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15910 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER ' CITY OF CUPERTINO 15910 INSPECTION DIVISION JOB INSPECTION RECORD • - Iaa� PERMIT EXPIRATION JOB ADDRESS./01.,9�3 "' Wil as �UNIT# / _LOT# •PERMIT EXPIRES IF WORK OWNER -V6 CONTRACTORS CLf<p Lit, Rf rj IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE: 180 DAYS OF PERMIT ISSU- WANCE OR 180 DAYS FROM LASTCALLEDINSPEC710N. ' UFER. ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUTO COMPLY WITH THE APPROVED PLANS AND CITY OF .PERMIT VALIDATION GARAGE SLABS ITE CUPERTINO STANDARDS. GARAGE pq ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING q� v L ELECTRICAL \ ISSUANCE LATE MECHANICAL BLDG. ELECT PLG MECH PL(OG. ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT _ INFORM_ ATION WOOD FLOOR VALUATION SIFT, PLUMBING - MECHANICAL PERMIT TO ELECTRICAL - FRAMING STORIES TYPE CONSTR. INSULATION \ OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - - ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE' sa,IT FLoon ARCA Tor AL ACREAGE <� THE CONSTRUCTION TAX IS PAID ' DIAPHRAGM BUILDING USE ROOF SHEATHING RES No CON PR 00", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ E-1 ❑ ❑ Cl ROUGH SAN.# A ASSESSORS PARCEL NO PLUMBING - ELECT.ENERGY IRAf,T NO. PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACG FILE No < FRAMING ELECT.FINAL TEST ' INSULATION PLUMBING ZONING ENG,SITE NO. GAS TEST GAS ' I MECHANICAL FIRE SPRINK ENERGY T 2n Y El NEI v El NE]COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING l FLOOD LONE PLUG. ' EXTERIOR SHEAR ELECTRICAL RELEASE v� NEI r L7 N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH_ TEMPORARY APPROVALS BUILDING PLAN CHECK SCRATCH COAT ELECTRIC I lo- 3 - GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS-BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O�. PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE -. IMPORTANT! CONST..TAX PLEASE READ REVERSE SIDE BEFORE . "c`s',"d' ° CALLING FOR FINAL INSPECTION., TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATIOIU WITHfN RED LINES - USE BALL POINT PEN ONLY ��`• BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDINGJ- APPLICATION & PERMIT 15910 ADDRESS BUILDING - ELECTRICAL-PLUMBING-MECHANICAL /0/.43 U. tela[. Qct /oma Cri S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE AVE PRONE CONTRACTORS 2- rvAME Z UTLETS-SWITCHES-RECEP 1'l1':CO/T.90 1,5 tr'7C'alI].e LIC.No.C/0-,�yl LIGHTING FIXTURES 60 .30*-.80 ' v80 9,' 45 ADDRESS S PPLIANCES-RESIDENTIAL 4.00 DD�Ra,E�S /I� L(rU,Je7I/�11r OPpS /4(.LQAr, PHONE.(]1/0b / - . PANELS (1�D�-M1BfOO .QQ DATE OF APPLICATION ARCHITECT PLANCHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER ' LIC.NO. SIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION SS zip TEMP.METER OR POLE INS. 20.00 ADDRESS � MOTORS/-30CJA /-7+%Z SEE F . /$. ADDRESS /p „gyp, S Jb - SERVICE CHANGE 20.00 w o o LICENSED CONTRACTORS DECLARATION �r L/(a'u�T2AG 0 70 /�J l� 7/dot' c Er w 1 hereby affirm that I am licensed under provisions.(Chapror 9 (t\\ ISSUAIGCE DATE H < (cmnntencing with Section 7000)of Division 3 of the Business and O BLDG. ELECT. PLG. MECH. H m i Professions Cole and my license is in full force un rffec. ❑ ❑ ❑ z o m - License CIa s Lie.Number Y (��,�__..�� 4 z w Date Commctor�El ¢y s - BUILDING PERMIT ¢ ¢ w OWNER-BUILDER DECLARATION INFORMATION X o u w I hereby affirm that 1 am exempt from the Contractor's License MISC.- - REFER TO ORD 3 VALUATION $/FT. Fgoa Law forthe following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 11�(Q9.90 w� Code:Any city orcounty whlchrequlresapermiuo mnslrurL alio, ¢ ¢ Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.�CO�NTR. LIC.'NO. ELEC. n O¢ requires the applicant for such permit to file a Signed statement that (.(.!7/1�+L G�, I Co TOTAL PERMIT TO F m he is licensed pursuant to the provisions of the Contractor's License G/Lv4�Y Fit Law(Chapter 9(commencing with Section 70(0)of Divieiii ofthe a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE 5 D STORIES TYPE CONSTR. e. I-$ by basis for the or aA exemption,Any violation of Section en L$ d ; � by any applicant fora permit subjects($500)the licannoacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(1500).): ❑ I,as owner of the property,or my employees with wagesas BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Cade:The Contractor's License Law does not apply to an owner of _ proper,, who builds or Improves Iluacon,and who Ines Such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE • mems are not hrough ownemployees,for sale. If,ed however, the improve- ments mprove- GAS-EA.SYSTEM-1 6.00 mems are not intended or offered for sale.If,however.the bathing or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have ihr burden of proving that he did not build or int- RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ID I, ❑ .❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Basincis LAWN SPRINKLERS-I INC5 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 for such projects with a contracloos)licensed pursuant to SEWER-SANITAR Y-STORM EA.200h/10.00 I he Contractors License Law. TRACT NO. PARCEL NO. ❑ I am exempt under See. ,B.&P.C.for this WATER HEATER W/VENT 6.00 re:Ia.I1 Owner Date WATER SYSTEM 5.00 ACC.DATE ACG FILE NO. WORKERS'COMPENSA'I'ION 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.Li b.C.). Policy No. Company, 1 44 - Q ID Certified copy is hereby fornlsh,d. FIRE SPRINK ENERGY T-24 Z Z y� Certifie co�'yy is filed�I trI I nspection division. MISC.- REFER TO ORD. O Applicant !'p 0 V❑ N❑ V❑ No T CERTIPICAT Ii OF EXEMP"PION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU >_ COMPI'.NSATION INSURANCE PLG.CONTR. LIC.NO. PLG. EL O ('Phis section need not be completed if the permit is far one TOTAL Y❑ NE] Y ❑ N❑ 7) Z hundred do]lots IS 100)or less,) U O I certify that in the performance of the work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY IL F mit is issued,I shall not employ any person in any manner so as to Ubecome subject to the Workers'Compensation Laws of California. ED Date Applicant ' a ALTER OR ADD TO MECH. - 5.00 BUILDING } m Nuptio i TO APPLICANT: If,:deer making this CertificatePe yf nix H ? or Visin Ofshouldbecomesubject to tire Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions io the Leber Code, you must forthwith comply with FEE U such provisions or This permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10MC.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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 6.00 - Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that 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 stun, Iowa relating to building construction, and BOILER-00MP.(3 H.P.or 100,000 B.T.U.) 8.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCI. MECHANICAL above-mentioned property for inspection purposes. (We) agree to Savo, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE - 10.00 mnlin is pe nn it. MECH.CONT, LIC.NO. MECH. . > TOTAL ECH, [:TOTAL: Signatar of Applicant/Contractor Uule OFFICE COPY