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18745 POST THIS CARD NEAR FRONT OF BUILDING Irl PERMIT NUMBER 'CITY OF WPERTINO 18745 . INSPECTION DIVISION JOB INSPECTION RECORD ' PERMIT EXPIRATION JOB ADDRESS e�r 18 AA UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER ClylD et CONTRACTOR G✓p 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 - PERMIT VAI IDATION CUPERTINO STANDARDS. . GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED PAID UNDERGROUND /SLAB J r1 PLUMBING UVI Lj ELECTRICAL - ISSUANCE UPTF. MECHANICAL Ditv- Cupertino FLOG ELECT. PLc. MECR, OO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOORINFORMATION ! 114 PLUMBING VALUATION $TFT. � � _ . , MECHANICAL " ELECTRICAL PERMIT TU FRAMING "'—"l �'� 1 LQ–C , INSULATION STORIES TYPE CONSTR. OCC GROUP RES UNITS, PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sa.FT PLooIi Anen TOTALACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID 9UILo1NG USE ROOF.SHEATHING RES. ..IND ',,ON PB olm., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN,# PLUMBING ELECT.ENERGY TRACTNO. PARCEL NO TUBS B SHOWER PANPLUMBING ENERGY MECHANICAL - MECH.ENERGY ELECTRICAL - ACC LATE ACC.FmP NO, BUILDING ENERGY FRAMING ELECT.FINAL TEST INSULATION PLUMBING ZONING ENG.-SITE NO. GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY T,3u COVER NO WORK UNTIL ABOVEMAS BEEN SIGNED HEATING . Y ❑ "� N� FLOOD ZONE A,LUC. EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. °❑ "❑ Y N❑ 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 OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM uJ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H� ONE'WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o' PLEASE GIVE JOB ADDRESS WHEN PHONING. z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE 7 CALLING FOR FINAL-INSPECTION. TOTAL X7 21 OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN.ONLY r BUILDING PROJECT IDENTIFICATION PERMIT NUMBER F. W APPLICATION & PERMIT BUILDING —ELECTRICAL_PLUMBING—MECHANICAL Ax74VADDO -5 vL." �& OWNER PLAN CHECK VALIDATION p1wK of c�-PHONE 0:54156QTY. ELECTRIC PERMIT FEE, CONTRACTORS N/a� , • OUTLETS-SWITCHES-RECEP '10.00/1.00 l/�' ,Jo uc.ND 7¢b3 LIGHTING FIXTURES 10.00/1.00 r-orvrRacroR's AD RE �r„}� APPLIANCES-RESIDENTIAL ,' '4.00 ' E 5U VYirf (� v,10NE .�Q� PANELS 10.00 - ”' DATES OF APPLICATION AR CN ECT - OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. E NGINEER QQ••�� t' Q �L-*P- & LIC.rvD. - 0111 ISIGNS TRANS. :.3.00 ARCH.OR ENG. F "PERMIT VALI DATION AD Es .�,I.1 , SPECIAL CIRCUIT - 5,00 9 M,� IAPZrP +5 EMP.METER OR POLE INS.`,', 20.00 / O u aPRANr's - MOTORS ADDRESScSEE FEE SCH. - SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION A' �• �- L "—.� 1 'Q o u I hereby.affirm that 1 am licensed under provisions of Chapter z "' (commencing with Section 7000)of Division 3 of the Business and, ISSUANCE DATE OCT 19ABLDG. . -ELECT. PLG. MECH. r w. i LIISGIS C Cod and I license Is N full fort ' _ ❑ r ❑ ❑ z o L¢enseC ass Lio Number - - - O z,r w Date Contractor City of no a OWNER-BUILDER UECLARATIO � - BUILDING PERMIT dro a ° - MISC:— REFER TO ;" - INFORMATION X g u - I hereby affirm that 1 am exempt from the Conlroctor's License I F u 0 4 Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT. - PERMIT ISSUANCE ' 10.00 Code:Any city or county which requires a permit to construe[,.Iter, ' 2 Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. .LIC.NO. - v - _ ELEC. 77 �� ' in e rcuuesthe applicant for such permit to file a signed statement that TOTAL w e, he is licensed pursuant to the provisions of the Contractor's'License PERMIT TO - ' i Law(Chapter 9(commencing with Section 7000)of Division 3 of the ` a- Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE �-�- r m the basis for the alleged exemption.Any violation ofSectio,7031.5 - STORIES_- TYPE CONSTR. by any applicant for a permit subjects the applicant loacivil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 of not more than five hundred dollars($500)J:. - - ❑ I,as owner of the property,or my employees with wages as ggCK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.uwTS- - their sole compensation,will do the work,and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of ,. properly who builds or improves thereon,an, whD docs SUCK work FIXTURES-PER TRAP S.00 ,SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- / rents are not intended oroffered forsale.If,however,the building' - GAS-EA.SYSTEM-l1NC.40UTLETS-6'.00 - orimprovement is sold.within'one year of completion, the,owner- ` builder will have the burden of proving that he did not build or bm GAS-EA.SYSTEM-'OVER 4(EA.) . 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 - RES ,IND CON PB Omer ❑ 1,as owner o1'the property,.,,I exclusively cart...ing with ❑ ❑ ❑ . 0 ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6,00 ASSESSORS PARCEL NO. and.Professions Code:The Contractor's License Low does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contract's for such projects with a contmetor(s)licensed pursuant to - the Contractor'sLicense Law. SEWER-SANITARY-STORM EA:200ft/10.00 TRACT NO, PARCEL NO. ❑ Iam exempt under Sec. ' ,BARC.for this reason WATER HEATER W/VENT 6.00 owner - Date WATER SYSTEM 5.00;" ACC.DATE +ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that) have e certificate cf consent to sel Ginsurs, or.certificate of Work rs'Comp tion Insur:I$Ico,or a certified - ZONING ENG.SITE NO. copy then ( ab.0-). - Policy No puny O . ❑ Cerlle yishereb fu heti FIRE SPRINK ENERGY LY4 , \ Z ZCertif' - h [, c'tY i c- o I vision. O Appllc.nt _ MISC.- REFER TO ORD. v❑ '. N❑ v ❑ N❑. ~ �+ PERMIT ISSUANCE 10.00 LU CERTI ICATEEEXEMPT ION VRWORKERS' FLOOD ZONE A.L.u.C:- CL 0 COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. - d O (This section need not be completed if the permit is for one TOTAL Y❑ N� Y ❑ NE] Z' hundred dollam($100)orless) U O. 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY. LL F mit is issued,'I shall not employ any person in any manner so as In , Q U , became subject to the Workers'Compensation Laws of California. - - - d Date Applicant ALTER OR ADD TO MECH. 5.001BUILDING making} N NOTICE TO APPLICANT: If,after this Certificate of Ex- _ ' Z 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 ` such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUC'TIONLENDING AGENCY AIR HANDLING UNIT(OVER 10;MC.F.M.) 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(Sec. MICROFILM ^ 3097,C1v.C). - HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's AAdress ELECTRIC l certify that l haveroad 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-COMP(3 H.P.or 100,000 B,T.U.) 6.00 hereby authorize representatives of this city to enter,upon the 1301-mLER-COMP (Over 100,000 BTW SEE FEE SCH. ' MECHANICAL, above-mentioned property for inspection purposes. (We) agree to save,-both,nunity and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which pERMIT ISSUANCE 10.00 . CONSTTAX may in any way accrue a 'nst said City in consequence of the g rims er • MECH.CONT. LIQ NO. MECH. TOTAL TOTAL J 70 nature of pplicant Contractor D [e // /. OFFICE COPY