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15666 POST THIS. CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 15666 INSPECTION DIVISION .� JOB INSPECTION RECORD "` �6, 10541 PERMIT EXPIRATION JOB ADDRESS �0 / 0LFL UNIT# _LOT# //11 PERMIT EXPIRES IF WORK, OWNER CONTRACTOR 4m,, J" j' IS..NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPEOTION 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 PERMIT VALIDATION CUPERTINO STANDARDS. , GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BO ELaT P© MK� i 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT INFORMATION PLUMBING WOOD FLOOR VALUATION $/FT. � - - MECHANICAL ' ELECTRICAL PERMITT ' FRAMING INSULATION - STORIES TYPE CONSTR. lzOFC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - SO FT FLOOR AREA TOTALACREAGE ROOF NOTE:NO FINAL INSP.SHALIP .9 EFORE DIAPHRAGM THE CONSTRUCTION TAX IS A D BUILDING USE ROOF SHEATHING RES IND CON PI Du. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE -INSP. [I El 0 1:3 0 ASSESSORS PARCEL NO. ROUGH SAN.# - L . PLUMBING 0 ^ ELECT.ENERGY I TRACT NO, PARCEL NO, TUBS&SHOWER PAN PLUMBINGENERGY MECHANICAL MECH.ENERGY T ELECTRICALBUILDING ENERGY ACC DATE ACC.FILE NO. I FRAMING ELECT.FINAL TEST INSULATION PLUMBING. ZONING ENG.SITE No. GAS-TEST., _ GAS MECHANICAL FIRE SPRINK. ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED TtEATING I Y � -"E ° "C . . . EXTERIOR SHEAR ELECTRICAL RELEASE FLQOD ZONE ALU.0 INTERIOR SHEAR, FIRE DEPT. - Y❑ N Y ❑ "D' SHEETROCK GRADE - FEESUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS - NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCVOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. ' Z — SEE PERMIT FOREXPIRATION DATE = MECHANICAL IMPORTANT!, i ;; coNST.TAx P , PLEASE.READ REVERSE SIDE B�FORE CALLING FOR FINAL INSPECTION. TOTAL 3� OFFICE COPY ' APPLICANT TO FILL-IN INFORMATION-WITHIN RED LINES - USE BALLPOINT PEN ONLY �'� - - - PERMIT NUMBER •_�Vll oINC_S LLDING PROJECT.I DENT]FICATION APPLICATION & PERMIT `jk " A GREE !� *�- f BUILDING—ELECTRICAL-PLUMBING—MECHANICAL 15666 NAMER'E +' PLAN CHECK VALIDATION NAME A T DTV. ELECTRIC PERMIT FEE TN NTRACTOR'S \-•J - n A - UTLETS-SWITC HES-RECEP 10.00/1.00 SLlc.ry LIGHTING FIXTURES 10,00/1.00 CONTRACTORS -- m- APPLIANCES RESIDENTIAL '4.00 PANELS ,10.00 . DATE OF APPLICATION ARCM CT PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 " ENGINEER - Lic.NG. SIGNS TRANS. 3.00 ARCH.OR ENG. . - PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 zip TEMP.METER OR POLE INS. 20.00 APPLICANT'S - - - ADDRESS - MOTORS ' .SEE FEE SCH. • r ,. SERVICE CHANGE 20:00' U 09 LICENSED CONTRACTORS DECLARATION 'ca u' I hereby affirm that i am licensed under provisions of Chapter 9 .. 2,w ISSUANCE DATE y < n (commencing wit Section 7000)of Division 3 of the Business BLDG.' ELECT. PLG. "MECH. Profession C icen Liis in full f r ❑ ❑. Z z m W Licen e C ss Lic.Numb r Date1`➢ I1��� Contra _ ¢ ¢-w a O NDER DECLARA O BUILDING PERMIT — 0 d o - - INFORMATION `x ; I hereby affirm that 1 am exempt from the Contractor's License MISC.— _ REFER TO ORD la u O j Law for the following reason.(Sec.7031,5,Busines-sand Professions VALUATION $/FT. — PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct, alter, ' ¢ ¢ <0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELECca K . cz u requires the applicant for such permit to file a signed statement that TOTAL - - PERMIT TO u w m w' he is licensed pursuant to the provisions of the Contractor's License ft p / t'y�-/�/ F i c Law(Chapter 9(commencing with Section 7000)of Division 3 of the `48 — tx /_L�-7✓ i o Business and Professions Code)or that he is exempt therefrom and ny�yv� PLUMBING PERMIT FEE ¢ I- es the basis for the alleged exemption.Any siolation of Section 7031.5 1 N STORIES. TYPE CONSTR. n ;� by any applicant fora pemtit subjects the,appli - - . canttozcivilpenalty ALTER-DRAIN IEA) 5.00 of not more than five hundred dollars(S500).)i ' '❑ I,as owner of the property,or my'employees with wages as - BACK FLOW PROTECTDEVICE 400 their sale'Compensation,will do the work,'m .nd the structure is not , OCC.GROUP, RES.UNITS , .t 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 sG.Pr.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improves _ . . mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 - or improvement.is sold within one year of completion,the owner- USE GAS-EA.SYSTEM-OVER 4(EA.) "2.00 builder will have the burden of proving that he did not build or int- BUILDING prove forpurpose of sale.). - INDUSTRIAL WASTE'INTER. 30.00 - ,,,RES 'IND 'CON PS other ❑ 1,as owner of the properly,am exclusively contracting with ❑ El ❑ ❑ ❑ licensed ecntiacWO4o construct the project(Sec. 7044,Business LAWN SPRINKLERS.-1 INC 5'V.B. 6.00 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 IEA.) 1 contracts for such projects with a eontmetor(s)licensed pursuant to _DYER - theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10. TRACT NO. .PARCEL NO. ❑ lamexempt'under Sec. ,B.&P.C.for this . WATER HEATER W/VENT 0 "' reason Owner Date' WATER SYSTEM - Ace.DATE ACC:FILE NO. WORKF-RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 'Oy O Ino - 1 hereby alllrm that I have a certificate of consent to self-insure, - ZONING - ' . 1 ora certificate of Wo ejj��11 pet on Insurancg,Or a cern fief ENG.SITE NO. ropy the o cl ,ILJhC). r( �,JI/ry"'LC copyYN m�f{hanY till ' ❑ Certified Copy is hereby furr115 'd. *.-0, - - , FIRE SPRINK ENERGY T]4 ��erf it, 'opYis filed wit t 'it idivision. - MISC.+ REFER TO ORD. " 'Q O Applicant V' NEI Y1:1 NEI to PERMIT ISSUANCE CIiRTI FICATE OF EXEMPTION FROM WORKERS' FLOODZONE A.L.U.O. LLI COMPENSATION'INSURANCE - PLG.CONTR. LIC.NO. PLG, ' Z (This section need not be completed if the permit is for are TOTAL Y❑i N Y❑. IN hundred dollars(S100)m less.) O 1 certify that in the performance of the work for which this perms TV MECHANICAL PERMIT FEE FEE SUMMARY LL U mil is issued,I shall not employ any person in any manner so us to _ become subject to the Workers'Compensation Laws of California. M Date ApplicantALTER OR ADD TOM ECH. 5.00 - BUILDING ' } N NOTICE TO APPLICANT'. If,after making this Certificate of Ex- ? emption,you should become subject to the Workers'Compensation APPLIANCE 1- provisions of the Labor Code, you must forthwith comply with - 5.00 - PLAN CHECK C,) such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10,000QF.N1.) 4 FEE ' CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,000C.F.M.16. 0 ttJEISMIC FEE - I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.CJ. - , HEATING UNIT(TO 100,000 S.T.U.1 Lende'r's Name HEATING UNIT IOVER 100,000 B.T.U.) '1 - Lenders Address LECTRIC I certify that I have read this application and state that the above .VENTILATION FAN (SINGLE) information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H. ca-100,000B.T.U.) 6.00 ,r•�s S authorize representatives of this city to enter upon the BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify arid keep harmless the City of MISC.- REFER TO ORD. •` Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE - CONST.TAX may in any way,accrue against said City in cgnsequenc of the { ant of this per If MECH.CONT. LIG NO. MECH. TOTAL Signator of Applicant/Contractor Date I 3 - OFFICE COPY