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15684 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16$4 INSPECTION DIVISION JOB INSPECTION RECORD g PERMIT EXPIRATION JOB ADDRESS Wo« 'Q UNIT# LOT# - - PERMIT EXPIRES IF WORK OWNER CONTRACTOR e L CON'S7 Co, IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT.ISSU. FOUNDATION - ANCE OR 180 DAYS FROM NOTE: UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. • PR EGUNITE'. TO COMPLY WITH THE APPROVED PLANS AND CIT'OF rERmrt VALIDATION GARAGE SLABS CUPERTINO STANDARDS. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ' PLUMBING - ELECTRICAL ISSUANCE DATE ' MECHANICALRLuc ELECT, PLG. MECH PAS ' ❑ 1 ❑ 1 ❑ ❑ _ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �c� : ' BUILDING PE IT WOOD FLOOR �`„ INFORMATION VALUATION T. ' PLUMBING - IV Ir MECHANICAL Vv V ELECTRICAL - PERMIT ro FRAMING ' OVEN INSULATION STORILS't TYPE CONSTH, Ucc GROUP '•RES UNITS —� PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn FrFLooR AREA TOTAL acacacL . DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING HES IND CON Pg Om., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Cl I] L L 0 ASSESSORSPARCF,L NO ROUGH SAN.# PLUMBING . ELECT.ENERGY _ TRACT NO, PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY - MECHANICALMECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO FRAMING e2m&L .1 ELECT.FINAL TEST _• ZONING ENG SITE N0. INSULATION - PLUMBING ' GAS TEST - GAS FIRE SPRINK ENERGY T,24 MECHANICAL v NL ❑ N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD zorve aL.0 C. INTERIOR SHEAR - 'FIRE DEPT. Y ❑ N❑ Y L NL SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC - - PLAN CHECK GAS 7 - FEE p. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. SEISMIC FEE �L7 OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o^ LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX p PLEASE READ REVERSE SIDE BEFORE c TOTAL lJ p CALLING FOR FINAL INSPECTION. OFFICE COPY' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY �. BUILDING PROJECT I DEVTI FICATION PERMIT NUMBER BAD UIILDIN568 G 1 4 , F Q4 rl APPLICATION & PERMIT 1 R BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1 4 Ow�]N�Ef/g��SE �V per/ t QTY ELECTRIC PERMIT FEE PLAN CHECK VALIDATI . I . - x71= !- ONE NAME CONTRACTOR \ NAME / - y2,,,.,.,, ,��II11,,,� [OUTLETS-SWITCHES-RECEP ' 10.00/1.00 -i'luL 6w . "CLIC N-30 00 . LIGHTING FIXTURES 10.00/1.00 ADDRESS offs APPLIANCES-RESIDENTIAL 4.00 ADDRE�SS' ly C PHONE(4Y�g47-(3(p PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE ^C.NO. oR ENGINEER uc.No. SIGNS TRANS. 3.00 - ARCH.ORErvG. �. SPECIALCIRCUIT -5.00 PERMIT VALIDATION aDOREIS Q�/ryy�� t4 //Ir// EMP.METER OR POLE INS. 20.00 -' avvucaurs MOTORS SEE FEE SCH. ' ADDRESS . ' pO SERVICE CHANGE 20.00 O o 0 LICENSED CONTRACTORS DECLARATION 1 ¢v v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE H 3_N LL'ommencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. r y z Professions Code and hey license is in full forty aad,{ff ❑ '❑ ❑- z O w License Class f Lic.Numft<•I 2Q ""v] o L t: DuteT�y-lZl /�ContractorGiC IJ - `¢ Y s ,EBQILDING PERMIT ¢ ¢ IL¢ OWNER-BUILDER DECLARATION FORMATION wOu0 ` MISC.- REFER TO ORD ; u I hereby ulfinn that 1 um exempt from the Conlmetnr's License - VALUA ION - S/FT. H .. Oa Law for the following reason.(Sec.7031.5,Business and professions PERMIT ISSUANCE - 10.00 Code:Any city or county which requires a permit loconstruct,alter. //fTVYf a ¢ 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CENTEL LIC.NO. ELEC. K O¢ requires the applicant for SIICM1 permit to fill 8 Signed alall'ml'nt IItBf TOTAL PERMIT TO u w se he is licensed pursuant to the provisions of the Contractor's License r z i Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. n ;m by any applicant lora permit subjecisthe applicant toacivilpenalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars IS5001J. ❑ 1,as owner of tile m e property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole colo pensafiun,will do the work,and the structure is not intended ar offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law docs not apply to an owner of property who builds orimproves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE himself re through his own employees,provided that such improve- merits mselfonot intended oroffered ees,provided thathowever,Ihimproing GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 or Improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 IEA,) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im RES IND CON PB Omar prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 E1 IN ❑ ❑ I,as owner of the property,am exclusively contracting with 0 El licensed contractors to construct tale p...per(Sec.7044,Business LAWN SPRINKLERS-I 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(EA.) 1.00 contracts tbrsuch projects wish a contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO. ❑ lain exempt under Sic.-,BARC,for this WATER HEATER W/VENT 6.00 reason Owner hate WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPHNSATION 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 thereof(Sec.3800,Lath.C.). Policy No. - CompanY�ll,L1A eernC Hl,iv�l RSV 4 O jE Certified copy is hereby jurnishcdf74Ql;4Q( `jD-OWP) FIRE SPRINK ENERGY T24 Z Z ❑ Certific p is EI /with IfC coy inspection division. MISC.- REFER TO ORD. Q Applicant \ Y NE] Y 0 NE] H y PERMIT ISSUANCE - - 10.00 W_ zoNE A.L.U.C. cc CIi R'I'IRICATE E BAEiON ION RAN WORKERS' d O COMPIiNSAI'ION INSURANCE kANCIi PLG.GONTR. LIC.N0. PLG. ❑ ❑ (This section need not he completed if the permit is for.one TOTAL Y N Y N Z hundred dollars(5100)or less.) U O I certify that in the performance of the work for which this per- DTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any lemoner so as to U become subject to the Workers'Compensation Laws of California. y Dam Applicant ALTER OR ADD TO MECH. 5.00 FELECTRIC 7Lf } m NOTICE ilio APPLICANT: If,after making this Certificate of hx- Z emption,you should become subject to the Worker'Compensation APPLIANCE 5.00 provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10PMC.F.M.) 4.00 /] CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 N � 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. HEATING UNIT(TO 100,000 B.T.U.) 6.00 3097,CN.C.). Lenders Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address I certify that l have readthis application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct m 1 agree to comply with all city and county - PLUMBING ordinances and state laws relating m building construction, aBOILER-COMP(3 H.P.or 100,0008.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,0008TU)SEE FEESCH. MECHANICAL \ uho,rucationed property for inspection purposes. (We) agree to save,-indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ' may in By way Bee a against said City in consequence of the rondo of is per MECH.CONT: LIC.N0. MECH. / TOTAL TOTAL O(p Sign lure of Applicant/Contractor Date OFFICE COPV r