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17451POST THIS CARD NEAR FRONT OF BUILDING CITYtrCUPERTINO INSPECTION DIVISION . JOB INSPECTION RECORD JOB ADDR ESSS. _ UNIT #i�L T# OWNER ONrRACTOH PERNIITNI*NRER 17451 PERMIT EXPIRATION PIRES PERMIT IT EXPIR IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION R CORD NOTE: ALL GRADINGDRAINA S LL BE INSTALLED TO COMPLY H THE APPROVE P NS AND CITY OF CUPERTIN UFER • PR EGUNITE ' -' PERMIT VALIDATION 1 ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL - MECHANICAL I00 eLOG El ELECT PLED EECC(Iy' x -T K�J 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT, PLUMBING MECHANICAL ELECTRICALv elmuT U ry FRAMING I STORIES nI TYPE CONSTR INSULATION OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO . VT FT (LOON PHFA TOTAL ACREAGE " _ ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID DIAPHRAGM Uua D INc u El RES INU Co P(1 DVD �16 � ROOF SHEATHING "APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. nSSE55OR5 PAHCEL NO ROUGH SAN.# PLUMBING ELECT. ENERGY TRACT NO PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC DATE ACC FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT. FINAL TEST ZONING ENG SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE SPHINK Y0 NE ENERGY T"74 ' O NO MECHANICAL -9 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE v� N� 4L U C vL N'[] EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. FEE SUMMARY SHEETROCK - GRADE EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC T FEE PLAN CHECK �:.. GAS SEISMIC FEE'" NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, Il' ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0� •- PLEASE GIVE JOB.ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC l PLUMBING MECHANICAL /• I r( ' CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL %I. OFFICE COPY _rte. '--APFLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALLPOINT PEN ONLY r $UI LDING PROJECT I DENTI FICATIO APPLICATION & PERMIT ILDING -ELECTRICAL-PLUMBING-MECHANICAL TERMIT NUMBER . . I's• �6a' 1 7'4 5 1 BUILDING ADJ%V a )/%�% v c� OWry EN'S NAME QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHONE " DATE OF APPLICATION DorvrRAcrDRs CONT 'A JT/{ uc. No UTLETS-SWITCHES -RECEP 10.0011.00 LIGHTING FIXTURES 10.00/1.00 rorvTRAcrons ADo ss A�/O% PNONE PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR ENGINEER uc. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE PC: NO. SIGNS TRANS 3.00 ARCH. OR Erva ADDRESS ZIP SPECIAL CIR 5.00 P RM T VALIOA ON li EMP.R POLE INS. 20.00 APPLICANTS AOPREss 41125 SAW a&_4 MOTO - SEE FEE SCH. SERVI HANGE 20.00 LICENSED CONTRACTORS DECLARATION ut UDE A 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing will, Section 7000) of Division 3 of the Business and Professions CoA � - Is in full G Licence Clan Lie Number r BLDG. 1:1 ELECT. El PLG. MECH Uale.O _O/I_�Contracmr'�(+y�.''_ - BUILDING PERMIT OWNER-RU1LDER DECLARATION Iiip-17• 1 hereby oftiro that I am exempt final .5 the Conlmctorr License Professions Law for the following reason. thee. ]031.5.ermit to construct, Code: Any city or county which structure permit roconsuance, also improve, demolish, nr repair any structure, prior to its issuance, also INFORMATION MISC.- REFER TO ORD VA WAn ON S/FT. ' PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. N0. ELEC. requires the applicant for such permit to lite a signed statement that he is licensed purs,mnt to the provisions of the Contractor's License TOTAL PERMIT T DTV. PLUMBING PERMIT FEE Law (Charter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt tlulrcirlon and One basis for tiro alleged exemption. Any violation of Section 7031.5 1 FSTORIES TYPE CONSTR. by any applicant for a permit subjects the applicant lou civil penalty of not more than five hundred dO1lars (S500).1: ALTER -DRAIN & VENT -WATER (EA.) 5.00 ❑ 1, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered 1'ar sale (Sec. 7044, Business and Professions BACK F LOW PROTECT. DEV ICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 Code: The Contractors License I.ow does not apply to an owner of property who builds or improves thereon, and will) does such work himself or through his own employees, provided that such improve- ments are not intended or offered for sale. IC however, the building FIXTURES - PER TRAP - 5.00 BE, . FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - 1 INCA OUTLETS 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 of ins" Prove for purpose of saleJ. Cl 1, as owner of the property, an, exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING u RES IND CO PB Omer ❑ Cl ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS -I INC 5 V.B. 6.00 ASSESSORS PARCEL NO. licensed contractors to construct the project (Sec. 7044, BpbInCSS ^ul Pmfesx4mx Code: 'I'Ine Contractor's License Law does not apply to .:r owner of Properly who builds or improves thereon. and who contraL'.- for such projects with a contortions) licensed pursuant t0 file Contractor's License Law. LAWN SPR INKLERS - OV ER 5(EA.)" 1.00 SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO, PARCEL NO. ❑ I amexemptunAe, See ,R.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Uate WATER SYSTEM 5.00 ACC.OATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORK ERS'COMPENSAI'ION DECLARATION 1 hereby affirm that I have a cenifreme ofconsent to self -insure. or a certificate of Workers' Compensation Insurance, or a cer6Ged ZONING ENG. SITE NO. copy IhercolASeq,v - Lah.C.l. /M?/f1 ANO Policy ereo jC 0,L.& ' ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24 ❑ CertilurDglyyljt]filyyirjWAllYia�itygy�cction division Applicant_ /G�/fi4aE1FJ Y ❑ N❑ Y ❑ No MISC.- REFER TO ORD. CERTIFICATE OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLG. TOTAL COhIPENSATION INSURANCI! (This section aced not be completed it the pernit is for one Y ❑ N ❑ Y ❑ N❑ QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or less.) I certify that in the perfon,mnce of the work for which this per- mit is issued, 1 shall not employ any person in any Bluffer so as In BUILDING become subject to the Workers' Compensation Laws of Calcomin. Date Applicant NOl'ICE TO APPLICANT: If, after making this Certificate of fix- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE T emption, you should become Subject to the Workers Compensation provisions of the Labor Code, you nunI forthwith comply with such provisionsar (his permit shall be due nwd revoked. AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM �! I hereby affirm that there is A construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Cw C.), HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OV ER 100,000 B.T.U.)9.50 HEATING Lender's Name Lender's Address FAN (SINGLE) 4.00 PLUMBING I certify that l haveread(hisapplicution and state that the aboveVENTILATION information is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and BOILER - COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,0008TU) SEE FEESCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. (We) agree to save, indenmify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. N0. MECH. TOTAL TOTAL N �'/✓((!/V//1� ranlin f this permit. ,_./ A4460 -/ i�lr7 Signature of APPlical Contractor Date 1 y OFFICE COPY 1Z