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16221 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER l.r CITY OF CUPERTINO " 16221 INSPECTION DIVISION 14 � yQ I '/�J yJ!�OB INSPECTION RECORD + uV�/�-�1 711�I Ly I PERMIT EXPIRATION JOB ADDRESS�/� UNII�Ta#M _LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. I UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE' TO COMPLY WITH THE APPROVED PLANS AND CITY OF Pf.RnvT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. -' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB - q - 88• "'I PLUMBING ELECTRICAL I f CDissuANCE DATE MECHANICAL. _ L ELECT PLO mecR . 1 El ❑ ❑ ; 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING` VALUATION - SIFT, MECHANICAL ELECTRICAL PERmIT To - FRAMING INSULATION STORIES TYPE CONSTR; DCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED " . ,ROOF -' NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SOFT FL.Mi AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IND CON PB Omr, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ El ❑ ASSL55ORS PARCEL NO ROUGH SAN.N PLUMBING - ELECT.ENERGY TRACT NO. PARCEL NO TUBS 8 SHOWER PAN - PLUMBING ENERGY MECHANICAL' MECH. ENERGY ELECTRICAL - - BUILDING ENERGY ACC DATE ACC FILE NO FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION v PLUMBING 2-GASTEST _ GAS MECHANICA4 FIRESPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - _Y E] NCj Yo NO I/ A.LUC — F EXTERIOR SHEAR ELECTRICAL RELEASE 3.b' 1'. 11 NF. INTERIOR SHEAR FIRE DEPT. YE) No Y L 1 SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVAL BUILDING ; SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE J OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ELI ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC I j, VII- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ' PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL `CtS OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION ,PERMIT NUMBER BDILDING APPLICATION & PERMIT �� / ("\( ADDRESS 1l{^/(-jNn((p lel flap BUILDING - ELECTRICAL-PLUMBING-MECHANICAL E" R..' NWNEy PLAN �CHECKLpID�ATIlON CITYELECTRIC PERMIT FEEQsyW04ag . ! NAMECONTRAcroR's OUTLETS-SWITCHES-RECEPsiame .18:8611000 `JT F/ t LIC.NO. 3' LIGHTING FIXTURES r DTRACrolas ADDRESS PPLIANCES-RESIDENTIAL 4.00 AD (TlePHONE PANELS 10.00 DATE OF APPLICATION ARCHI T LIC. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C,N0. ENGINErQ ^ lFe J „ �- c.No. � SIGNS TRANS. 3.00 ADDRESS ENc' SPECIAL CIRCUIT 5.00 - PERMIT VALIDATION nP EMP. METER OR POLE INS. 20.00 APPLICAN ADDDRESSDRESSMOTORS SEE FEE SCH. XEl.l` Mcrldill SERVICE CHANGE 20.00 Cl w o o LICENSED CONTRACTORS DECLARATION _I U < Z'U 1 hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE H (commencing with Section 7000)of Division 3 of the Business and P,< (yp�'" ELECT. PLG. MECH. r w i Prol'ossione Code,and my license is in lull forte and effect yy/ ❑ E: ❑ a o - License Class Lie.Number w; w Date ConUuctor < m s C.. BUILDING PERMIT rc ¢w OWNIiR-BUILDER DECLARATION �IEO u'xr;e I- 1 hereby affirm that I am exempt from the Contractor's License MISC.- - REFER TOO INFORMATION Fao¢ Law for the followingreason.(Sec.7031.5,Business and Professions pERM1T ISSUANCE 10. I VALUATION S/FT: Code:Anycity orcounty which requires a permit to construct,alter, rCC / a ¢¢2O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEG / - ca G¢ requires the applicant for such permit to file a signed statement that TOTgI, I �� 6 w m y he is licensed pursuant to the provisions of the Contractors License sP^y-E-fl�EMIT TD riat Law(Chapter 9(commencing with Section 7000)of Division 3 of the �T /` f 4 o Business and P � Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE t `' '` mQhe-4 ¢ H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a ; by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundreddollm,(S500).): ALTER-DRAIN&VENT-WATER (EA.)..b:BO ,50 ❑ I,as owner of the properly,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contractor's License Law docs not apply Rr nn owner oI' properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP ^G,eG I SO.FT.FLOOR AREA -TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 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 of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON Pe Other 13 . . Las owner of the property,ani exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 600 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law docs not apply . to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 amtmns for such projects with u contractors)licensed pursuant it, _ the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am • emp under Sec. ,B.&P.C.tort is WATER HEATER W/VENT 6.00 reason - _ owne Dat WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. ' ORKER COMPENSATION DIiCLARATION WATER TREATING EQUIP. 5.00 1 hereby atfirm that I have a certificate of consent to se)f-insure, or a elltificule of W,oloH,Compensalion Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,LAC.). Policy No. Company O ❑ Certified copy is hereby furnished. Z 2 ❑ Certified copy is Filed with fire city inspection division. FIRE SPRINK ENERGY T-24 O Applicarit - MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ w CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE a-.1&80 FLOODZONE A.L.U.C. LU COMPENSATION INSURANCE PLG.WNTH. LIC.NO. PLO, Z (This Section need not be Completed If the permit is for one TOTAL 17 5th Y❑ NE] N[]Y❑ N U O hundred dollars(8100)orlcvs.) I certify that in the performance of the work for which this per. QTY MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,I shall not employ any person many manner so as to become subject to the Workers'Compensation Laws of California. 0_Of Uaa• Apph°ant ALTER OR ADD TO MECH. 5.00 BUILDING >wrn NOTICE TO-APPLICANT: u' x ,after making this Certificate of Fi F 2 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 . U 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 10ACC.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the perflu mince of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC C 1l m I certify Dat I have read this application and male Ihaf the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING r� ordinances and state laws relafing to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 I �, hereby authorentioned representatives ins ec this city es emir 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. upertino 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 •rant off permit. • MECH.CONT. LIC. MECH. AJrYft � ' TOTAL Ig a ore o TOTAL SAp icon[/Contractor Ua e r OFFICE COPY