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16521 POST THIS CARD NEAR FRONT OF BUILDING PERMITNUMBER' CITY -OF CUPER TINO 16521 h.' INSPECTION DIVISION JOB INSPECTION RECORD _ PERMITEXPIRATION JOB ADORE /Q SO Og/Ls✓i L-LC � UNIT# - '_LOT# PERMIT EXPIRES IF,WORK OWNER ,(p I,I/ - CONTRACTOR- IS NOT STARTED WITHIN INSPECTION ATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATIONANCE,OR 180 DAYS FROM i 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 f UNDERGROUND /-SLAB PLUMBING r ELECTRICAL ' - V� ISSUANCE unr MECHANICAL ® BLDG_l ELECT I PLG. MECR. - DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING - - MECHANICAL 1 107 e__& ELECTRICAL - PERMIT To FRAMING Vk,0b D V6� 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 SOLLFI.00RAREA TOTTLACRf:AGE - DIAPHRAGM THE CONSTRUCTION TAX IS PAID BULGING use ROOF SHEATHING RES IDG CON PB 0,m APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED . FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORSPARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY TUBS 8 SHOWER PANPLUMBING ENERGY - TRACT NO PARCEL NO MECHANICAL MECR.ENERGY ELECTRICAL BUILDING ENERGY ACC GATE ACC FILE NO FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING - GAS TEST' - GAS MECHANICAL - FIRE SPRINK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING r❑ N❑ r ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.Luc. INTERIOR SHEAR FIRE DEPT. . Y❑ N❑ Yo No 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 OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING • PLEASE GIVE JOB ADDRESS WHEN PHONING. o� - SEE PERMIT FOR EXPIRATION DATE— MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY 314 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION 'PERMIT NUMBER BUILDING ��y� �f• APPLICATION & PERMIT ` 16521 / AOD�LJJVc/ //AjeVI� kC �C BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S ME PLAN CHECK VALIDATION �� N•' DTV. ELECTRIC PERMIT FEE 40 NAMQRAcroRs •�l� OUTLETS-SWITCHES-RECEP , 10.00/1,00 I.C.No. LIGHTING FIXTURES 10.00/1.00 OTORS - PPLIANCES-RESIDENTIAL 4.00 CONTRA PHONE PANELS 10.00 DATE OF APPLICATION, I ARCHITECT PLAN CHECK FEE .C.NO, OR PANELS (OVER 200 AMP). 20.00 . ENGINEER LIC.No. �' SIGNS TRANS: 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP• TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 w o o LICENSED CONTRACTORS DECLARATION a i w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE ,H" a N (commencing with Section 7000)of Division 3 of the Businessand - BLDG. ELECT. PLG. MECHe H w z Professions Code,and my license is in full force and effect. - ❑ ❑ ❑ El o m License Class Lic.Number - 0 w H w Data Contractor ` 10 a xQ� BUILDING PERMIT re a OWNER-BUILDER DECLARATION o a u INFORMATION X ; IL r- I hereby afrrm that I am exempt from the Contractor's License MISC.- REFER TO ORD F :m j Law for the following reason.(Sec.7031.5,business and Professions PERMIT ISSUANCE VALUATION E/FT. Code Any city or,c only whichrequiresapernlittoconsimet,alter, 10' .1711-(� rcto ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ' vuDLL requires the applicant for such permit to file a signed statement that TOTAL U7 PERMITTO $✓, he is licensed pursuant to the provisions of the Contractor's License (• H z r Law(Chapter 9(commencing with Section 7000)of Division 3 of the Woo S7d V� no Business and Professions Code)or that he isexempl therefrom and, OTY. PLUMBING PERMIT FEE a r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. d ; m , by any applicant fora permit subjects the applicant toa civil penally , ALTER-DRAIN -WATER IEA.) 5.00 . of not more than five hundred dollars(5500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITE their 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:'rhe Contractor's License Law does not apply foam 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- meats 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- builder will have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other ❑ I,as owner of the property,am exclusively contructing 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:'fire 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 contoclor(s)licensed pursuant to SEWER-SANITAR V-STOflM EA.200ft/10.00 the Contractor's Lice se hew. TRACT N0, PARCEL N0. ❑ mpt t der,Sec., ,B.&P.C.f r I 's WATER HEATER W/VENT 6.00 reason owner Durr WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. . WORKI RS'CO ENSATION D1iCLARA'f16 WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 h""sae n 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.C.). Policy No. Company Q ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. MISC. REFER TO ORD.O Applicant Y❑ N❑ Y ❑ N❑ X y CI:RTIFICA'1'1:01:EXEMPTION FROM WORK IiRS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU COMPENSATION INSURANCE PLG,CONTE. LIC.NO. PLG. CL Z I 'rhis section need not be Completed if the permit is for one TOTAL Y C] N❑ Y[3NE]N hundred dollars(S 100)or less.) ) 0 I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY IL 1- mil is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of C'ufifornla. y Doti, Applicant ALTER OR ADD TO MECH. 5.00 BUILDING >_ to NOTICE'I'O APPLICANT': If,after making this Certificale of Ex- F Z 22 emption,you should become subject to tire Workers'Compensation APPLIANCE 5.00 PLAN CHECK O provisions of the Labor Code, you must forthwith comply with FEE - 13 �- U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.I 4.00 . CONSTRUC1TONLEND1NGAGENCY AIR HANDLING UNIT IOVER10MC.F.M.) 6.00 SEISMIC FEE 0-0 I hereby affirm that there is a cunstnmliun lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,C'Iv.C'.). HEATING UNIT TO 100,000 B.T.U.) 8.00 Lender's Name H EATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC 1 certify that I have read Dlis application and stma 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(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-nientioned property for inspection purposes. BOILER-COMP (Over 100.000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. W�finamliahilitics,judgments, costs and expenses which PERMIT ISSUANCE 10,00CONST.TAX nccruaagstsaid Clty in consequ•Ace of the run MECH.CONT. LIC.NO. MECH. TOTAL TOTAL `7G,Z �-anl/ tractor [c OFFICE COPY