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15008 I POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO INSPECTION DIVISION 15008 JOB INSPECTION RECORD :�,o l O \\ ,f " Y t Al PERMIT EXPIRATION -%....�� JOB ADDRESS /o/d3 „" (.�/OL �(� UNIT#, ' _LOT# PERMIT EXPIRES IF WORK OWNER C coNTRACTOR /S•�� `s�/ IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD Iso DAYS 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 APPROVED PLANS AND CITY OF • I PERMIT VALIDATION CUPERTINO STANDARDS. , GARAGE SLABS /' t POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB . PLUMBING ELECTRICAL - ISSUANCE DATE -� MECHANICAL - BLDG. ELECT. - PLG.., MECH. 00 NOT POUR FLOOR UNTIL ABOVE HASBEENSIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION S/FT. • ' MECHANICAL ' Q Lr i ELECTRICAL I PERM ro - FRAMING INSULATION I CAI- �I- DRIES 1 TYPE CONSTR D l OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED o.PT.FLooRAHEA Tor ALAcee.AGE ROOF NOTE:NO FINAL INSP. L OE MADE BEFORE TAX I DIAPHRAGM THE CONSTRUCTION TAX S PAID " tlUILD1 G USE ROOF SHEATHING RES IND CON PB OI— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH SAN.q ASSESSORS PARCEL.NO PLUMBING ELECT.ENERGY TUBS&SHOWER PAN ' � . PLUMBING ENERGY TRACI NO, PARCEL NO MECHANICAL MEGR ENERGY ELECTRICAL- - BUILDING ENERGY ACC DATE ACC.FILE NO FRAMING — ELECT.FINAL TEST ZONING ENG.SITE NO.. INSULATION '�. PLUMBING - GASTEST GAS MECHANICAL FIRE SPRINK ENERGY T-24 ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y El "❑ ` ❑' "❑ ^/ - EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE AL.U.Cr INTERIORSHEAR FIRE DEPT. pw Y ❑ No ? ❑ N❑ SHEETROCK, GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROV LS BUILDING Sa. SCRATCH,COATELECTRIC PLAN CHECK GAS FEE • NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - ISEISMIC FEE lI U OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC LLI ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL /I/ CALLING FOR FINAL INSPECTION. ' OFFICE,COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY r QUI LDI NG,PROJEQT I DENTI FICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT ADDRESS 11q3�Q O L BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 15008 OWNER' NAM/E� PLAN CHECKVA ATION i, CVQTV. ELECTRIC PERMIT FEE �J PHONE J-�/\ �] / f CONTRACTO S NAE / q �j UTLETS-SWITCHES-RECEP 10.00/1.00 _ /S/lC 2 G� ¢.rvcyJ�/ 9 LIGHTING FIXTURES 10.00/1.00 CONT ACTORRS �j APPLIANCES-RESIDENTIAL 4.00 (J(J PHONE�u� Gp-� PANELS 10.00 DATE OF APPLICATION ARCHITECT- P.C.-NO.PANELS (OVER 200 AMN 20.00 PLAN CHECK FEE' ENGI Lb1 LIC.No - SIGNS TRANS. 3.00 ARCH.OR Us PERMIT VALIDATION ADORE3`5�.- �00 �esn� SPECIAL CIRCUIT 5.00 ✓ L„9G� zIP 04 EMP.METER OR POLE INS. 20.00 (�APPLICANTS y� / MOTORS SEE FEE SCR. \kl �[J LjJp/ SERVICE CHANGE 20.00 woo LICF-N ED CONTRACTORS DECLARATION a v I hereby affirm that I am licensed under provisions of Chapter 9 S/ r z w ECT. DATE (commencing with Section 7000)of Division 3 ol'the Business and W Professions Cod an m license is in full fory'y�ylppf'ce4 BLDG. ELECT. PLO, MECH. z o y'� Licpms y Lic.Number [r 6LI wr w D:Rc Contractor 1 It a W< OWNER-BUILDER DECLARATION D BUILDING PERMIT MISC.- REFER TO ORD INFORMATION E: ;' N I hereby al'frm that 1 mn exempt from the Contractor's License VA ATION u O in Law for the following reason.(Sec.7031.5,Business and Professions S/FT. quiresa permit to construct,alter, PERMIT ISSUANCE 10.00 m At Code:Any city or county which re p ar 2 ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. n wCLL requires the applicant for such permit to file a signed statement that _ TOTAL he is licensed pursuant to the provisions of the Conlmctor's License ,nOPERMIT I-zQLaw(Chapter 9(commencingwith Section 7000)of Division 3 ofthe ,�ss Z i O Business and Professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT BftV /CYj/04 Q.� ¢ r-$ lire basis for the alleged exemption.Any violation of Section 703 t.5 STORIES TYPE CONSTR. u ; _ by any applicant for a Permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($500).): ❑ L as owner of the property,or my employees with wages as BACK FLOW PROTECT-DEVICE 4,00 OCC.GROUP RES.UNITS 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,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 5D.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenot intended or offered for sale,If,however,the budding GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2,00 \ builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30,00 RES IND CON PB other ❑ I,as owner of the property,am exclusively contracting with C3 1:1El ❑ 1:1licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-.1 INC 5 V.B. 600 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 a contractor(sl licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. lam reasum exempt under Sec. ,B.&P.C,for this WATER HEATER W/VENT 6.00 ' l Owner, Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORKS RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy,throcof ISec.3800,LaEC.I. �G0 Policy No. Com any O ❑ CerliDed o is her by for 'S d. FIRE SPRINK ENERGY T-24 Z Z ❑ Car y fi ed to m y inspection division. S+ Applicant MISC.- REFER TO ORD. Y ❑ N❑ v ❑ ' No cy CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD2oNE A.L.U.C. LU COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLO. EL O Illus section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ D 0 hundred dollars IS 100)or less) I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not employ any person in any manner so as io O W become subject to the Workers Compensation Laws of California. n Dale ApplicantALTER OR ADD TO MECH. 5.00 BUILDING } 0 NOTICE TO APPLICANT: If,after making this Certificate of Ex- 2 emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK ' provisions of the Labor Code, you must forthwith comply with FEE C.0 such Provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.FM,) 6.00 SEISMIC FEE 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 6 issued(Sec. MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Leader's Name H EATING UNIT(OV ER 100,000 B.T.U.)Leader's Address ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 informationcorrect. S Ctat11 agree tcomply with all city and county PLUMBING ordinances and state laws relating m building construction, and BOILER-COIx'tP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. BOILER•COMP(Over 100,000 BTU)SEE FEE BCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO,ORD. uperium nst Iia lines,judgments, costs and expenses which CONST.TAX may in y ay ace a against said Cil consequence of the PERMIT ISSUANCE - 10.00 an f is permit. MECH.CONT. LIC.NO. MECH. _ TOTALTOTAL ' _1A Signature of Applicant/Co hector eta Dat OFFICE COPY