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16384POST THIS CARD NEAR FRONT OF BUILDING. .;CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD, -A-y JOB ADDRESS/OJ o � ��'✓%f1- /UG/4- Jf. UNIT# - _LOT# (� 1 ^ f� OWNER Y"4 Ld V/s ejJ. CONTRACTOR Ri� piw.rU,�/�•y/,• " PERMIT NUMBER ' 16384 PERMIT EXPIRATION �I - PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN . 180 DAYS OF PERMIT ISSU-. ANCE. OR 180 DAYS FROM' LASTCALLED INSPECTION." INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION - NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED', TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. - LIFER . � � PREGUNITE PERMIT VALIDATION - (• -f /1 ISSU ANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED c=22- u/% dC�,j- �D UNDERGROUND/SLAB PLUMBING q'�T2Sd ('�, �-r - ELECTRICAL MECHANICAL ,e'T� w., � BLDG ELECT I PLG, MECH 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING P PERMIT -ffiFORMATION ` PERIVII �T�-rnJ WOOD FLOOR PLUMBING sty MECHANICAL• ELECTRICAL n` - Ole FRAMING INSULATION •STOHIES TYPE CONSTR.-7 y - OCC•GHOUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID so. FT. FLOOR AREA - TOTAL ACREAGE DIAPHRAGM - .. ROOF SHEATHINGHEs INLDINNG USE CON PB D ID• ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS' - .DATE INSP. - ROUGH SAN.p nssEssaRs rnHCEi. NO, � PLUMBING ELECT. ENERGY TUBS &SHOWER PLUMBING ENERGY, I HACT NO. PARCELNO: �� MECHANICAL MECH. ENERGY ELECTRICAL -� BUILDING ENERGY � ACC. DATE � ACC.FILENO, � , FRAMING /F ELECT. FINAL TEST PLUMBING ZONINGINSULATION '- ENG. SITE.No. GAS TEST GAS' - ' MECHANICAL FIRE SPRINK Y ❑ N❑ ENERGY T24 ` ❑ NO COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR - ELECTRICAL RELEASE pLooD zorue `' ❑ "❑ A.L u.c. ' Y ❑ N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING' •moo, INTERIOR LATH TEMPORARY APPROVALSV SCRATCH COAT ELECTRIC PLAN CHECK FEE ' - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE' OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252-4505, H� , ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. . SEE PERMIT FOR EXPIRATION DATE - MICROFILM ELECTRIC (ld PLUMBING MECHANICAL covsr.'rnx IMPORTANT! 1. PLEASE READ REVERSE SIDE BEFORE CALLING FOR•FINAL INSPECTION.' TOTAL O 4--o" OFFICE COPY A APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY " i36LDI NG PROJECT I DENTI FICATION APPLICATION &PERMIT BUILDING - ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 16384 /] O I J o BUILDING ADOREss G/A d WNER'S /- ' L� N�O t/S>i+ ��i.Iv55tKyu1 �C• PHONE- 7,9V/61 - /CONTRACTORS - - - OTY. ELECTRIC PERMIT FEE • PLgN CHECK VALIDATION DATE OF APPLICATION CONTRACTORS uc. No. OUTLETS -SWITCHES-RECEP 10.00/1.00 ' LIGHTING FIXTURES ' 10.00/1.00 CONTRACTOR'S ADOHESS afb �AI '�"1'4o &; PRONE 7 / APPLIANCES -RESIDENTIAL 4,00 PANELS 10.00 ARCHITECT OR ENGINEER LIC. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. .. ' SIGNS TRANS. 3.00 ADDRESS OR ENG. ZIP SPEDIALGIRCUIT. - 5.00H. PERMIT VALIDATION U O/'../ // z ISSUA/NCE A E/E I BLDG. ELECT. PLG. MECH. ❑ ❑ ❑ EMP. METER OR POLE INS. x29:00 0 nooeessTS MOTORS ."' SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 1 hereby aflinn that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, a my license is in full force@ nd effect License Clas Lic. Number !9.2"A0/2 Date �� •, _Qp_-_Cnntruclor 7 .�.� OWNER -BUILDER DECLARATIONi I hereby al'1'inn that I am exempt from the Contractors License Law for the following reason(Sec. 7031.5, Business and Profnssimts Code: Any city Out emoty which requires a permit to constnmt, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit In file a signed statementisLithat pursuanten the provisions of the )ofDivlor's License he is (Chapter 7s exempt theren3ofthe Laww(Chand Poncosions Code) th thad lie Business and tile alllegede Code) nr IAn h i dation t therefrom and. hebasis lot theallegedexemption, nny he applicant subjects $500).licanl juucivil penalty toaction malty by any more than fora hundred of not more than five hundred dollars (55001J: ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sea 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenotintendedoroffered for sale. If, however, the hullding or improvement is sold within one year of completion, Ilse owner- builder will have the burden of proving that he did not build or it.- prove for purpose 1, as o er of theJ. ❑ owner of the property, am exclusively contracting with as ocontra mors to construct the project La 7044, Business licensed and Professions Code: The Contractor's License Law does not apply to an owner of property who ba contr improves thereon, and who con Cods for such projects with a conlructor(s)-licensetl pursuant to the Contractor's License Law. Cl tum excntpt under Sec.., B &P.C.'for this • reason 6 f 7 1 ¢U�1LDING PERMIT \GNFORMATION MISC. - REFER TO ORD PERMIT' ISSUANCEVALUATION /a 4/ $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL a PERMIT TO �4/Aj w4 -L t - OTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. • ALTER -DRAIN & VENT -WATER (EA.) 5.00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA, GOND. 5.00 FIXTURES - PER TRAP 5.00 GAS-EA.SYSTEM-11NC.40UTLETS 6.00 SO, FTFFLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE ❑ I❑ ❑N ❑ Other❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. fi.00 LAWN SPRINKLERS -OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. : PARCEL NO. WATER HEATER W/VENT 6.00 Owner Dale' WATER SYSTEM 5.00 WORKERS'COMPENSA')' ION DECLARATION L hereby affirm that I have a certificate ofconwnt m selHlnsure, or a certificate of Workers' Compensation Insurance, or it certified copy thereof (See. 3800, Lab.C.). Policy No. rA2z ACC.DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. MISC. - REFER TO ORD. -Company- ❑ Cendledc hictehy,funushed. W Certified ¢ f Ih Ih pity Idspedion Aivision. Applicant _ FIRE SPRINK _ Y N ENERGY T-24 Y NC] ❑ 'CL'R7 P CA'I'G OF HXL'll Pl ON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if tile permit is for one hundred dollars IS 100) or less.) I certify that lin the performance of the work for which this Per -FEE mil is issued, I shall not employ any person In any manner Silas to become subject to the Workers'Commensal ion Lawsor California. Date Applicant NOTICE: TO APPLICANT: c If, after making this Certificate of Ex - emption, you should become subject to the Workers' Compensahon provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY I hereby affirm Ihul there is a construction lending aguncy for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). Lender's Name PERMIT ISSUANCE 10.00 FLOOD ZONE Y NC] A.L,U,C. Y ❑ NC] PLG. CONTR. LIC. NO. PLG. TOTAL MECHANICAL PERMIT FEE FEE SUMMARY ' BUILDING - p J I _ ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 - AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE ' AIR HANDLING UNIT( OVER 10A00 C. RM.) 6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Address 1 certify that 1 have read this application and stale that the above information is correct. Lagree to comply with all city and County budinamers and state laws relating to building construction, and hereby authorizethis rly m enter upon the hereby authorize representatives inspection o riteed property for inspection puny ts. (We) a• save, Indemnify and keep harmless the City of uperti agui t liabilities, judgments, costs and expenses which ay i a ay ace against said City in consegU nee f the fan[ I per t. r ne Si ore of A n Co a or at 1rA--. HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 00 VENTILATION FAN (SINGLE) 4.00 BOILER- COUP (3 H.P. or 100,000 B.T.U.1 6.00 PLUMBING BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. -. REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL TOTAL Q 3 �� OFFICE COPY .