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17411 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PERMIT NUMBER - �:. a � 17411 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB .JOB ADDRESS •� Z r 1- 'k`hG�D �_g�(��V fl1INIT# LOT it ��77 � / 't)/ I( r / ePE MITE XPIRES�IP WORK OWNER � CONTRACTOR VL) � ��11 kLro' 'CO IS.•NOT-GTAR4-ED-WITHIN . INIPgCTION DATE 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 PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAuoATION. CUPERTINO STANDARDS. _ GARAGE SLABS 1 ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED +P)-ZD—gciS� rzz+ k;-" ulxbi'? ON - �5` �•" `� UNDERGROUND /SLAB PLUMBING - - AFF V1, ; 1- ELECTRICAL - CI19 Of WORD ISSUANCE JAI MECHANICAL BLDG ELECT - PLG. MecR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PEaMIT WOOD FLOOR - INFORMATION PLUMBING EVALUATION SIFT. 1 MECHANICAL r• -'1 ELECTRICAL '.PER" To II FRAMING -LU. �� '�AJU'UST�L .4.1%U=Qf jZ.I INSULATION 4' STORIES TYPE coNsnT. OCG GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - - ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE "' `T.11.0011A -A TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IND CON PB 0"", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑' ❑ ❑ ASSESSORS PARCEL,NO ROUGH SAN.a PLUMBINGWER PAN ELECT.ENERGY- P TUBS&SHOPLUMBING ENERGY TRACT N0, ARCELNO MECHANICAL, p MECH.ENERGY ELECTRICAL ^lr BUILDING ENERGY .. ACC.OnrE ACC FILL No FRAMING Jp ELECT.FINAL TEST . . INSULATION � � � ZONING PLUMBING _may- yam : � ENGSITE N0. GAS TEST , ' GAS MECHANICALFIRE SPRNK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ •"❑ ` ❑ "❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.LUC.. �- G'£S% INTERIOR SHEAR FIRE DEPT." r❑_ N❑ ❑ N❑ ` SHEETROCK GRADE FEE SUMMARY. EXTERIOR LATH - BUILDING INTERIOR LATHS BUILDING , T 5''I�i TEMPORARY APPROVALS, SCRATCH COAT. ELECTRIC PLAN CHECK GAS FEE s' I; NO TAPE-OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H� - ONE-WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. —,SEE PERMIT.FOR.EXPIRATION DATE — MECHANICAL D IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR.FINAL INSPECTION. 3 � OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -'USE BALLPOINT PEN ONLY BUILDING PROJECT IDENTIFICATION - _ - FERM IT NUMBER .. BD1hDIrvG APPLICATION &.PERMIT ""' 1 ADLyy�y� FANW BUILDING—ELECTRICAL—PLUMBING—MECHANICAL a.,' ��'� OWNERS! - PLAN CHECK VALIDATION N E g CL!'�S QTY. ELECTRIC PERMIT - FEE , cONTEACTORs ZOIGUTLETS-SWITCHES-'RECEP 10.00/1.00 x UO O: LHTING FIXTURES . - 10.00/1.00 .L"rJ ��'6 1 CONTRACTOR'S 't APPLIANCES-RESIDENTIAL 4.00 ; ADDRESS 0 HOrvEs PANELS 10.00 DATE OF APPLICATION ARCHITECT - PLAN CHECK FEE P.C.NO. oPANELS (OVER 200 AMP) 20.00 . ENf GINEE j `.tee uau��"� SIGNS TRANS. � 3.00 jfj , A�RC9H�OR y ENG. PERMIT VALIDATION .SPECIAL CIRCUIT 5:00 O / EMP.METER OR POLE INS. . 20:00 a APPLICANTS MOTORS - - SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 �yI--, � 1- ) o o LICENSED CONTRACTORS DECLARATION A�'` viLuv� rc u� I hereby affirm that I am licensed under provisions of Chapter') APR - ISSUANCE DATE yl w (commencing with Section 7000)of Division 3 of the Business and - - - D vv, BLDG. ELECT. PLG.' MECH. F 0 z Professions Cade,' d my lioanac is in full for c and ejf L 2 0 — License Class Lin.Contractor ZZB� p 9 r Date 6.A• Contractor - CI .,Q� C N ' a m E _ y � BUILDING PERMIT rc st OWNER-BUILDER DECLARATION a o a le INFORMATION K I hereby affirm that I am exempt from the Contractor's License MISC.— _ REFER TO ORD u.- og Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE' 10.00 Cd "�VALUATION - $/FT. m Code'Any city or county which reyairesa permit to construct,alter, st 0 improve,demolish,Dr repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.areqbiree the applicant for such permit to file a signed statement thbl TOTAL TO w mhe is licensed pursuant to the provisions of the Co tractor's License Law(Chipler9(nommencing with Section 7000)ofDivision 3 ofthe 1 " Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. i ;'_^ by any applicant for apernlit subjects the appiWinston a met penalty DRAIN&VENT-WATER IEA. 00 ) 5. of not more ALTER- than five hundred dollars($500)J: d0 - ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure Is not - intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ' Code:The Contractors License Law does not apply to an owner of ` properly who loll,,or improve]'Ihercon,and who daex S,sell work 3 FIXTURES.PER TRAP 5.00 FD SO,FT.FLOOR ALFA TOTAL ACREAGE himself or through his own employees,provided titat such improve- ( meals a re not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4OUTLETS .6.00 - orimprovement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or int- BUILDING USE prase for purpose of sale). INDUSTRIAL WASTE INTER. 30,00 RES 'IND CDN PB Diner ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. '8.00 ASSESSORS PARCEL NO. and Professions Cod,The Contractor's Lecose Law does not apply - to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 }-E--57- 03,.13 contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 J the Contractor's License Law. TRACT NO. PARCEL NO. r ❑ lam exempt under Sec.—,0&P.C.-for this WATER HEATER W/VENT -'-6.00 reason Owner _ Date' WATER SYSTEM 5.00 rD 'ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION _ - WATER TREATING EQUIP. - 5.00 hereby affirm trial I have a certificate of consent to self-insure, ' or a certificate of Workers'Compensation Insurance,or a'certified - ZONING ENG.SITE NO, copy thereof j$@ X500,Lab.C. Policy No. Company O "❑ Certifie py is Ir um shed. FIRE SPEINK ENERGY T24 Z Z , ❑ Certi Ie co Is file w' I the city Inspection division. MISC.- REFER TO ORD. - O Applicant - _ Y ❑ N❑ V ❑ N❑ CC y :R'1' -ICA1 'O'EXEMPTION FROM WORKERS' PERMIT-ISSUANCE - 10.00 z,r D 'FLOOD ZONE A.L.U.C. W C P.NSATION INSURANCE PLG.CONTR. LIC.NO. PLG: p '� d O (This iron bond not be completed if the permit is for one TOTAL �Ct 0� Yt❑ N❑ V ❑ N❑ 0 2 hundred dollars($100)or less.) - - U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mil is issued,I shall not employ any persue in any manner so as m Wbecome subject to the Workers'Compensation Laws of Califonda. Q. Date Applicant ALTER OR ADD TO MECH. 5.00 a 90 , .BUILDING 81 �^ } rn NOTICE TO APPLICANT, If,after making this Certificate of Ex- 2- emption,you should become subject to the Workers'Compensation APPLIANCE 6.00 PLAN.CHECK :,;I 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=CF.M.) 4.00 ' CONSTRUCT ION LENDING'AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 - SEISMIC FEE I hereby affirm that there is a construction lendingngency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Csv.CJ. HEATING UNIT(TO 100,000 B.T.U.). 8.00 Lender's Name HEATI NG UN IT 100,000 B.T.U.)9.50 ' Lender's Addrese ELECTRIC I certify that l 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 count 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 ec this city,to enter Inion the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL 6'D above-mentioned property for inspection purposes. Qurte to , I dent ify and keep h"rmlesi the City of MISC.- REFER TO ORD.as I' bili es,judgments,'costs and expenses which - - CONST.TAX y cru against said City in consequence of the PERMIT ISSUANCE 10.00 Js1QDY pet iLMECH.CONT. LIC.NO. - MECH.TOTALj,( TOTALA lieanf/Contractor Date OFFICE COPY