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15233 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO , 15233 INSPECTION DIVISION JOB INSPECTION RECORD ,� / PERMIT EXPIRATION JOB ADDRESS �� 's/' wozc �-� UNIT4*--LOT# PERMIT EXPIRES IF WORK OWNER —/Z3 -- CONTRACTOR /_/f}#ON/1"' EGc C7jZ) L IS NOT STARTED WITHIN INSPECTION DA E INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU FOUNDATION ANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF ftP61MIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -g-.f - WAG �L T �,�� ' '' - /- -H•K.. UNDERGROUND /SLAB Ipw PLUMBING ELECTRICAL - ISSUANCE LATE MECHANICAL Luc ELECT vO MECR '❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUI(lU-oING PE RMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING ) MECHANICAL ' ELECTRICAL PERMIT TO 1 fl—e` / FRAMING STORIES TYPE CONETR INSULATION OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED To*AL Ace encE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sD." F`Oor+AReA DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING use. RES IND CON PB Ott....�... ROOF SHEATHING ❑ ❑ ❑ ED APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Assessoas vARceL No - ROUGH SAN.R PLUMBING ELECT.ENERGY iRAct No PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY ' MECHANICAL MECH.ENERGY ACC DATE ACC FILE NO ELECTRICAL BUILDING ENERGY FRAMINGELECT,FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE SPRINK ENERGY T-]< MECHANICAL v [] N0 v ❑ N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD zomE n-1 INTERIOR SHEAR- FIRE DEPT. ❑ N� ❑ N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM / Irl ARRANGE FOR INSPECTION BY PHONING 252-4505ELECTRIC, "'1� F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. z MECHANICAL SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY + BUILDING PROJECT IDENTIFICATION PERMIT NUMBER / BUILDING APPLICATION & PERMIT [ �j X ADDRESS J J BUILDING-ELECTRICAL-PLUMBING-MECHANICAL P OWNER'Sf PLAN CHECK VALIDATION .,44 NAMES If ELECTRIC PERMIT FEE PHO\NE - t.7 y_D NAME -- OUTLETS-SWITCHES-RECEP 10.00/1.00 ,_, LIGHTING FIXTURES 10.00/1.00 b a o Fled ND. oi. 11 S_ CONTRACTORS DRESS APPLIANCES-RESIDENTIAL 4.00 O /YVL S PHONE PANELS 10.00 DATE OF APPLICATIO w CT N " ARCPLAN CHECK FEE P,C.NO. oR PANELS (OVER 200 AMP) 20.00 ENGINEER uc.No. SIGNS TRANS. 3.00 ADDRESS ENG' SPECIAL CIRCUIT 5.0Q PERMIT VALIDATION zIP TEMP.METER OR POLE INS. 20.00 - APPLICANT MOTORS SEE FEE SCH. ADDROREss SERVICE CHANGE 20.00 woo LICENSED CONTRACTORS DECLARATION PAP , ¢ m0 u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE a "' (commencing with Section 7000)of Division 3 of the Businum and BLDG. ELECT. PLG. MECH. w i Professions Cody-, RIy license is in full fo a I'oc7. ❑ ❑ ❑ i O u, License CI ss `4 a Lic Number 615e# Go 6 < m ea I7:oe � fContractor ,,yy�� ¢ ¢w a OWNER-BUILDER DECLARATION 1un� BUILDING PERMIT o a " MISC.- E O ORD INFORMATION K ;ec r 1 hereby allinn that I am exerupt from the Contractor's Lieensn 0 O¢ Law for the following reason.(Seo.703 t.5,Business and Professions VALUATION $/FT. � - Code:Any city or county which requiresa permit toconstrucLalter, PERMIT ISSUANCE _7.0,00 SC 2 ¢ improve,demolish,or repair any structure,prior 10 its issuance,also ELEC.CONTR. LIC.NO. - ELEC. OLO K DLL requires the applicant for such permit 10 file a signed statement that TOTAL PERMIT TO n w m he is Inclosed pursuant to the provisions of the Contractor's License FiQ Law(Chapter9(commencingwithSectiou7000)ofDivisiou3oflhc Business and Professions Code)or ilia,he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ r o the hasis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. d ;'9 by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars($500).1: ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 their sole com pensalion,will do lite work,and the structure is not OCC.GROUP REB.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code The Contractor's License Low does not apply to an owner of 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- GAS-EA.SYSTEM-GAS6.00 meals are not intended or nDeretl for sale.If,however,the buildmg r or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE v builder will have the burden of proving that he did not build or im- "lovel'urPurpose ol'eala). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Ome. ❑ 1,as owner at the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sea 7144,Business I LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Pru l'essions Code The Contractor's License Law does not apply to an owner of property who builds or i...provcs thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a comractorlsl licensed pursuant to Ole Conlranor's Liccose Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ l am exempt under Sec. ,B.&P.C.lin this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK F-RS'COM PENSA'FION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to sell-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified �(1 topy thereof(Sce.3800,Lab.C.).ry J . Policy N'o. Company_U u 1 0 U Cer,il ie co is IT by ar ehed.WC 37S39-z- FIRE SPRINK ENERGY T 24 Z Z / ❑ Certif is s IiI �Nh_ to lily inspection divmon. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ Oj- ApplieanD c // •\ v N V N ~ viPICA1'1i 017 FXCMPTFROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A CC CI:R' .L.u.C. ION LU COMPENSATION I N SURANCE PLG.CONTE. LIC.NO. PLG. CL Z This section need not be completed if the permit is for one TOTAL Y[:J N0 Y ❑ N❑ hundred dollars IS I DO)or less.) U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued, 1 shall not employ any person in any manner so as to become subject 10 the Workers'Compensation Laws ul'California. i Dam Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } In NOTICE TO APPLICANT': If,after making this Certificate of EX- Z emptiun,you should become subject m 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.F.NL) 4.00 CONS'PRUCf10N LENDING AGENCY AIR HANDLING UNIT(OVER 10DWC.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the 3097 performance 01'the work lot which this permit is issued(Sec. MICROFILM HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC I cenily that I Icvc read this application and state that the above VENTILATION FAN (SINGLE) 4.00 �t information is correct. 1 agree to comply with all city and county PLUMBING �1 ordinances and slate laws relating 10 building construction. and BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP love,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. [Cupertino against liabilities,judpmmits, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ay io any way accrue against said Cily in consequence of the ran'ng this pens' . MECH.CONT. LIC.NO. MECH. S .L,r TOTAL TOTAL hg alar Applicant/Control Ute OFFICE COPY