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16687 POST THIS CARD NEAR"FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16687 INSPECTION DIVISION JOB INSPECTION RECORD . �iy 1' • PERMIT'EXPIRATION. JOB ADDRRE�`SSO6 / S�YtYou LLSZ_�UNIT#� _LOT# PERMIT EXPIRES IF WORK , OWNER ' 6J'� e-(,,\ CONTRACTORS.i 11v� - - IS NOT" STARTED WITHIN INSPE TION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ' FOUNDATION - ANCE OR 180 DAYS.FROM .NOTE: _ LASTCALLED INSPECTION. LEER - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH.THE APPROVED PLANS AND CITY OF P HIMI t VALIDATION CUPERTINO STANDARDS. 1 GARAGE SLABS - "_ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �� / X: ` UNDERGROUND /SLAB " yll/(� 'j• �y PLUMBING h I l •t . : tt N/y ,�{ ti ELECTRICAL yl�11L ISSUANCE DATE !�"G MECHANICAL T BLDG ELECT PLG. MECH 00 NOT POUR FLOOR UNTIL ABGVE HAS BEEN SIGNED A BUILDING PERMIT` _ ' INFORMATION PLUMBING WOOD FLOOR VALUATIONn� s/FT. MECHANICAL - Z? G!G(d ELECTRICAL / h-y-PERMIT To FRAMING. � A �YII' IG VIII INSULATION - - O.IES TYPE CONSTR. �N acc.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOFNOTE:NO FINAL INSP,SHALL BE MADE BEFORE 5O?Fr'/FLoo_R n rorA:ACREAGE DIAPHRAGM s THE CONSTRUCTION TAX IS PAID ' Jb. / BUILDING USE ROOF SHEATHING RES IND CON PB 0111- APPLY NO ROOFING UNTIL ABOVE HAS BEEN'$1GNED " FINALS DATE INSP.' ❑ ❑ El Q 0 ROUGH SAN.N ABSEsSUH5 PARCEL NU_ ' PLUMBING %jjj, ELECT,ENERGY TRACT NO PARCEL NO TUBS 8 SHOWER PAN, PLUMBING ENERGY - MECHANICAL MECH.ENERGY ACC.DATE ACC.FILE NO. ELECTRICAL BUILDING ENERGY FRAMING - ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION' •�� PLUMBING GAS TEST - GAS MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NE ` I] N❑ EXTERIOR'SHEAR ELECTRICAL RELEASE FLOOD ZONE A L U.C. INTERIOR SHEAR - FIRE DEPT. Y ❑ NQ .Y ❑ ' IN E] SHEETROCK GRADE FEESUMMARY EXTERIOR LATH - BUILDING INTERIOR LATH , TEMPORARY APPROVALS BUILDING s^OD SCRATCH COAT, ELECTRIC PLAN CHECK GAS fTlAPER PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY• - SEISMIC FEE Y OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING,252-4505, ELECTRIC- wONE WORKING. DAY BEFORE REQUIRED INSPECTION. PLUMBINGiPLEASE GIVE JOB ADDRESS WHEN PHONING. ��'� SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! coNST.:,Tnx,.;,,.,xw PLEASE READ REVERSE SIDE BEFORE' CALlINCrFOR.FINAL INSPECTION. - TOTALS 3�. ` . OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY •' BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER APPLICATION & PERMIT 16687 �I ADDRESS 0 w (� ( �' � UG//Y' �n BUILDING-ELECTRICAL-PLUMBING_MECHANICAL P` OWNER'$ p� PLAN CHECK VAL[1ATION r NAME `' '/� CQ (�GyT$S DTV. ELECTRIC PERMIT FEE •f S-•Uyy_•'-(/Xrl\` GU 1 //�i(T� PHONE RAMIE crCRs OUTLETS-SWITCHES-RECEP 10.00/1.00 b - LIC.No. r LIGHTING FIXTURES 10.00/1.00 �D CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 ADOR Ess PHONE PANELS 10.00 DATE OF APPLICATION OAcRITEGT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.c,NO, ENGINEER LIC,NO, SIGNS TRANS. 3,00 AooAEss ENG SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION 'i - -• ' n ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS SERVIWE 20.00 wa o LICENSED CONTRACTORS DECLARATION a u 'I hereby affirm that I um licensed under provisions of Chapter 9 ISSUANCE DATE m G H (commencing with Section 7000)of Division 3 of the Nosiness v'd BLDG. ELECT. PLG. MECH. H so z Professions Code,and niy license is in full force mid effect. p� oi a License Class Lic.plumber Yl F m J, Date Contractor Wof - ses BUILDING PERMIT at S, wu OWNER-BUILDER DECLARATION as X ;e I hereby affirm that I am exempt from tire Contractor's License MISC.- REFER TO OR INFORMATION H a_oj Law for the followingrcason.(Sec.7031.5,R esinessand Professions PERMIT ISSUANCE. 10.00 VALUATION $/FT. Code:Any city or county which requiresa permit to construct,alter, OD �� SE ¢o improve,demolish,or repair any s[Rmtore,prior to its issuance,also FLED.CONTR. LIC.NO. ELEC. J 0, requires[he applicant for such permit to file a signed statement that TOTAL 'd..DD - PERMIT TO n MID wse he is licensed pursuant to the provisions of the Contractor's License z< Law(Chapter 9(commenem,with Section 7000)01Division 3of the I -�I ` 4 D v Business and Professions Code)or That he is exempt therefrom and DTV. PLUMBING PERMIT FEE AMI ' I OI -1 II: $ the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR. a3 - by any applicant fora permit subjects the applicant toacivilpenally ALTER-DRAIN&VENT-WATER (EA.) 5.00 I toy.as than fivehundred property, re(my em: 0 jFY I.as owner of the property,or my employees with wages us BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS sh'I•� ihei sole compensation,will do the work,and the stnlclure is not I intended or offered for sale (Set. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 e Code,The Contractor's License Law docs not apply wan owner property who builds or improves thereon,and who does such woof FIXTURES-PER TRAP 5.00 � PD SC.FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ffemsare not intended oroffenO for sale.If,however,the building GAS-EA.SYSTEM-11PIC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA,) 2.00 e-�l0 builder will have Ilse burden of proving that Ile did not build or hit- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 REB IND CON PB Clear ❑ I,as owner of the property,ani cxchtsively Conlraoling 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 Conlmc[oi a License Low docs not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts for such projects with a confructor(s)licensed pursuant to the Cyntructor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL ND, -f lam exempt under Sec..,B.&P.C.1'or this WATER HEATER W/VENT 6.00 es n Own Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WOR.Ii RS'COMPENSA'I'ION DECLARATION- WATER TREATING EQUIP, 5.00 1 hereby affirm that I have a certificate of consent In self-insure. - or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(See.3800,Lal C.). - Policy No. Company O ❑ Certified ropy is hcreby.lumishcJ. FIRE SPRINK. ENERGY T24 Z Z O Certified copy is filed with the city inspection division. ❑ ❑ ❑ FC] N Y O Applicant MISC.- REFER TO ORD. y - N = Ln CERTIFICATE OF EXEMPTION FROM WORKERS* PERMIT ISSUANCE 10.00 .L,DA' FLOOD ZONE A.L.U.C. W > . COMPHNSATION INSURANCE - - PLG.CONTR. LIC.NO. PLG. 1 O (This section teed not he completed if the permit is for.one TOTAL . UD. Y❑ IN Cl Y❑ N❑ M Z hundred dollars IS 100)or less.) U O I certify that in the performance of the work for which This per- OTY MECHANICAL PERMIT FEE FEE SUMMARY LL I- mil is issued.I shall not employ any person in any manner so as to U became subject to file Workers'Compensation Laws of California. Uy Date Applicant ALTER OR ADD TO MECH. 5.007. 00 BUILDING Z6�UD } N NOTICI7 TO APPLICANT: If,after making this Certifier a of Ex- F Z atnption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you ..it forthwith comply with FEE U such provisions or[his permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER IQWOC.RM.) 6.00 SEISMIC FEE 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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC . t I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree ID 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 ,1.013 hereby authorize representatives of Ibis city to enter upon the BOI LER-COMP Waver 1 E FEE SCH.00,000 BTU)SE above-mentioned property for inspection purposes. MECHANICAL (WC) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT 10.00 CONST.TAX may in any way accrue against said City in consequence of the ]. b granting of)his penult. MECH.CONT. LIC.NO. MECH. -zq_ Tor1,1 S-S.D_ TOTAL igniture pplicam/Contractor Date :� 6 OFFICE COPY