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17673 POST THIS CARD NEAR FRONT.OF BUILDING PERMIT NUMBER CITY:DF' CUPERTINO 17673 INSPECTION DIVISION •;.'Y`l JOB INSPECTION RECORD _ - �.. / ., - It IT XP ATION JOB ADDRESS . KeJ Jl `' s UNIT# _LOT#� PERMIT?€XPIRES IF WORK OWNER II-P'x` corvTRAcroR f S' `� IS�NOT�� TARTED WITHIN, INSPECTION DATE ,INSPECTOR' INSPECTION RECORD leooays DF PERMIT Issu _'' ANCE OR 180 DAYS FROM , FOUNDATION %,i.... NOTER - •-, LAST CALLEDINSPECTION. 'OPER � � � .ALC GRADING'AND"DRAINAGE SHALL BE INSTALLED 1 PREGUNITE TO COMPLY'WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED • UNDERGROUND /SLAB , ••° O - qA ' PLUMBING /+`N�. IA u,[ >/ 3 ELECTRICAL City of Cupertind. IssuANce DATE ( r MECHANICAL .. - BLuc rtu:ri. PLc. MECR. • 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - .BUILDING PERMIT INFORMATION WOOD FLOOR - - VALUATION s/PT. PLUMBING ' MECHANICAL. - • TERM ll i0 .ELECTRICAL' „y -' - ��,. `•�G FRAMING STORIES IYPE CONSTR., .INSULATION .' OCC.GROUP -RES.UNITS . PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 50 I T.R.00R AREA TOTAL ACREAGE ROOF ^ ' ' NOTE.NO FINAL?NSP.SHALE BE MADEBEFORE DIAPHRAGM''•' -;, THE CONSTRUCTION TAX IS PAID V• BUILDING USE . ROOF SHEATHING '- Res ' IND CON PB ow.- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS ' DATE ?NSP. ; 0~ 0 ❑ ❑ I] n SSESSOR ISPACEI NP'.• . . - , ^ ROUGH `. `..I : .SAN.0 - PLUMBING "" - ELECT.ENERGY- - �' TRACT NO PARCEL ND. TUBS&SHOWER PAN.` - PLUMBING ENERGY : MECHANICAL - " MECH.ENERGY. ELECTRICAL - - ACC.LATE ACC.FILL.NO. BUILDING ENERGY FRAMING . - - ELECT.FINAL TEST zoNlNc -ENG SITE NO. INSULATION PLUMBING GAS TEST GAS "' MECHANICAL' - FIRESPRINK ENERGY T-za T.COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - - - y Ej'' "� •` `N� rLOOD mNE n.l..u.c.- ' EXTERIOR SHEAR ELECTRICAL RELEASE - v E] N[] _ Y L 'NO INTERIOR,SHEAR FIRE DEPT. .. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH - BUILDING /^ . . INTERIOR LATH - - TEMPORARY APPROVALS , - BUILDIyG V SCRATCH COAT ' a ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE: . OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDMG FINAL IS SIGNED BY BUILDING INSPECTOR. mICROFILM ARRANGE FOR INSPECTION BY,PHONING 252-4505 - ELECTRIC �: ONE WORKING„DAY BEFORE-REQUIRED INSPECTION.' PLUMBING 0 1 ; _PLEASE'GI,VE JOB'ADDRESS WHEY; ONING. SEE'PERMIT FOR EXPIRATION DATE — ,,. MECHANICAL IMPORTANT! CONST. TAX z PLEASE READ'REVERSE SIDE BEFORE'. -; CALLING FOR.FINAL INSPECTION. TOTAL `OFFICE COPY �r?&etCANT TO FILL IN INFORMATION WITHIN RED LINES_ USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FICATION 1 - PERMITNUMBER - - BUTLo"c APPLICATION & PERMIT 1 rJ � r��j AOOnE55 / '• ' ' ' , I 1 1 W BUILDING—ELECTRICAL—PLUMBING—'MECHANICAL �. OWNER' PLANCHECKVALIDATION - R t "AMP QTY. ELECTRIC PERMIT FEE ; PHONE co ACTOR CO N OUTLETS-SWITCHES-RECEP 10.0011.00 PLIC No Q LIGHTING FIXTURES 10.00/1.00 CONTRACTORS - '...APPLIANCES'-RESIDENTIAL, 4.00 ., ADDRE S� . r PHONE-,�7 .� 'PANELS 10.00 .DATE OF APPLICATION ogcHiTecT -PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.c.NO.• ENGINEER .. - '' uc.NO, ,:_' SIGNS TRANS. - 3.00 AARCH.08 DDRESS ENG! _ SPECIAL CIRCUIT 5.0Q PERMIT VALIDATION ZIP EMP.METER OR POLE INS_. 20.00 AADORCEss PPLISS - MOTORS ' SEE FEE SCH. T ' „ .y, - - SERVICE CHANGE 00- LICENSED C(INTRACTOltS Df:CLARA'fION a v w 1 hereby'affirm that I am licensed under provisions of ChSp(er 9 E AY 1 1 ISSUANCE DATE ,y < H (unamencing with Section 7000)of Division 3'0l'the Nosiness and - , BLDG. 'ELECT. ',_PLG- MECH' F N z Professions Cod• anJ y cense is in full'fore def I-. Q� , ¢ i to o Date�la-ss Lin.Number — �4�-_ CIa)'`OI Cupertino El El ❑ I 9 m r Dote_ /Lyf�//- Lic+ utor_ _ OWN'R-OUILDIiR DEGL ATI -• BUILDING PERMIT W'o MISC.— - REFER TO ORD INFORMATION W ; 0 y I hereby affinn'Btat am excinpl Irom the Contractor's License - VALUATIONS $/FT• 1 F LL o ¢ Law for the fallowing reason.(Sec.703+.5,Basinessand Profess+ons PERMIT ISSUANCE .. - 10.00 Coda Any city oecounly whU re luhresal ernul r onstnml,x0et, 2 M ¢0 hmprove,demolish,orrepacany;tructuru priori d. isstance also ELEC.CONTR. . - LIC.NO. ELEC. q� a. D¢ requires the applicant for such Permit to ode a signed statement License _ TOTAL PERMIT TO , F m a. he s licensed pursuant to the Provisions of the Contractor's state s ntthat > ' Law(Chapler9(coatmencingwdh Section7000)o1 Dlvision3ofthe - io Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE ' ¢F the basis for the alleged exemption.Any violation of Section 7031.5 W STORIES TYPE CONSTR. n ;_ by any applicant fora permit subjects the applicant toacNil penally - affront more thamfivehundred rlollars($5001.). ALTER-DRAIN&VENT-WATER (EA.) 5.00 ` ' ❑ I,as owner nL the property,or my employees will,wagca as BACK FLOW PROTECT.DEVICE 4.00 .'s their sole compensation,will do the work,and the sl reclare is nn+ - - OCC.GROUP RES.UNITS %� .. intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Codd The Contractor's License Law docs nut apply to an owner 61 -' -• . himself Or tobuildss wnmployeereomand who docs such work FIXTURES-PER'TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE himsclf or through his own employees,provided that such improve- - mentsare not intended nraft'ered+'orsale.If.hmweveg+hi'building GAS-EA:SVSTEM-1INC.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 of proving that he did not build or im. BUILDING USE 'Hive for purpose of sole.). - INDUSTRIALWASTE INTER. - 30.00 RES' IND CON ' PB Other ❑'1,as owner of the property,am exclusively contracting with ❑ ❑ . ❑ ❑ ❑ licensed contractors tm construct tire S e project(Sce. 7044,Business LAWN SPRINKLER -1 INC 5 V.B. - 6.00 ASSESSORS PARCEL NO. and Professions Code:'I in Contractor's Licunse'Law does not apply r -' 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 contrucfor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft the Contractors license Law. /10.00 TRACT'No." PARCELNO.- 01amexemptunder,Sec. ,11.&RC.for this reason WATER HEATER W/VENT 6.00 ' Owner Dane WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0, WORKERS'COMPENSA I]ON DECLARATION : WATER TREATING EQUIP. 5.00 ; 1 hereby affirm +hat I have a certificate of consent to self-insure. - -, or"certificate of Workers'Compensation Insurance,or u certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Company ' Q ❑ Certified 'tpy,ls h• by Turn istied. FIRE SPRINK ENERGY T-R4 Z-Z Cell ified f/l�y yy�,,��Y�e�r �wl�l�h �theity �insprrotion division. F O A 1 jean!-1(li/_/f}/�' _1 MISC.- REFER TO ORD. v ❑ N❑ Y ❑ N❑ CC r2 CHH'IlF iTEOF EXEMPTION FROM WORKIERS•' PERMIT ISSUANCE- 10.00 I FLOOD20NE A.L.U.C. W > COMPENSATION INSURANCE PLG.CONTR. LIC'.NO. PLG. C' O I'I'his section'need not be .rmfl tvd'it the Permit is for one TOTAL I Y❑ N❑ Y ❑ N❑' ' Z hundred dollars IS l 00)or less.) - U O 1 certify that in the perforntance of the work 1'or which thisper- TY. MECHANICAL PERMIT. FEE FEE SUMMARY LL H mil is issued,I shall not employ any person in any manner so as to ' - O w, become subject to the Worker Comperaction Laws of California. `h a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING .} W NOTICE TO APPLICANT: If after Tasking this Certificate of IEx- [[ ♦--Z eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK Provisions of the Labor Code, you must forthwith comply with �- 'U such provisions or this permit shall'he d (T eemed revoked. AIR HANDLING UNIT O 10=C.F.W • 4.00 FEE' - CONSTRUCTIONLiENDINGAGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE fo '.�r�t-- I hereby affirm that there is a construction lending agency for EXHAUST HOOD)WITH DUCT) 5.00 the perrntance of the work for which this permit is issued+Sve. - MICROFILM 3097,Civ.C.).. a H EATI N G U N IT-(TO 100,000 B.T.U.) 8.00 ' - �- Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 r ' Lender's Address - ELECTRIC I certify that I have read this application and stale that flee above VENTILATION FAN (SINGLE) 4.00 - infnmmimn is correct. I agree to comply with all city and county - - PLUMBING ordinmces-aod state laws relating to buildjng construction, and BOILER v COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby above-mentioned orire representatives ec on this to e1 upon the BOI LER-COMP (Oia r 100,000 BTU)SEE FEE SCH. MECHANICAL berida ma ilevitd property-oorinsp of purposes. , i(We) agree to save, indemnify and keep harmless the City of ' MISC.-MISC.- 1. . REFER TO ORD. - r Caper line against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said.City in conseyucnce'of lite a gof+hie heroin 1 p MECH.CONT: LIC.NO. - MECH.' TOTAL o2p D4 JI/ , TOTAL Sitiature of ApphcaarEJC tractor Dae _ ?' °+' OFFICE`COPY,