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17919 POST THIS CARD.NEAR FRONT OF BUILDING' PERMIT NUMBER CITY OF CUPERTIN0 17919 INSPECTION DIVISION JOB INSPECTION RECORD T / 11. E;,MIT EXPIRATION JOB ADDR ESS_73-3 1 �Vl Q.ASI,l_V--L UNIT# _LOT# '1.' - r 1 PERMITIIEXPI�iES'�IF(ILVORK OWNER Cy,. �, CONTRACTOR IS NOT STARTEIS,WITHIN INSPECTION DATE I SPECTOR INSPECTION RECORD 180 DAYS OFPER T ISSU. FOUNDATION ZIll'iANCE OR 180 DAYS FROM NOTE: LASTCALL'ED INSPECTN IO . Uf ER / z ALL GRADING AND DRAINAGE SHALL BE INSTALLED' • - - PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OFkERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. �• POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ' PLUMBING, - ELECTRICAL ISSUANCE DATE MECHANICAL - BLDG. Ei Bc . PLG7j MECH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT v❑ WOOD FLOOR - - INFORMATION,, .;,,., 10 PLUMBING VALUAT'ON�,Lptai _ I r.Y r MECHANICAL ELECTRICAL P R IITT(rll FRAMING �I' f " INSULATION � '� STORIES TYPE cory sTR, OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED- ILA 10TAL AORf;AGE .' ROOF- NOTE:NO FINAL INSP.SHALL BE MADE BEFORE i THE CONSTRUCTION TAX IS PAID DIAPHRAGM h...� BUILDING USE ROOF SHEATHING RES IND CON An o0 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH SAN.W ASSESSOHS PARCEL NO. � PLUMBING' ELECT.ENERGY TRACT NO. PARCEL No. TUBS&SHOWER PAN PLUMBING ENERGY - MECHANICAL MECH.ENERGY ACC DATE ACC.FILE NO, ELECTRICAL 5. BUILDING ENERGY FRAMING S, ELECT.FINAL TEST—' ZONING ENG,SITE NO, INSULATION PLUMBING - . GAS TEST GAS FIRE SPRINK ENERGYT-14- MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ° ❑ N❑ EXTERIOR SHEAR FLOOD ZONE A U.C.- ELECTRICAL RELEASE INTERIOR SHEAR - FIRE DEPT. Y ❑ N❑ Y ❑ N[] SHEETROCK, GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING T T . INTERIOR LATH TEMPORARY APPROVALS _ - SCRATCH COAT ELECTRIC 'PLAN CHECK'• "r GAS ,. FEE ' NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. SEISMIC FEE • 1. OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM' w ARRANGE FOR INSPECTION BY PHONING 252-4505„ ELECTRIC H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE,JOB ADDRESS WHEN PHONING. ZMECHANICAL — SEE PERMIT FOR EXPIRATION DATE IMPORTANT! coNsr.TAX PLEASE READ REVERSE;SIDEBEFORE TO CALLING FOR FINAL INSPECTION. OT CTION. 3rr3 OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER 9UILDI5GvPE27T�n/a, Gf - FSp6/ UAPPLICATION & PERMIT IT ADORE 3 A. —ELECTRICAL—PLUMBING—MECHANICAL 17919 OWNER'S �- AN L(H�ECK V ALSOA7Z10�NAE TV. ELECTRIC PERMIT FEE—�6 NAMUTLETS-SWITCHES-RECEP 10,00/1.00FRAcroRs C.//Its LIC.NO. LIGHTING FIXTURES-• 10.00/1.00 ^ ONTRAcrons PPLIANCES-RESIDENTIAL 4.00- f 1 p`� S/G/�JH�L pgoNE PANELS 10.00 DATE OF ARPLICATION ARCHITECT - PLAN HECK 11.'®NO.. OR - PANELS (OVER 200 AMP) 20.00 17� � -1t_ � ENGINEER ^^^ 221 Lm.NO. SIGNS TRANS. 3,00 .W ARCH. ( OR ENG. - E IT VA CATION 2 ADDRESS SPECIALCIRCUIT 5.00I� ZIP TEMP.METER OR POLE INS. 20.00 .T.. ASMOTORS SEE FEE SCH. iia CD ADDREDDRESSS pjl SERVICE CHANGE .20.00 w o o LICENSED CONTRACTORS DECLARATION <u 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE - y G H (commencing with Section 7000)of Division 3 of the Business anJ BLDG. ELECT. PLG. MECH. r m z Professions Code,and mylicense Is in lull force and effect. z O m— License Class Liu,Number 9 m c Date Contractor El El a s: BUILDING PERMIT a ¢ w OWNER-BUILDER DECLARA'T'IONA. INFORMATION X ; A� I hereby affirm that I ren=exempt from tla Contractor,License MISC.— � REFER TO ORD v- LL0q Law for the following mason.(Sec.7031.5,Idusinessand Professions PERMIT ISSUANCE .rem 2 VALUATION Cade:Any city or county which requires a permit to construct,alter, - O Qa, Q N Improve,demolish,or repair any structure,prior to Its isslallCe,AISO ELEC.CONTR. LIQ NQ L 6 o m requires the applicant for such pennit to file a signed statement W m a- he Is licensed pursuant to the provisions of the Contractor's I-icensc ' PERMIT TO z < Law(Chapter 9(commencing with Section 7000)of Division 3 of the L f 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE :1 10n ne F o the basis for the alleged exemption.Any vlolmion of Section 7031.5 STORIES TYPE CONSTR. aim byanyapplicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN (EA.), 5.00 of ore than five hundred dollars 0500).): - 1,as owner of the property,or my employees 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,CONIC. 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-PER TRAP 5.00 , EA TOTAL ACREAGE himself or through his own employees,provided that such Inlprove- 1 ments 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 completion,the owner- builder will have the burden of proving that he did not build or im- GAS•EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose orsale.). INDUSTRIAL WASTE INTER. - 30.00 RES IND CON PB Other ❑ I,as owner of the property,am exclusively contracting with -❑ licensed contractors m construct the poacel(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 of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with u con traemr(s)licensed pursuant to - [beContormor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No, PARCEL No. ❑ Tum exempt under Sec. ,B.&BC.for this WATER HEATER W/VENT 6.00 elan Owner Date B�� WATER SYSTEM - 5.00 ACC,DATE. ACC.FILE NO. WORKERS'COMPENSATI N DECLARATION WATER TREATING EQUIP." 5.00 I hereby affirm(hal 1 have n cerli LL of consent to salbinora, - or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Company Q ❑ Cerlilled copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certilied copy is filed with the City inspection.doision. F 0 Applicant MISC.- -REFER TO ORD. Y C] N�• Y �• No W CFR'1'IFICA'I'E OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. UJ > COMPENSATION INSURANCE PLG,CONTR. LIC.NO. - PLG. Z (This section need not be completed if the permit is for one TOTACL L Y N Y 'N� hundred dollars IS 100)or less.) U'0 I certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY LL F (nil is issued, I shall not employ any person in any manner so as to O W become subject m the Workers'Compensation I-ows of C.IiIornio. Date A Imam BUILDING C.J 1'p ALTER OR ADD TO MECH. 5.00 } w NOTICE '1'O APPLICANT: If,after making this Certificate of Ex- F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE CJ suds provisions or this permit shall hu deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 i CONSTRUCTION(-ENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 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 Lsnder's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC I certify that 1 have read this application and smte that the above VENTILATION FAN (SINGLE) 4.00 information is correct I agree to comply wilh'all city and county PLUMBING oNinances and.state laws relating to building construclinn, and BOILER-COMP(3H.P.or1OO,000B.T.U.) 6.00 hereby entionim representatives forinsec this city to enter Inion the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purr ity to (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, costs m_ expensee which PERMIT ISSUANCE 10.00 CONST.TAX may in a way accrue against said City in consequence of the ' ranlin (his permi' MECH.CONT. LIC.NO. MECH. TOTAL TOTAL C Sig a A pf'a t/ 'onhactor D.HL, OFFICE COPY