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17267 1.y 'i. POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 17267 INSPECTION DIVISION JOB INSPECTION RECORD ' PERMIT EXPIRATION JOB ADDRESS J .�d w �'S L—L_L`Y�UNIT# - _LOT# 'ty1 - PERMIT EXPIRES IF WORK i OWNER � L c U corvTRACTofl .J e. - IS NOT STARTED WITHIN - 1 - INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION - NOTE: . �' UFER ALL GRADING AND DRAINAGE.SHALL BE INSTALLED LAST CALLEDINSPECTION. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS / 7 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND ITSLABFEBT rE� I i ��y y L•� C PLUMBING .SLC ELECTRICAL-. . - ISSUANCE DATE MECHANICAL. I. - BLOc eLECT PLA. MEck DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION $IFT. PLUMBING MECHANICAL ELECTRICAL PERMIT TO FRAMING - T —e-4 INSULATION STORIES PE CONSTR, INSULATION X97 L ONb ,OCG GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED } ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE so.PT FLOOR AREA TornLncRLncE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUII:DING USE ROOFSHEATHINGRES IND CON PB OEC APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.N PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY � _ -- MECHANICAL MECH.ENERGY ELECTRICAL , ACG OnrE ACC PILE NO BUILDING ENERGY ' ,. FRAMING' 1+- ELECT.FINAL TEST . 6• B ZONING ENG,SITE N0. INSULATION - -- PLUMBING " GAS TEST GAS FIRE SPRINK ENERGY T 94 MECHANICAL Y El EXTERIOR ❑ No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L EXTERIOR SHEAR � ELECTRICAL RELEASE �� Uc. ❑ N❑ INTERIOR SHEAR FIRE DEPT- L NE]- SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH i BUILDING BUILDING INTERIOR LATH . TEMPO RARY APPROVALS 0 14S SCRATCH COAT ELECTRIC PLAN CHECK GAS 'FEE 62.5 NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 1 . OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM �� ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC U.1 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ,Od z PLEASE GIVE JOB ADDRESS WHEN PHONING.. j — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! , CONST;TAX PLEASE READ REVERS ESIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. /. Z OFFICE COPY A�PLI.`'AINT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LD1 NG PROJECT I DENTI FICATI ON - PERMIT NUMBER BUILDING APPLICATION & PERMIT �� AGOREss� 1 I BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ', ' OWNER'S 1f� PLAN CHECK VALIDATION NRME y OTV. ELECTRIC PERMIT FEE 'W1 �e � HDNE y 6-y CONTRACTORS SVN E OUTLETS-SWITCHES-RECEP 10.00/1.00 r N'l eS LIC.NO-56"AU13 LIGHTING FIXTURES 10.00/1.00 400 cONTRACTORs APPLIANCES-RESIDENTIAL 4.00 Q - UURppEss S Co- HOB - o,typ 1 PHONE 6b2'vlZ PANELS 10.00 DATE OF APPLICATION ARCHITECT - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. O ENGINEER LIC.No. SIGNS TRANS. 3.00 POR Ess ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 APPuanry S.A MOTORS SEE FEE SCH. / ��°°UREss f•V• �TS 2 Ir>q (�- Tp9 ca., SS00 SERVICE CHANGE 20.00 1 D� Aa,�pvLU�� woo LICENSED CONTRACTORS DECLARATION L� CC w" a v t I hereby affirm that I um licensed under provisions of Chap ler 9 � s J~ ISSUANCE DATE r z °' (commencing with Section 7000)of Division 3 of the Business and - w ¢ SLOG. EL PLG. M . r 7 z Professions Code, my license is in full force and•eJf•c. IFL�Y_,+I, Q z H o License CI s Liu.Number-I I _vl f w Date Contractor- 411y Of CU < se E� DertmO' BUILDING PERMIT ¢ B:w _ OWNER-BUILDER DECLARATION INFORMATION X ;LL vHi I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD H LL m W Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.001/ 0.00 2100 VALUATION $/FT. m � Code:Any city orcounty whichrequiresa Permittoconstruct,alteq - DDD r a ¢Q improve,demolish,or repair any structure,prlOf to IIs issuance,also ELEC.DDNTR. LIC.NO. ELEC. '] ppy�xx i O LL requires the applicant for such permit to file a signed statement that TOTAL i a JLv PERMIT TO w m he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencingwith Section 7000)of Division 3 of the 11 ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE l ( lie- C f$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.. y i ,- by any applicant for a permit subjects the applicant W aclvil penalty ALTER-DRAIN&VENT-WATER (EA.) 5,00 JO of not more than five hundred dollars f$5001.1: ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 DCC.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,GOND. 5.00 Cade'the Contractor's License Law does not apply In an Owner of Property who builds or improves there on,and who does such work FIXTURES"PER TRAP 5.00 SO,FT,FLOOR AREA TOTAL ACREAGE himselfre of intended own employees, le.I C,hothatsuch improve mentsare through his oroffered for employee,prided that r.suhebuddin6 GAS-EA.SVSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Osber prove 1,as owner of side.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ I,as owner of the property,um exclusively contracting with licensed contractors to construct the project(Sec. 7044,Business LAWN SPR INKLERS- 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 Ibercon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ' contracts for such projects with a contramor(s)+cented pursuant m SEWER-SANITAR V-STORM EA.200ft/10.00 the Coactor's License Law. TRACT NO, PARCEL NO. - r ❑ I antrm exempt under Sec.-,14&P.C.for Ibis WATER HEATER W/VENT 6.00 ho reason Nl Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconsent to seff-insure. ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy thereof(See.3800, b.C.). S- _r ''y NCompany � uUu Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified p is filed ;t]t t e city inspection division. MISC- REFER TO ORD. O Applicant V ❑ N[1] Y ❑ N� M LO CERTIFICATE 01'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00,124 FLoao zoNE A.L.u.c. DO > COhIPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG, y� CL Cl (This section need not be Completed if the permit is for one TOTAL (�✓ V❑ N� V N❑ hundred dollars 1 S 1001 or less.) U O 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 in any manner so as to become subject to the Workers'Compensation Laws of California. U1 Uuto ApplicantI ALTER OR ADD TO MECH. 5.00 .DO BUILDING �Ub } W NO')tICIi TO APPLICANT: If,alter making this Certificate of Ex- - F 2 emp ion,you should become subject to the Workeri Compensation APPLIANCE ex, I 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 FEE r2 0.2-S CONSTRUCTION LENDING AGENCY r2- CONSTRUCEIONLENDINGAGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE 4 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(Sce. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATI NG UN IT ER 100,000 B.T.U.)9.50 �24 �D Leader's Address ELECTRIC ' I certify that l have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING x p/ ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.Or 100,000B.T.U.1 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP IDVBf IOO,D00BTUISEE FEESCH. MECHANICAL SV G. above-mentioned properly for inspection purposes. r (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. uperlino against liabilities,I. I• cols, costs and expenses which- (2 DO CONST.TAX may n any way accrue gain aid City in consequence of the PERMIT ISSUANCE 10.00 4 rand offlus permit 1(�` y MECH.CONT. 'LIC.NO. MECH. /` pp e}• 2-)6-p4 TOTAL/I 7, TOTAL a-a'1�YX� r Oma-/4 Signature Of Applicant/COntractor Date OFFICE COPY