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14554 POST THISICARD NEAR FRONT OF BUILDING PERMIT NUMBER ' CITY OF CUPERTINO 14554 INSPECTION DIVISION . JOB INSPECTION RECORD S•, ( U 30 •PERMIT EXPIRATION JOB ADDRESS UNIT# _LOT# �. L /pthMIT 2)(f&ESWF WORK ' OWNER a 4 fJ CONTRACTOR r! ) L I, IIS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTI NRECORD 180 DAYS OF PERMIT ISSU. , FOUNDATIONANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNIT.ETO COMPLY WITH THE APPROVED PLANS AND CITY OF PI:HMrt VAI.IDATIGN CUPERTINO STANDARDS. ' GARAGE SLABS ' _ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB �'"'+�� ' PLUMBING - ) ELECTRICAL ' ISSUANCE DATE. MECHANICAL BLDG. ELECT. PLG MECH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION _ VALUATION SIFT. PLUMBING . - - ' MECHANICAL - ELECTRICALa�//.�11�� PERMIT TO FRAMING PAM -/''7�r* D, o w'R INSULATION STORIESIF TYPE CONSTR, ocT 217198s OCC GROUP HES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I city Of Cupertino . ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SC) FT FLooa naeA TOTAL AcacAce DIAPHRAGMTHE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING I I HES - IND CON PB DIP- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ns5ESSUHSPARCELNO ROUGH SAN.p PLUMBING ELECT.ENERGY ' TNACI NO. PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL - MECH.ENERGY ELECTRICAL ', BUILDING ENERGY ACC.OATE ACC.FILE NO FRAMING ELECT.FINAL TEST ZONING - ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS - FIRESPRINK ENERGY T2 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v ❑ "❑ Y ❑ NF] EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE Ai UC. ' Y ❑ N❑ Y ❑' N❑. INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIQR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC - / PLAN CHECK - GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC G7 ul • �• 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 CALLING FOR FINAL INSPECTION. OFFICE COPY . I' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 1 r BUILDING PROJECT lDENTIFICATION PERMITNUMBER BUILDING APPLICATION & PERMIT - 14554 ADDRESS E BU' 'Q/Z3 /U 01 WOaF 3p ILDING-ELECTRICAL-PLUMBING-MECHANICAL 14 5 5 4 OWNEP'B PLAN CHECK VALIDATION NAA .Sot rQESSDTV' ELECTRIC PERMIT FEE PHONE' CONTRACTORS rvamE --/0 OUTLETS-SWITCHES-RECEP 10.00/1.00 fC/N 6C 7WlG rrc sec.No. fes$73 LIGHTING FIXTURES 10.00/1.00 p•-Z7 CONTRAycroR'p &-r) 7re APPLIANCES-RESIDENTIAL 4.00 A PORE r - ,�C Li/� L PHONE /vyy PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.O.NO. OR PANELS (OVER 200 AMPI 20.00 ENGINEER nuc.No. SIGNS TRANS. 3.00 ARCH,OR ENG. - PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 [t(3 1*1 4oe s1A e- zIP EMP.METER OR POLE INS. 20.00 APPLI - MOTORS SEE FEE SCH. ADDRESS EBS 12313 DIF Al C/1.-Z SERVICE CHANGE 20.00 O o LICENSED CONTRACTORS DECLARATIONRAW G u p 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE H f y (commencing with,Section 7000)of Division 3 of the Business nd BLDG. ELECT. PLG. MECH. R O i Professions Cod and my license is in full force e�fxp� El Ix ❑ ❑ Z 0 o License Class O Lie.Number _! F M H j Date Contractor Yr rrS-- ¢ r fa BUILDING PERMIT ¢ ¢w OWNF,K-B UILUIIR DECLARATION INFORMATION w ;LL N I hereby affirm that I am exempt from the Contractor's License MISC.- O ORD VALUATION $/FT. F U N 4 Law for life following reason.(Sec.7031.5,Business and Ptofesama, -PERMIT ISSUANCE .10.00 3-00 Code:Any city or county which requires a permit t.constant,alter, p Q¢ p Imp/ofproving e,demolish,or repair any structure,prior to its Uinc,,,alm ELEC.CONTR. LIC.NO. ELEC. '^ 0 G LL reqs the applicant for such permit to file a sign statement that TOTAL 2-L PERMIT TO A w$ he icensed pursuant to the provisions of the ntractor's License /J FiQ Law. hapter 9(commencing with Section 70 )ofDivision3ofthc E 4 O Busss and Professions Code)or that he exempt therefrom and ATV. PLUMBING PERMIT FEE / ¢ Hp the is for the alleged exnnplimt.Any solation ofSection 7031.$ STORIES/ TYPE CONSTR. a3 � by applicant fora permit subjects eapplaunt toacrvil penalty ALTER-DRAIN -WATER IEA.) 5.00 of notmore than five hundred Bolla (5500).1: ❑ I,as owner of the propert or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS theiole compensation,will d the work,and the structure Is not inteed or offered for sale -. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 CodThe Contractor's Li' nze4Law does not apply to on owner of proty who builds or proves thereon,and who does such work FIXTURES-PER TRAP 5.00 BQ FT.FLOOR AREA TOTAL ACREAGE • himf or through his wo employees,provided that such improvo- meare not inten d or offered for sale.If,however,the braiding GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or irovement i old within one year of completion,the owner- GAS-EA.SYSTEM-OVER4 1EA.1 2.00 BUILDING USE builr will hav he burden ofproving that he did not build or im- RES IND CON PB Olner Proforpur seofsaln.). INDUSTRIAL WASTE INTER. 30.00 0I,as mer of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑liced c tractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC5V.B. 6.00 ASSESSORS PARCEL NO. o ssions Code:The Contractor's License Law does not apply wner of property who builds or improves ther on,and who LAWN SPRINKLERS-OVER 5 (EA.I 1.00 cis for such projects with a corantetar(s)licensed portant toSEWER-SANITARY-STORM EA.200ft/10.00n ttnctor'B License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,H.&P.C.for this WATER HEATER W/VENT 6.00 reiism Owner - Dote WATER SYSTEM 5.00 ACC.DATE ACD.FILE No, WORKERS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy therefSe�.38(1/1,Lab.C.l. -��rsl�LlC Policy No. C9 Odmpany_ O 0 Certified Copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z jp Certified py ¢ file4. city ms ection division. O D , (F_y_ .F _.411,7-A oC-,,..� MISC- REFER TO ORD. ❑ ❑ ❑ - ❑ A pllcanl rY N V N rn PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. Lu CfiRTI FICC0 OF EXEMPTION INS FROM WORKERS' W �_ COh1PIlN5A1'ION INSURANCE PLG.CONTR. LIC.NO. - ,PLG. , CL 0 (Phis section need not he completed if the pernlil is for one TOTAL Y❑ N❑ Y.❑ N❑ :) Z hundred dollars($100)or less.) U O I certify that in the performance of the work f which this Per. OTY MECHANICAL PERMIT FEE FEE SUMMARY W 1- mit is issued,1 shall not employ any person i y manner yr as to U become subject to the Workers'Compenuf Laws of California. O y Date ApplicamALTER OR ADD TO MECH. 5.00 BUILDING } m NOTICE TO AZbecome If,after aking this Certificate of Ex- F 2 emptier,you ssub' t to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of you must forthwith Comply will) FEE such provisionsshall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CON LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.EM.) 6.00 SEISMIC FEE I heFeby ofre is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the perl'a' cc of the work for which this punnh is iswad(Sac. - HEATING UNIT(TO 100,000 g.T.U.) 8.00 MICROFILM 3097,Ci J. ^ Londe ' Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC hl �0 Lcn is Address I certify lhatl have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction,and BOILER-CUMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the bove-mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL a (We) agree to save, indemnify and keep barmless the City of MISC.- REFER TO ORD. Cupertino againstliabilAwniDlIgments, costs and expenses which PERMIT ISSUANCE - 10.00 CONST.TAX may in any way asicf.c sl said City in consequence of the rondo•of this mit ..L MECH.CONT. LIC.NO. MECH. i2e z'7-aV TOTAL TOTAL Signature Applicant/Contractor Date OFFICE COPY' -