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15521 IL POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 155.21 ' INSPECTION DIVISION JOB INSPECTION RECORD' PERMIT EXPIRATION :JOBADDRESS 10123 North Wolfe RC1. UNIT# (0 LOT# PERMIT EXPIRES IF WORK OWNER Things RememberedCONTRACTOR IS^NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION'RECORD 180 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 PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING - - ELECTRICAL - ISSUANCE DATE MECHANICAL BLDGELECT PLG. MEC. C3 ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING - VALUATION MECHANICAL - PERMIT TO ELECTRICAL FRAMING STORIES" TYPE CONSTR, INSULATION ' OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED sa.Pr.PLooR Alien rorwL wc+Ewcu ' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE ' DIAPHRAGM THE CONSTRUCTION TAX IS PAID BU LDING USE ROOF SHEATHING RES BVD CON 'PB amr, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 El 0 1:1 A55ESSUHS PARCEL NO ROUGH SAN.a PLUMBING - ELECT.ENERGY - rRncr No PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY . MECHANICAL MECH.ENERGY ACC DATE ACC FILE NO. 4 ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING - GAS TEST GAS .. MECHANICAL FIRESPiaNK ENERGY T.]a COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` ❑ NO . ❑ NO pF u+DD ZONE ALUC. EXTERIOR SHEAR ELECTRICAL RELEASE O • INTERIOR SHEAR FIRE DEPT. - Y [—] NE vL NQ. I SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING I- SCRATCH COAT - ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL'ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR' MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 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 .PPLICANT.TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER BUILDING - APPLICATION & PERMIT 1 7) ADDRESS ,-` / � I J J d- A/E b)w4 e- BUILDING-ELECTRICAL-PLUMBING-MECHANICAL LARRIsH NAME PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE NTRA 7 R s laeula. NAMERacfTORs/ UTLETS-SWITCHES-FECES 10.00/1.00 -/r4 - L 1 tOrd LIC.NO. 19 1 l2 LIGHTING FIXTURES 10.0011.00 ADDRESS OR's ,O l. - ' G4i� APPLIANCES-RESIDENTIAL 4.00 ,ytots, t1(yPHONE $3' 4-( PANELS 10.00 "' DATE OF APPLICATION . ARCHITECT PLAN CHECK FEE P.C.NO. on � ��,, PANELS (OVER 200 AMP) 20.00 E�a�` LL SCJ9p4 rW•la[5e"SUc.No. SIGNS TRANS. 3.00 ADDRESS eNc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 ADDEPPLID TS - MOTORS SEE FEE SCH. ADDED - SERVICE CHANGE 20.00 ,00 0o LICENSED CONTRACTORS DECLARATION a i w I hereby affirm that 1 am liumard under provisions of Chapter 9 _ ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT- PLG. MECH. w i Professions Codpl•a license is in full forcepl� e{[ - z 0 w- Li-en s .I ` Lic.Number r 7 -i Z 1 m -0 Date _Contractor a m 2 BUILDING PERMIT rc M w car OWNER-BUILDER DECLARATION INFORMATION K 3 LL I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD I 'A VALUATION $/FT. o¢ Law for the following reason.(SEC.7031.5,Easiness and Professions r LL PERMIT ISSUANCE 10.00 Code:Any city.,county which requires a permit to construct,alter, B IS¢o improve,demolish,or repair any ahucture,prior[o its issuance,also ELEC.CONTRA LIC.NO. ELEC. a S, requires the applicant for such permit to file a signed statement that TOTAL PER TO K m ui he Is licensed pursuant to lite provisions of the Contractor's License r z < Law.(Chapter 9(commencing with Section 7000)of Division 3 of the 4 0 Busness and Professions Code)or that Ile is exempt therefrom and OTY. PLUMBING PERMIT FEE BE F o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES - TYPE CONSTR. u , .. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER'(EA.) 5:00 of not more than five hundred dollars($5001.)'. ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 Dec.GROUP Res.UNITS their 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 • properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD,FT.FLOOR ARE. TOTAL ACREAGE himself or through his own employees,provided that such improve- Rantsare not intended uroffered for side,If,however,the building GAS-EA.SYSTEM-1 INC.4 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 Or im- GAS-EA.SYSTEM-OVER 4'(EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. - 30.00 RES IND CON PB Omer ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ 0 11 licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO. and Professions Coda:The Contractor's License Law dues 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 contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10,00 TRACT NO, PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner -ORIF.aConE �n pat WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO. s S t DbcLARAT N WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO. of a certificate of Workers'Compensation Insurance,or a certified - copythereoftSec.3800,Lab,C.)Ly �k Policy No. Company ff _ - O ❑ CeftiLedc �� FIRE SPRINK ENERGY T.24 Z Z ❑ Certified is I y inspection ivmon. O Applicant Z MISC.- REFER TO'ORD: Y❑ N❑ Y ❑ No W CERTIFICATE OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C., LU COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. a 0 (This section need not be completed if the permit is for one TpLG. O Y❑ N❑ ❑v N F] LD Z hundred dollars($100)or Iesa) U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT E FEE SUMMARY LL F- mit is issued,1 shall not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of California. Dme A licent BUILDING IL, PP ALTER OR ADD TO MECH. 5.00 Q } m NOTICE TO APPLICANT: If,after making this Certificate of Ex- F 2 emptlon,you should become subject to the Workers'Compensation APPLIANCE PLAN CHECK provisions of the Labor Code, you most forthwith comply with FEE U such provisions or this permit shall be deemed revoked. ' AIR HANDLING UNIT ITO 10=C.F.M. CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 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 is issued(Sec. - - MICROFILM 3097,Co.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify riot I 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-COMPI3H.P.or100,000B.T.U.) 6.00 hereby authorize representatives of this City to enter upon the .BOILER-COMP IOVB1100,000 BTU)SEE FEE SCH. MECHANICAL a V� above-mentioned property for inspection purposes. -�� (We) res to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cuperti against hall ities,judgments, costs and expenses which CONST.TAX may i y way an ainst said City in consequence of the PERMIT ISSUANCE Hf.6B ranti g f is pe MECH.CONT. LIC.NO. MECH. 6/7I�(� �- TOTAL ��U. TOTAL ' ignature of pplame Contractor 1e ate// V OFFICE COPY