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18164 POST THIS CARD NEAR.FRONTOF BUILDING PERM IT NUMBER CITY OF CUPERTINO 18164 INSPECTION DIVISION • JOB INSPECTION RECORDt p ��/� PERMIT EXPIRATION JOB ADDRESS _ UY l / 41.E • VC_UNIT# _LOT# PERMIT EXPIRES IF WORK CwNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE . INSPECTOR' INSPECTION RECORD 180 DAY S'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 AP PROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. PAI[) GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,SUN 0 1969 UNDERGROUND /SLAB J /n •�- ' PLUMBING h' , 4 NS 0 IA LLL( ELECTRICAL Clty,Of Cupertino I ISSUANCE DATE MECHANICAL BLDG ELECT I PLG. I MEC.. ED 0 . I I DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BuaDINc PERMIT INFORMATION WOOD FLOOR - VALUATION SIFT. PLUMBING MECHANICAL ELECTRICAL - -- -------------- PERMITro FRAMING I �� INSULATION STORIES TYPE CONSTR. � - UCC.GHOUP HES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO FT,FLOOR AREA TOTALACHEAGI • 'ROOF NOTE:NO FINAL INSP-SHALL BEMADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IND CON PB on'., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ AssessoRS PARCEL NO ROUGH SAN:W PLUMBING ELECT.ENERGY TRACT NO, PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICALMECH,ENERGY A ELECTRICAL BUILDING ENERGY C.DATE ACC.FILE NO FRAMING - ELECT.FINAL TEST INSULATION, - � PLUMBINGt ZONING ENG,SITE NO. GAS TEST GAS / MECHANICAL N�N RGV T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ FALUC • EXTERIOR SHEAR ELECTRICAL-RELEASE INTERIOR SHEAR FIRE DEPT.SHEETROCK' GRADEMARY EXTERIOR LATH BUILDING INTERIOR LATH ' TEMPORARY APPROVALS BUILDING SCRATCH COAT-'F ' - ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BU ILDING ISNOTPERMITTED UNTILBUILDING FI NALISSSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC • mm U.1 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE,BEFORE TOTAL n7 , CALLING FOR FINAL INSPECTION. + +d� OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBERBUILDING APPLICATION & PERMIT ADDRESS rV ItL4 1816 4 B I �ANG-ELECTRICAL-PLUMBING-MECHANICAL r.t OWNER'5 PLAN CHECK VALIDATION NAME DTV. .ELECTRIC PERMIT FEE V NE CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 ONAME ( LIGHTING.FIXTURES 10.00/1.00 CONTRAS sgcTOR's ADD PPLIANCES-RESIDENTIAL . 4.00 j 5CNITECT G HOrvE PANELS' 10.00 DATE OF APPLICATION ' OR PANELS (OVER 200 AMP), 20.00 •PLANCHECKFEE P.C.NO. ENGINEER - - Uc.HO. SIGNS TRANS. 3.00 AARCH OR DDRESS ENG. SPECIAL CIRCUIT 5.06 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. . 20,00 AADDU"DDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 �7b VI11.. j pO o LICENSED CONTRACTORS DECLARATION - _ --VCL ri w I hereby affirm that I am licensed Under provisions of Chapter9 ISSUANCE DATE m< W (commencing with Section 7000)of Division 3 of(lie Business and I BLDG. ELECT. PLG. MECH. H e t Professions Code,and my license is in full force and effect. x ❑ � ❑ ❑ oDate Contractor i w o License Class Lia Number z Y j f,' a OWNER-BUILDER DECLARATION Clty OP CJQOttItIO BUILDING PERMIT w U INFORMATION F. ;n y' I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD B. Law for the following reason, 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 �p VALUATION $/FT. Code:Any city or county which requires a permit to construct.alter, KK Q 0improve,demolish,or repair any slruchue,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. A D m requires the applicant for such permit to file a signed statement that TprgL�.�s�U - A W m y lie is licensed pURnant to the provisions O1 the Contractors License PERMIT TO H z Law(Chapter 9(commencing with Section 7000)of Division 3 ofthc Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE `e 1 t et. a 1<D the basis for the alleged exemption.Any violation of-Section 7031.5 STORIES I TYPE CONSTR. o ; by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00 of not more than five hundred dollars($500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW 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,GOND. 5.00 Code:The Contractor's License Law does not apply to an owner Ot j Property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve- meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner-. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). I INDUSTRIAL WASTE INTER. 30.00 RES' IND CON PB Other ❑ 1,as owner of the property,am exclusively contracting with ❑ 0 ❑ ❑ ❑ licensed contractors to constructthe project(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 contractors)licensed pursuant to the Contractor's License Law. - SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. 'PARCEL NO. ❑ I um exempt under Sec. ,B.&BC.for this WATER HEATER W(VENT 6.00 reason Owner Dam WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofconsent to sel Ginsare, or a certificate of Workers'Compensation Insurance,car a certified ZONING ENG.SITE NO. copy thereof(See.3800,Lab.C.). Policy No. i Company O ified copy is hereby furnished. FIRE SPRINK ENERGYT24 Z Z ❑ Certified Is fed illt the ity inspection dlvision. O Applicant �� MISC.- REFER TO ORD. Y❑ N❑ Y 0 NE ~ rnPERMIT ISSUANCE 10.00 � CERTIFICATE OF li%EhIPTION FROM WORKERS' FLOOD ZONE A.L.U.C. LU a 00MI117NSATION INSURANCE PLC.CONTR., LIC.NO. PLG, d O (This section need not he completed if the permit is for one TOTAL V N Y N[] Z hundred dollars IS 100)or Ies,) U O 1 certify that in the performance of tire work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY LL l- mit is issued.I shall not employ any,person in any manner so as to Q W become subject to the Workers'Compensation Laws of California, y Date "ApplicantALTER OR ADD TO MECH. 5.00 BUILDING >_ on NOl'ICE TO APPLICANT': If,after making this Certificate of lix- ♦- 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 U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.FJV0 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,00011EM.) 6.00 SEISMIC FEE 1 hereby affirm,that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of lire work for which this permit is issued(Sec. MICROFILM 3097,CDC.), HEATING UNIT(TO 10D,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Qb I certify that l have read this application and staletbnt tbeahmn, VENTILATION FAN (SINGLE) 4,00 information is.correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to buildingcOaSlmefion, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon Ibe above-mentioned property for inspection purposes. BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.60 CONST.TAX ay in any way accrue against Said City in consequence of the rantin of this mit. MECH.CONT. LIC.NO. MECH. 6 TOTAL TOTAL ,2�,06 signature of Applicant/ tractor Ua[e OFFICE COPY