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16054' 11 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO' INSPECTION DIVISION JOB INSPECTION RECORD - a /{�� I,1 JOB ADDRESS �Q 3 ��''VY'(' ��•�'�� -'� UNfG# _ LOT# OWNER �%vAj Ll CONTRACTOR - PERMIT NUMBER , �60�� PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTI DATE INSPECTOR INSPECTION RECORD - FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS.' UFER - PREGUNITE PERMIT VALIDATION `;,�,'•;, - :• [' J ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL- - PAID BLDG ❑ ELECT, a PLG, , . El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' f� 1 BUILDING PERMIT INFORMATION N WOOD FLOOR VALUATION �4 D '- SIFT. ~ PLUMBING � 1 rA MECHANICAL ELECTRICAL 'PERMIT TO M 6L�C FRAMING INSULATION STO iES," TYPE AINSTR, OCC GROUP RES UNITS. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID so. I 'LORE AREA TOTAL ACBPACE DIAPHRAGM' ROOF SHEATHING A. SL . ow• . RLS IND 8 ILDCNN UPB L L APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.L ' ROUGH' SAN.4 - ASS ESSUHS PAH CF. I. NO. PLUMBING ELECT. ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT No PARCEL NO I ' MECHANICAL _ MECH.ENERGY ELECTRICAL - BUILDING ENERGY - ACC. DATE ACC FILE NO FRAMING ELECT. FINAL TEST - INSULATION � PLUMBING 20NING ENG. SITE NO: GAS TEST GAS • - MECHANICAL FIRE SPRINK v • N� ENERGY T. 24 ` L NL COVER NO WORK UNTIL.ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR + 'EL RELEASE N' FLOOD ZONE y .N� ALUC.ECTRICAL YL NL INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING ' 'BuiLOINc INTERIOR CATHTEMPORARY APPROVALS SCRATCH COAT ELECTRIC -' PLAN CHECK FEE - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM ARRANGE FOR•INSPECTION BY PHONING 252-4505, . ��, ONE WORKING DAY BEFORE REQUIRED INSPECTION..' o PLEASE GIVE JOB ADDRESS WHEN PHONING. Z = SEE PERMIT FOR EXPIRATION DATE - ' ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. = TOTAL OFFICE COPY R O Z_z P 0 CC LU 0.0 00 LL U OW A APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ' '6UI LD1 NG PROJECT I D NTI FICATION - . APPLICATION & PERMIT BUILDING—ELECTRICAL—PLUMBING—MECHANICAL -PERMIT NUMBER C p ,. 6 C7 J �F BUILDING t ADDRESS oWNER's - "AME (.0.9 " Jim C � NE QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIOATION D ERACTORs UTLETS- SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 Lee R�k-p LIE. NO. CONTRA ADDRESS OR's APPLIANCES - RESIDENTIAL 4.00' PANELS 10.00 PHONE DATE OF APPLICATION OR ENGINEER Ill. No. PANELS PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P; C.iNO. ISIGNS TRANS. - 100 ARCH, OR ADDRESS ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION' TEMP. METER OR POLE INS. - .-29,p0 0 ZIP APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 J O0 LICENSED CON TRACTORS DECLARATION - I hereby affirm That I am licensed under provisions of Cllupter'I (Commencing with Section 7000) of Division 3 of the Business and Professions Code, anti my IICCn,seIs In full force and effect.. Class—sc. Number Date Contractor OWNER -BUILDER DECLARATION ISSUANCE DATE +' BLDG. ELECT. PLC. MECH. �_ /v El El �l�jG ^ 9 17 9UILDING PERMIT MISC.— REFER TO OR V I hereby affirm that I am exempt from the Contractor's License Law lorthe followingunson.(Scc. 7031.5, Businessand Prowssions Code: Any city or county which requires a permit to construct, alter, Juno INFORMATION pERMIT ISSUANCE - �— VALUATION ELEC. CONTE. 77N0. ELEC. �q (��t o�I TOTAL p?�L- improve, demolish, of repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License PERMITTO Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prolbssions Code) or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE f GM 7 the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit suhjeels the applicant toa civil penalty of not more than tive hundred dollars ($500).): - STIBHIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, anti the structure is not BACK FLOW PROTECT. DEVICE 4.00 __UCC.GROUPRES. UNITS ' DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (See 7044, Business BW Professions Code: The Contractor's License Law does not apply to an owner of ' FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM - 1 1 NC. 4 OUTLETS 6.00 property who builds or improves thereon, and who docs such work himself or through his own employees, provided that such improve- Bents are not intended or offered for sale. If, however, the building SO, FT. FLOOR AREA TOTAL ACREAGE , 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 of .]I.). ❑ 1, as owner of the property, aril exclusively contracting with RES' IND CON" PB Other 11 Ellicensed INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contractors to construct the pr"jocl (Sec. 7044, Business and Professions Code: The Contractor's License Law dues not apply to an owner of property who builds or improves thereon, and who ASSESSORS PARCEL NO. contracts for such projects with a contractor(S) licensed pjoamntln the Contractor's License law. ❑ Iamexempturider Sec. ;B.&P.C. for this reason SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT No. PARCEL NO. WATER HEATER W/VENT 6.00 Ow^e` Date WATER SYSTEM 5.00 ACC. GATE' ACC FILE NO. WOIZKIi S'COMPliNS,\TION ECLARA7'ION WATER TREATING EQUIP. 5.00 ' I hereby affirm that I have a certi0cat of consent to self -insure, ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.C.). ' Policy No. Company MISC.- REFER TO ORD. Cl Certified copy ishereby furnished' ❑ Certified copy is tiled with the city inspection division. Applicant FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ CHR77FICA'I E OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE (Phis section need not be completed if the permit is fur one Y ❑ N ❑ Y ❑ N ❑ PLG. CONTR. LIC. NO. PLG, TOTAL hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per. mit is issued, I shut[ not employ any person in any InanneF sn as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY become subject to the Workers' Compensation laws of California. ALTER OR ADD TO MECH. - 5.00 Date Applicant NOTICE 10 APPLICANT: If, alter making this C'erlificute of Ex. BUILDING APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=CF.M.) 4,00 PLAN CHECK FEE ' emption, you should become subject m the Workers'Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this pCrmil shall he deemed revoked. AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE • CONS'rRUCHON LENDING AGENCY I hereby affirm Hill there is o construction lending agency for EXHAUST HOOD (WITH DUCT) : 5.00 ' the performance of the work for which this permit is issued (Sec. 3097, Civ.C.T MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's N....cAddress - HEATING UNIT 100,000 B.T.U.) 9.50 ELECTRIC VENTILATION FAN (SINGLE) 4.00 I certify that l have read this applicalion and state that life above information is correct. I agree to comply with all city and county ordinances and State laws relating to building construction, and PLUMBING BOILER- DOW (3 H.P. Or 100,000 B.T.U.) 6.00 hereby authorize roperty tokens of this city to enter upon the above-mentioned property forinsp ofpurposes. BOILER -COMP. (Over 100,000 BTU) SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC. - REFER TO ORD. upm.tino against liabilities, judgments, costs and expenses which a in any way accrue gainst said City in consequence of the PERMIT ISSUANCE 10.00 CONST. TAX ing of this permit MECH. CONT, LIC. NO. MECH. . Sig to f plic u Factor Date TOTAL TOTAL OFFICE COPY