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16455 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16455 . INSPECTION DIVISION JOB INSPECTION RECORD '7 PERMIT EXPIRATION JOB ADDRESS_�q �� s'T.+Z5'=-3AJ '0!L r UNIT# _LOT# S PERMIT EXPIRES IF WORK OWNER oLCONTRACTOR [. ,� IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT.ISSU- FOUNDATION NOTE: ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED . . Y UNDERGROUND /SLAB PLUMBING ELECTRICAL G Issuarvce DATE MECHANICAL BLDG ELecr PLC. mecR DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - INFORMATION PLUMBING VALLJTION SIFT. MECHANICAL F ELECTRICAL PBRnIn TO FRAMING INSULATION - STORIES TYPE Co STR_ 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 011, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. SAN.N PLUMBING ELECT.ENERGY TUBS B SHOWER PAN PLUMBING ENERGY TRncT No. PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY Acc OaTe Acc FILE No FRAMING ELECT.FINAL TEST INSULATION PLUMBING OOHING BNG SITE NO, GAS TEST GAS MECHANICAL _ FIRE SPRINK ENERGY Tea COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑ v ❑ "❑ EXTERIOR SHEAR ELECTRICAL RELEASE _ FLOOD ZONE ALUC. INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ r�.❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS _ BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUFANUY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252=4505, ELECTRIC Da o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL 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 BUILDING APPLICATION & PERMIT 16455 ADDRESS {^ `` _ ' . BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OwNER'S PLAN CHECK VALIDATION AMIC R Asa-gbss CITY. ELECTRIC PERMIT FEE PHONE CONTRACTORS ,.,,, ,_OUTLETS (� N E 77/75 OUTLETS-SWITCHES-RECEP 10.00/1.00 6LIC.ND. 7 LIGHTING FIXTURES 10.00/1.00 nooAess'DR.s ^On- PPLIANCES-RESIDENTIAL 4.00 �� PHONE i�`-"'�(,b PANELS 10.00 DATE OF APPLICATION. ARCHITECT PLAN CHECK FEE P.C.'NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER uc.NO. SIGNS TRANS. 3.00 noaa'Ess G. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 APPLICANT'$ V !? ADDREss MOTORS SEE FEE SCH. SERVICECHANGE 20.0 Yn // w o o LICENSED CONTRACTORS DECLARATION rt is U I hereby affirm that I um licensed under provisions of Chapter 9 !! y2 i ISSUANCE DATE a (commencing with Section 7000)of Division 3 of the Business and H wD Professions Co y1pI I ntyy��lic��nnce is in full for and rife.. - `'i ELECT_ PLG. MECH. o z w o LicenClass LS.fdt Li..Numb._ 5C/ IJ, I ❑ 71 H m j Uate .77 Cont reefer C7 LJ ¢ w 4 OWNER-BUILDER DECLARATION BUIL NG PERMIT a O > X g y I hereby affirm that 1 am exempt from the Contractors License MISC.- REFER TO ORD H u O In Law for the following reason.(Sec.7031.5,Bminess and Professions VALUATION $/FT. PERMIT ISSUANCE ♦ fwrF Code:Any city orcounty which rcquiresupenmuoconshucLuller, Q Q Q 0 Improve,demolish,Of repair any stmCtnM,prior t0 Its Issuance,also ELEC.CONTR, LIC.NO. O Ir requires the applicant for such permit to file a signed statement(hut TOTAL PERMIT TO a w m m he is licensed pursuant to the provisions of the Cmntnmror's License z a Law(Chapter 9(commencingwith Section 7000)of Division 3 office s i O Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE X 1 the basis for the alleged exemption.Any violation of Section 703 LS n �? by any applicant for a permit subjects the applicant to a civil penalty STORIES TYPESTR, of not more than five hundred dollars($500f). ALTER-DRAIN& VENT-WATER (EA.) 5.00 ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 400 their sole comp . . compensation,will do the work,acid the structure is not OCC.GROUP RES.UNITS tended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00 Code:The Contractor's License Law docs not apply to an owner of Vp property who builds or improves thereon,and who docs such workFIXTURES-PER TRAP 5.00 so.FTFLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve- mentsarenotintendedorofferedforsale.If,however,file huilding GAS-EA.SYSTEM-l1NC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- builder will have the burden of proving that hC did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE Elf fors owner of theJ. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Othe, ❑ d as owner of the property,am exclusively contracting with ❑ � ❑ ED IN licensed rnions Cod : construct the project La 7044.Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law docs not apply to in owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ( contracts for such projens with a contractor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO. ❑on lam exempt under Sea. ,B.&P.C.for this WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARA'T'ION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of.....scut to sell'-insure. or a certificate of Workers'Compensation Insurance,or a c,,Hrj,d ZONING ENG.SITE N0. copy N I f Scc.�800,1�.y )��b folic N' t IE I �Al� c ❑ Certil'ie copy is hereby furnished. z A❑heen l fict upy-11 with 'ily inipeelion division. MISC.- REFER TO ORO. FIRE SPRINK ENERGY T 24 F O _fir PERMIT ISSUANCE Y❑ N E Y � N� LU N CI?RTIPI 470 F.NiAF.MPTINS RANC17 WORKERS' 10.00 FLOG ONEAYEu W � J COMPENSATION INSURANCE PLG.CONTR, LIC.No. PLG. CL 0 (this, section need not be completed if the permit is for one TOTAL Y� NZhudred dollurs(S100)orl...) El 1 certify that in the performance of the work I'or which this per- QTY MECHANICAL PERMIT FEE SUMMARY LL U mit is issued,1 shall not employ any person in any manner so as to FEE O w become subject to the Workers Compensation Laws of California. Dat` A I >- w n N01'ICIi TO APPLICAN'T: I If,alter making this Certificate of lix- ALTER OR ADD TO MECH. 5.00 BUILDING F-. ? enhption,you should become subject to the Workers'Compensation APPLIANCE 500 f41 LAN CHECK provisions of the Labor Code, you nesta forthwith m . ply with C..) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,f10DC.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6. IC FEE I hereby affirm than tulle is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.0 the performance of the work for which this Permit is issued(Scc. ILM 3097,Civ C.). HEATING UNIT(TO 100,000 B.T.U.) SDD Lender's Name Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that I 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 county PLUMBING ordinances and state laws relating to building construction, and BOILER-COUP(3 H.P.or 100,000 B.T.U.) 6.00 hereby uutuorue representatives of this City to enter upon the A_w abuvone.ti,,n,d property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCE. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which may in any way accrue against -fitCity in consequence of the PERMIT ISSUANCE &o CONST.TAX ran Ong this permit, MECH.CONT. LIC.NO. MECH. r� �� r r�� ,ems TOTAL -Flounce o(Apphcan(/CTOTALv ontractor Date G ff"J OFFICE COPY