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16665 POST THIS CARD NEAR FRONT OF BUILDING - PERMIT NUMBER CITY OF CUPERTINO 16665 INSPECTION DIVISION JOB INSPECTION RECORD ' PERMIT EXPIRATION JOB ADDRESS �� 57 ��dQ <] /'UNIT# _LOT# pERM1T EXPIRES IF WORK OWNER Ste- CONTRACTOR . IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PCIMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS •_,- POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB _ PLUMBING ' ELECTRICALi ISSUANCE.Un TE MECHANICAL BLDG ELECT PLG. MECH p ppi0 ❑ ❑ 10 DO NOT POUR FLOOR UNTIL ABGVE HAS BEEN SIGNED o BUILDING PERMIT PLUMBING WOOD FLOOR tz 5 19a INFORMATION VALUATION SIFT. . - MECHANICAL �1 01 Wet � ELECTRICAL /PERMIT TO FRAMING Ez"'P INSULATION STORIES TYPE GOOSED PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED S� UCC GROUP . RES UNITS ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING HES IND CON PB OII,., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ nSSESSOHS PARCEL NO PLUMBING ROUGH SAN.#ELECT.ENERGY TUBS&SHOWER PAN PLUMBING-ENERGY TRACT NO PARCEL NO MECHANICAL, MECH.ENERGY ELECTRICAL BUI LDING ENERGY ACC DATE ncc FILE No FRAMING ELECT.FINALTEST INSULATION PLUMBING ZONING ENG SITE NO. GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY L.24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ ^❑ Y ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE _ FL000 ZONE A uc. INTERIOR SHEAR FIRE DEPT. Y❑ N❑ v ❑ N❑ SHEETROCK I - GRADE FEE SUMMARY EXTERIOR LATH, BUILDING INTERIOR LATH TEMPORARYAPPROVALS BUILDING SCRATCH COATI IELECTRIC PLAN CHECK GAS I FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IUCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. z0 PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY tT3 d APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING.PROJECT I DENTIFICATI ON PERMIT NUMBER. - BUILDING APPLICATION & PERMIT `- 166.65 AUDI Ess BUILDING-ELECTRICAL-PLUMBING-MECHANICAL �' o ` OWNER'S 'PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE • ,v yj �ES PHONE _ S CONTRACTOR'S NAME / UTLETS-SWITCHES-RECEP 10.00/1.00 G..>�Ale �/�' IZS6tic.NO. i/'y17o;- LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ADOREss PPLIANCES-RESIDENTIAL 4.00 ' DD e•(-P,1µ. PRONE .-7i/00 PANELS r1�[BB li�- DATE OF APPLICATION 1 ARCHITECT OR 'S PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.No. SIGNS TRANS. 3.00 ADDRSS EENG,ESPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT'S ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20. Ow R 2 D o o LICENSED COY"TRACTORS DECLARATION a v t I hereby Afton that I an, licensed under provisions of Chapter 9 V z w ISSUANCE GATE H ¢ N (commencing with Section 711 of Division 3 of the Business and IS H o a License la t LA lily 'c ns•it. in Cull fort' p _ BLOC. ELECT. PLG. MECH. Z i W o License last a c.Number N H j Date CnnfmclDr OWNER-BUILDER DECL\ ATION C\ BUILDING PERMIT LL u MISC.- REFER TO ORD INFORMATION w a_ y 1 hereby cello that 1 so exempt from the Contractor's License u O j Law for the following rumor.(Sec.703 L5.Business and Professions VALUATION $/FT. - PERMIT ISSUANCE Qa,y Code: e,d rcityrud or county which structure permit W construct,alter,also -�� /�� ' Q ¢Q Improve,denlnl1511,Of rL•pfllr any Slrnetm0,prior 10 its issuance,x150 ELEC.CONTE. LIG NO. ELEC. m to requires the applicant for such permit to file a signed statement that TOTAL a a r z he is licensed pursuant to the provisions of the Contractor's License ELPERMIT �G� a Law(Chapter 9(commencing with Section 7000)of Division 3 of the 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ H the basis for the alleged exemption.Any violation of Section 7031.5 a3 � by any applicant lora permit subjects the applicant toa Clvll penalty STORIES TYPE CONSTR. of not more than five hundred dollars(S500).) ALTER-DRAIN& VENT-WATER (EA.) 5.00 ❑ I,as owner of the properly.or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 ocC.GROUP RES.UNITS sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00 Code:The Comraaor's License Law does not apply to an owner of . property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 so.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such inmprove- mentsarenotintendedorofferedforsate.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS,EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or int- BUILDING USE prove for purpose ofsule.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other ❑ 1,as owner of the property,um exclusively contracting with licensed contractors to construct the project(Sec 7044,Business LAWN SPRINKLERS-1 INC 5 V,B. 6.00 and Professions Code:'I'he Contractor's License Law docs not apply ASSESSORS PARCEL NO. to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with u contractor(,)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I um exempt under Sec. ,It.&f.C.for this WATER HEATER W/VENT reason_ 6.00 owner, Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. wORKF:RS'COMPIiNSnnON DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm That 1 have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a c nified ZONING ENG.SITE NO. copy theregqf S- .3 LaB f� tel// Policy No.`o O �f1�1(p](y/ .S"rCtF O ❑ Certified y is lit e y fir -til ed. FIRE SPRINK ENERGY T 24 Z Z /� O Certified p�,w�t y i• lilt It the city ns caion division. ♦- O!� Applicant 'I,Ci MISC.- REFER TO ORD, y o N E] Y ❑ NEI OC �' CIiRTlPIC1'I'E of EXEMPTION PROM WORKERS' PERMIT ISSUANCE - 10.00 FLOOD ZONE A.L.u.c. LU > COMPF-NSA'TION INSURANCE PILO.CONTE. LIC.No. PLG. (L ❑ IThi, section need not be compL ed i1'the permit is for one TOTAL Y❑ N Y ry � 2 hundred dollar,(SIOo)odes,.) EI U O 1 certify that in the performance oT the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY IL U mit is issued.I shall not employ any person m any planner ul as tO become subject to the Workers Compensation Laws of California. Liu Date Applicant ALTER OR ADD TO MECH. S.Op BUILDING } Z NOTICE'1'O APPLICANT: If,aHe,nmking this Certificate ul Ex- F enlption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of ill, lam bor Code, you list fonhoulh comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE CONS'T'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 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(See. MICROFILM 3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lenders Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC pZ "�� 1 certify Thal 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 Hibernator, is correct.I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COW(3 H.P.or 100,000 B.T.U.) 6.00 hereby mivc representatives ethis city to enter upon the BOILER-COMP (Over 100,000 RTU)SEE FEE SCH. abovmentinumoned property for inspectct ion purposuc MECHANICAL (We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD. ummino against liabilities,judgnlunts, cost,and expenses which CONSTTAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 . a g oft is / 1. n MECH.CONT. LIC.N0. MECH. j._ rorAL TOTAL "grorpre Of Applicant/Contractor Date OFFICE COPY