __I/L V N V N (D ~,L- 10.00 LU - CERTIFICATE COM OE A MOTION FROM WORKERS' PERMIT ISSUANCE FLOOD ZONE q.L.U.C. ' W COMI'Ii � NSAT10N INSURANCE PLG.CONTR. LIC.NO. PLG. CL 0 Z (This section need not be completed if the Permit is for one TOTAL Y E] 'N❑ Y E] N❑ hundred dollars IS 100)or less.) U O I certify that in the performance of dm work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,I shall not employ any Person in any manners.us 41 OW become subject to the Workerti Compensnt ion Laws of California. / - a Dale ApplicantBUILDING fQ } m NOTICE TO APPLICANT: If,after making this Certificate of Ex ALTER OR ADD TO MECH. 5,00 F ? emption,you should become subject to the Workers'Compensation APPLIANCE ' 5.00 PLAN CHECK provisions of the Labor Code, you must forthwiDt comply with FEE C„) - such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC'FEE , Sb 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,Cie C.).... HEATING UNIT(TO 100,000 B.T.U.) 6.00 Lender' H EATI NG UN IT(OVER 100,000 B.T.U.)9.50 Lender's Addr Address ELECTRIC I certify that I have read this application and stat,(hat the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county PLUMBING ordRUmces'und state laws relating B) building construction, and BOILER-CrJMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby'aullmrize representatives of this city to enter upon theowl uhove-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE BCH. MECHANICAL (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 accrue against said City in cnnsequenee of the PERMIT ISSUANCE 10.00 •ran ling of Ihis'pernit y MECH.CONT. LIC.NO. MECH. rn(Lys10 ` A Xlk TOTAL TOTAL Co Slgnemre of Apphcanl/ o tmc[or Date OFFICE COPY