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16051 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16051 ."" INSPECTION DIVISION JOB INSPECTION RECORD qc / / PERMIT EXPIRATION 4., JOB ADDRESS 7v �- I "T=N�•��- —' A/ UNIT# _LOT#' _ •PERMIT EXPIRES IF WORK; OWNER L�� - CONTRACTOR EL rUR_.d IS NOT STARTED WITHIN j 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 PERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. - -- - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 5„ ^-•r'"^ UNDERGROUND /SLAB 4` PLUMBING - r ELECTRICAL - .`p ` ISSUANCE DATE MECHANICAL - n ELECT. PLG. MECIT WrO DO NOT POUR FLO WOODUNTIL FLOORABOVE HAS BEEN SIGNED all Of CU INFORMATIONNG PERMIT VALUATION $/FT. PLUMBING MECHANICAL ELECTRICAL - - PERMIT To j FRAMING INSULATION MSTORIES TYPE CONSTJH, � ._ OCC GROUP RES,UNITS PLACE NO_SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED "ATSO FT.PLOOR AREA TOTAL ACREAGE ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE -A .+ DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING NES INBUILDING COONNusE PB Olen APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. SP ASSESSORS PARCEL NO ROUGH SAN.k PLUMBING ELECT.ENERGY - - TRACT NO. -PARCELNO TUBS&SHOWER PAN - PLUMBING ENERGY MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC GATE. ACC.FILE NO FRAMING" - ELECT.FINAL TEST - ZONING ENG.SITE NO, INSULATION � PLUMBING � • GAS TEST. GAS FIRE$PRINK ENERGY'T24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ° N[] EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALUC. INTERIOR SHEAR" FIRE DEPT. Y ❑ NEI Y ❑ N❑ SHEETROCK GRADE ' FEE SUMMARY ` EXTERIOR LATH - - BUILDING T77— INTERIOR -2 iINTERIOR LATH TEMPORARY APPROVALS BUILDING OZ�_ SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE , NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PER MITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. -MICROFILM' LU ARRANGE FOR INSPECTION BY PHONING'252-4505, ELECTRIC_ 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 �S Z/ CALLING FOR FINAL INSPECTION. OFFICE COPY . APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY .. BUILDING PROJECT IDENTIFICATION PERMITNUMBER , mllLmNG APPLICATION & PERMIT q �+0�� aoDREsa 7(99 I o / y BUILDING — ELECTRICAL—PLUMBING—MECHANICAL �; OWNER'S PLAN CHECK VALIDATION [NtAW& , TV. ELECTRIC PERMIT FEE r 1141 / PHONEY 6-Y ss Q OUTLETS,SWITCHES-RECEP 10.00/1.00 0110 uC.s 7800 LIGHTING FIXTURES 10.00/1.00 ADDRESS ss APPLIANCES-RESIDENTIAL 4.00 - PHONE "� PANELS 10.00 DATE OF APPLICATION ih OCH w RRPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER I.C.NO. SIGNS TRANS. 3.00 ARCH,OR ADDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP. METER OR POLE INS. 20.00 ` APPLICANT 'a ADORES' MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 w O zo LICENSED CONTRACTORS DECLARATION YQ ¢ w I•j I hereby affirm that I am licensed tinderprovisions3vif thhe ofsiness an z i ISSUANCE GATE ! yaw (commencing with Section 70se i II Division 3 of the Businessman BLDG. ELECT. PLG. MECH. m z Professions Cod n my licensee is in full for{{{{-rrr�yyyy��yy��,,��ff L ❑ ❑ ❑ . z O m — License C' s Lig. reactor _.3.7f[7[00 O Is — Date �'-3-gY Contractor—�TWIIiCI 5 Y E ¢ ¢ ¢ ¢ OWNER-RUILDER DECLARATION BUILDING PERMIT °' U MISC.— REFER TO ORD INFORMATION X 3 u h I hereby affirm That 1 am exempt from the Contractor's License !! u O ¢ Law for the following H uam.(Sec.7031.5,Businessand ProfessionsALUATION $/FT. � — w Code.Any city or county which requiresa permit loconstruet,alter, PERMIT ISSUANCE 10.00 - ¢ ¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG.NO. FLED. I O u ' requires the applicant for such permit to file a signet)statement that TOTAL PERMIT TO u w$w he is licensed pursuant to the provisions of the )of License o.de-z rzr Law siriadProffrom sions Codeng )t h Section is exemf II heon3ofthe f 4 o Business and Professions Code)or that he is exempt rection 70 and DTV. PLUMBING PERMIT FEE ¢ H. $ the basis for the alleged exemption.Any violation Of Section malty ORIES TYPE CONSTR. by any applicant Cora permit subjects tire applicant mucivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(my em): ❑ 1,as owner of the property,or my,and tires with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their 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,COND. 5.00 Code:The Contractors License Law does not apply to an owner of Property who builds or improves Ihereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or Ilnugh his own employees,provided that such improve- ments are not intended or offered lot sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- i builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 WOUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 truRES IND CON Pa Other ❑ I,as owner Of the property,um exclusively contracting with O licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 VB600 ASSESSORS PARCEL NO. and Professions Code:The Contractors License Law does not apply . . . to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractor(')licensed pursuant to the Contractor's LicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ laze exempt under Sec. ,li.&P.C.for this reason WATER HEATER W/VENT 6.00 Owner Uute _ WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of Consent to self-insure, ! or a certificate of Workers'Compensation Insurance,ora etlifmd ZONING ENG.SITE NO. copy thereof(See.3600Lab.C.). Policy No, Compa, ny_I" O' ❑ Certified copy is hereby funlished. FIRE BPRINK ENERGY T29 Z Z' Cerlil ie c y led with lit city insmction division.. F O Ap?phcant �r_. 6�_ '0 MISC.- REFER TO ORD. Y [:] N[:] Y [:] N� rn CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE .10.00 FLOOD ZONE A.L.U.C. W COMPENSATION INSURANCEPLG.CONTR. LIC.NO. PLG. CL 0 (This section need not be completed if the permit is for one TOTAL Y❑ N Y [] NEI ::) Z hundred dollars(SI00)or less) U O 1 certify that in the performance of the work for which this per- OTU. MECHANICAL PERMIT FEE FEE SUMMARY .UL h— mit is issued,1 shall not employ any person in any manner so as to o w become subject to the Workers'Compensation Laws of California. y Datc Appliant ALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE '1'O APPLICANT: If,after making this Certificate of Ex- ? empfion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Codc, you must forthwith comply with U FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the perlornance of the work for which this permit is issued(Sec. MICROFILM 3097,CN.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 1 certify Omt 1 have read this application and sidle that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I'agree to comply with all city and county BOILER-COMP(3 H.P.OF 100,000 B.T.U.) 6.001PLUMBING ordinances and slate laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- - REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 rami Of thisp it 8r 3—$$p MECH..CONT. LIC.NO. MECH. TOTAL TOTAL V Si oars of A=nt/Contractor Untc OFFICE COPY