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16662 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16662 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOBADDRESS //O/ ��'��`�iC.t� UNIT# LOT# -f '�" A�f ,/ PERMIT EXPIRES IF WORK OWNER To p^V ("/C/W/� CONTRACTOR a� [�� IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECT N RECORD 160 DAYS OF PERMIT ISSU. FOUNDATION NOTE: - ANCE OR 160 DAYS FROM I UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGESLABS . - r' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING _ ELECTRICAL - S / ISSUANCE CE UALE MECHANICAL BLDG ELECT PLG. MECR ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION SIFT. MECHANICAL ELECTRICAL PERMIT TO FRAMING 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 SO FT FLOOR AREA .TOTAL ACREAGE • DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING BUILDING USE Res IND CON PB Oma, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.p PLUMBING ELECT.ENERGY -. TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO MECHANICAL • MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO FRAMING ELECT.FINAL TEST INSULATION PLUMBING _�� ZONING ENG.SITE NO, GAS TEST GAS MECHANICALFIRE SPR INK ENE RGY T.zA COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` ❑ N❑ . ❑ No EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALUC. INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ N❑ SHEETROCK GRADE FEESUMMARY 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 ISNOTPERMITTED UNTILBUILDING FINAL IS SIGNED By BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. ZMECHANICAL - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER SURLDING APPLICATION & PERMIT 16662 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION 7A NLLLLLL AME OTY. ELECTRIC PERMIT FEE oNE HA ERacrons / UTLETS-SWITCHES-RECEP 10.00/1.00 LI, 6/ uc.No LIGHTING FIXTURES 10.00/1.00 none Ess loss PPLIANCES-RESIDENTIAL 4.00 Q PHONE �• PANELS 10.00 DATE OF APPLICATION ORRCHITECi PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.,NO. ENGINEER Lie NO. SIGNS TRANS. 3.00 ADDRESS ervc' SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 APPLICANTSSEE FEE SCH. ADDRESS MOTORS SERVICE CHANGE o0z Foo LICENSED CON TRACTORS DECLARATION < 1 hereby affirm that I am licensed under provisions of Chapter 9 y Q w (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE _ Professions Cade an ylit,l,is in lull f ,Sif BLDG. ELECT, I PLG. MECH, zo m Licuns Clens Lic.Number (Ljj((ii�r((J/ O Zw Datc. 0 • Contractor ❑ ❑ ❑ Qyf a aw a OWNER-BUILDER DECLARATION BUILDING PERMIT U LL Imreby affirm that 1 am exempt from the Contracmr's License MISC.- REFER TO ORD INFORMATION w ; m u. I LaJ Law for the following reason.(Sec.7031.5,Brnmessand Professions PERMIT ISSUANCE VALUATION $/FT. Code.Any city or county which requires a permit to construct,alter, 10.00 eaIS 3 0O improve,demolish,or repair any structure prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. DLL requires the applicant for such permit to file A signed statement that TOTAL ER MIT TO u w m w he is licensed pursuant ro the provisions of the Contractor's License D� Laza Law(Chapter 9(enn.element,with Sect ion 7000)of Division 3 of the �--C.J 4 D Business and Professions Code)or that he is exempt therefrom and- Y. PLUMBING PERMIT FEE F o the basis for the alleged exmnption.Any violation of Section 7031.5 nau 3`9 by any applicant for a permit subjects the applicant to a civil penalty STORIES TYPE CONSTR. ofnot more than five hundred dollars(S500L)' ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ 1,as owner of the property,or my employees will,wages ae BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offend for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of • property who builds or improves thereon,and who does such work FIXTURES-PE IXTURES-PESO.FT.FLOOR AREA TOTAL aeREACE R TRAP 5.00 himself or through his own employees,Provided that such improv. mems are not intended or offered for sale.If,however.the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one Year of conmletiml, the nwner- builder will have the burden of proving that he did not build or int. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose ofsalc.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pe Other ❑ I,as owner nt the property,ant exclusively contracting 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 Contractor's License Law does not apply to an owner a property who builds or improves 0rereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contoniculs)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I at,exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT reason 6.00 Owner Date WATER SYSTEM -5.00 '- ACC.DATE :ACC.FILE NO. WORKIik S'COMPISNSA'I'ION UfiCLARA'I'ION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent to self-insure. r a certilicate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy there _Q 00,Lab.C.). t1 L Policy No �1s/ Company- 5 L ✓�� D Certified copy is hereby furnished. Z Z ❑ Cert iii' "opy is tiled W the yF inspection division. FIRE SPR INK ENERGY T 21 P OP Applicant�X p - 41.11[r misc.- REFER TO ORD. Y� NE] YE] N� cc N CER'r1 PICA'1'1:OP EXESIPI'ION FRO WORAERSPERMIT ISSUANCE '10100//a FLOoo ZONE a.L.u.c. Q. O COAIPFNSATION INSURANCE PLG.CONTR. LIC.NO. PLC �1 Q. 0 (This section need not be comphied if the permit is for oI TOTAL Y❑ N Y❑ N U O hundred dollars IS 100)or less.) I certify that in the Performance of the work Her which this per QTY LL SUMMARY LL U mit is issued.I shall not employ any person in any manner so as to MECHANICAL PERMIT FEE O w become subject to the workers'Compensation Laws ofCaliRunia. a DaI` n1,phLpm ALTER OR ADD TO MECH. 5.00 BUILDING } N NOTICE 1'0 APPLICANT: 11,after making this Certificate of lix- ? emption,you should become subject to the workers'Compensatiun APPLIANCE 5.00 PLAN CHECK U sudltPr visins tonstlle or this bor pern Code,sall be deemed rou most evoked.dhwth uomply wvh AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE CONSTRUC'T'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10A00C.EM.) 6.00 I hereby affirm that there is a construction lending agency for SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 the peNi)nnunce of the work for which this permit is issued(Sec. 3097,Civ.C.). HEATING UNIT(TO 100MICROFILM ,000 B.T.U.) 8.00 Lender's Name Lender,Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that 1 have read this application and state Drat 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 13 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned Property for inspection purposes. BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to love, indemnify End keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX moil this Permit MECH.CONT. LIC.NO. MECH. ffl -f/ TOTAL TOTAL Sign ata fAppliea 'omractor Uutc OFFICE COPY