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15907 �• -POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER I 1 ,T CITY OF CUPERTINO 15907' INSPECTION DIVISION JOB INSPECTION �JRECORD 1.(N _ - PERMIT EXPIRATION JOB ADDRESS �V 1 E— _UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER C `J oNrq c 1�1 J IS NOT STARTED WITHIN I SPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION - - . ANCE OR 180 DAYS FROM NOTE:. p LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INS fA D PREGUNITETO'COMPLY WITH THE APPROVED PLANS AND CITY OF 19p PERnur vnuonnoN CUPERTINO STANDARDS. Jv� 1 V GARAGE SLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 100 - UNDERGROUND /SLAB- C11Y � (Mj, )4�1. 1 PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT FL77 MEC DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL PERMIT TO ELECTRICAL ` ,,I J,i FRAMING INSULATION STORIES TYPE CONSTR. OCC.GHOUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '11 I\/1 ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO FT.FLOORAREA TOTALACREAGE DIAPHRAGM' THE CONSTRUCTION TAX IS PAID BUILDINGUSE ROOF SHEATHING - RES IND CON PB 01n1.1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ROUGH SAN.a ASSESSOR SPARCELNO •_ PLUMBING ELECT.ENERGY - -�'' ''• I 'J-�� TRACT NO PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL pd6 MECH.ENERGY ACC DATE ACC.FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST ' ZONING ENG.SITE N0. INSULATION PLUMBING GAS TEST I GAS _ MECHANICAL FIRE SPRINK ENERGY r.74 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "o NCD EXTERIOR SHEARELECTRICAL RELEASE FLOOOZONE A,L.UC. INTERIOR SHEAR _ FIRE DEPT. - ❑ NEIY 01 IN SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH - TEMPORARY APPROVALS BUILDING SCRATCH COAT JELECTRIC - PLAN CHECK GAS - + FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE . OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. OCROFILM 'ARRANGE FOR INSPECTION BY PHONING 252-4505, Ll ELECTRIC tom- ONE WORKING DAY BEFORE REQUIRED INSPECTION. . . O� PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING Z -,SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! I CONST.TAx• c PLEASE'READ REVERSE SIDE.BEFOREr 1 TOTAL ~ CALLING FOR FINAL INSPECTION. OFFICE COPY s APF' ICANT'JO FALL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY — BUILDINGPROJECTIDENTIFICATION 1PERMIT NUMBER - J_A ,� APPLICATION & PERMIT q [Q0� dES I J J 3 O ' BUILDING—ELECTRICAL—PLUMBING—MECHANICAL - �_' S - PLANCHECK VALIDATION MCITY. ELECTRIC PERMIT FEE coaJean5Ca anERAcrDRs UTLETS-SWITCHES-RECEP 10.0061.00 ' LIGHTING FIXTURES 10.00/1.00 forvrRACrORs PPLIANCES-RESIDENTIAL 4.00 ' A ES PHONE PANELS 10.00 DATE OF APPLICATION' ARCH CT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO; ENGINEER . LIC.No. SIGNS TRANS. 3.00 ARCH,OR ENG. PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5,00 ZIP EMP.METER OR POLE INS. 20.00 _ AODRlessTs MOTORS SEE FEE SC 11P AID— �l SERVICE CHANGE 20.00 ,1` �(y��[��, woo LICENS17D CONTRACTORS DECLARATION' a v I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE y a uwAi (commencing with Section 7000)of Division 3 of the Business and DG ELECT. PLG. MEC f N 2 Professions C license is in full fu r f G i u, o License Cly Lic.Num - ❑ ❑ X. Cs w Contrucm It n¢ a OWNER-BUILDER DECLARATION BUILDING PERMIT F 0 w u INFORMATION F ;LL w I hereby affirm that I am exempt from the Contractor's License MISC.— - REFER TO ORD F u O J Law for the following reason.(Sec.7031.5,Business and Professions pEflM1T ISSUANCE 10.00 VALUATION SIFT. ode:Any city or county which requires a permit to construct,alter, ac aa 2 1 rove,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. - ELEC. wDLL re Tres the applicant for such permit to file a signed statement that TOTAL PERMIT TO $ he i icrmLd pursuant to the provisions of the Contractor's License ri>w Law( after9(commencing with Section 7000)of Division 3 of the ADD fVt C/'�-�- _ i O Bus ties ad Professions Code)or that lie is exempt therefrom and DTV. PLUMBING PERMIT FEE ��X''�e--��•✓✓ I I lG✓w 2 I- the basis r the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any app' am tura permit subjects the applicant toacivilpenalty ALTER-DRAIN -WATER (EA.) 5.00 of not more an five hundred Dollars(55001.): ❑ I,as ow at of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC,GROUP RES.UNITS their sole compo axiom will do the work,and the structure is not intended or offere for sale(Sec. 7044, Business and Professions DRAINS�FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contract 's License Law does not apply to an owner of property who builds improves thereon,and who does such work FIXTURES-PER TRAP 5,00 SQ FTFFLWR AREA TOTAL ACREAGE himself or through his n employees,provided that such improve- mentsorenotintelsdedo fl'crcd for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 ' or improvement is said wit 'n one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden f proving that he did not build or int- RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30,00 ❑ 1,as owner of the proper ,am exclusively cam roc ting with0 11 11 13 El licensed contractor to construct he project(Sec,7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contract 's License Law does not apply to an owner of property who builds improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts for such projects with a cont -torts)licensed pursuant to. SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law. 'TRACT NO. PARCEL NO. ❑ I amexempt under Sec. ,B.&P.C.far this WATER HEATER W/VENT 6.00 reason Owner Uate WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK E RS'COMPENSATION DI:CLA TION WATER TREATING EQUIP„ 5.00 - - I hereby affirm lost I have a certificate of consen o self-insure, .ZONING ENG.SITE NO. or a certificate of Workers'Compe1n^/sa/tion/Il rh yante, a Certified copy the rf'9fj$pesj§pQ.kp y T—L4.f2�'1 •r Policy Ndd..�bLL n eny_ ILl(moi. - O ❑ Ccrf lied copy is"hereby furnished. FIRE SPRINK ENERGY T24 Z Z ❑ rt ifi copy Is IC sp aspection division. O Applicant s�,{L_.'L! MISC.- - REFER TO ORD. . y [] N Y ❑ SNC ~ H PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U.C. LU — CERTIFICATEPr EXEMPTION FROM WORKERS' W COMPENS ATION'INSURANCE.. PLG.CONTE. LIC.NO. PLG. N Y N❑ Z is section need not he completed if the permit is for one TOTAL _ hundr ollars IS 100)or less.) L) O 1 certi at in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY W F mit is issued, '111 not employ any Parson in any Manner so as LLS O W become subject to Workers'Compensation Laws of California. BUILDING OL Date Ap ant ALTER OR ADD TO MECH. 5.00 } to NOTICE TO.APPLICAN . after making this Certificate of Ex- �. ? emption,you should become a ct Io the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Csidc, yo ust forthwith Comply with FEE V such provisions or this permit shall be Lice d revoked, AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGE Y AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 hereby option that.there is a construction leading Lacy for EXHAUST HOOD-(WITH DUCT) 5.00 the performance of the work for which this permit is issu (Sec. OCROFILM 3097,CiYC.). HEATING UNIT(TO 100,000 B.T.U.) g00 Lenders Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC ' I certify that I have read this application and Slate that the above VENTILATION FAN (SINGLE) 4.00 information a Correct. I agree li g to b with all city and county .PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 ^ hereby authorize representatives of this city to enter upon the gO1LER-COMP(Over 100,000 BTUI SEE FEE SGH. MECHANICAL QI abovL-mentioned property for inspection purposes, (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.pertino against liabilities,judgments, costs and expenses which' CONST.TAX [�ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00f�p an�f this pe —7 „/� ME LIC.NO. , MECH. �'�' 'L„x��^aJII � TO TOTAL &gai re o Applicant/Contractor Uate 2 OFFICE COPY