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15939 �••.; POST THIS RD NEAFJ FRONT OF BUILDING PERMIT NUMBER CI1TOFW ERTINO ` 15939 INSPECTION' DIVISION• JOB.INSPECTION RECORD , .Ide� PERMIT EXPIRATION ' JOB ADDRESS �d� ""• I•t/OLrE �9 UNIT# ' _.LOT# • " ' /� . . .PERMIT EXPIRESHF WORK„ T , OWNER Nom. �q.�7CONTRACTOR 11� '�GtsGT,Qi C IS NOT STARTED WITHIN " INSPECTION DA 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 , ,TO COMPLY WITH•THE APPROVED PLANS AND CITY OF PERMrt VALIDATION PREGUNITE - -CUPERTINO STANDARDS.. " GARAGE SLABS., " . . ,:,• `� ^_r - POUR NO CONCRETE UNTIL ABOVE HAS JO SIGNED 'O+ �W.40444,— UNDERGROUND K, Y UNDERGROUND /SLAB ' laYC j:�+iApf L. I / v PLUMBING _ 4 . . ELECTRICALS issuANCE uaiE ' MECHANICAL 'j ELecr. 'PLG. .MECR, I OO,NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR - VALUAT1oN - - .• $ic T. .PLUMBING - MECHANICAL •..` '',,,`p` i '� .�j ELECTRICAL' FERMI TO - L - � � � •'_ .. r FRAMING INSULATION' risroRiEs rWrONSTR. - I , - OCC.GROUPRES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN GNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE' SO-PT,FLOOR AREA TOTAL ACRFACE - .'r DIAPHRAGM' _4' , - THE CONSTRUCTION TAX IS PAID :i BUILDING USE ROOF SHEATHING ,. "' v - RES- IND .CON PB o : APPLY NO ROOFING UNTIL ABOVE HAS EEN SIGNED FINALS DATE INSP. El' O 'Cl ❑ ❑ ROUGH ♦:, - ASSESSORS PARCEL NO SAN k PLUMBING ' ' - ELECT.ENERGY, ` TUBS 8 SHOWER PAN , PLUMBING ENERGY, •TRACT No. .PARCEL No MECHANICAL ' ' ' MECH.ENERGY ELECTRICAL' - BUILDING ENERGY .Acc.DATE ACC.FILE NO FRAMING •I• - ELECT.FINAL TEST " INSULATION,'.' ZONING ENG SITE NO. - PLUMBING - •• GAS TEST' 1-. - GAS - • '. ��,•. 'FIRE SPRINK ENERGY T24 MECHANICAL y ElCOVER NO WORK UNTIL ABOVE HAS EEN SIGNED. HEATING - • "� ° "� EXTERIOR.SHEAR - ELECTRICAL'RELEASE FLOOD ZONE - A.L U C. INTERIOR SHEAR - ' ', FIRE DEPT. Y� • N❑ YL7 "NO SHEETROCK - GRADE _ .. FEE SUMMARY EXTERIOR.LATH '• ILDING .INTERIOR;LATH:; '- TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC FEEN CHECK •�< `a GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDINGFINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM I ' ELECTRIC ., •_ ., ARRANGE-FOR INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE' REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB"ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! ''" coNST.TAX e PLEASE-READ REVERSE SIDE BEFORE S x CALLING FOR FINAL INSPECTION. TOTAL. OFFICE COPY. ' . {1P,PLICANT TO FILL IN INFgJWATION WITHIN RED LINES - USE MLL POINT PEN ONLY BUILDING PROJECT IDENTIFIC N - PERMIT NUMBER AooREss 3flAc£ /ooS APPLICATION & P IT 15939 h/ - dLF� BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S NAME -, • PLAN CHECK VALIDATION s�� Sl1nJShh/IJ£ B F I'� QTV• ELECTRIC PERMIT FEE C°NTflACTOR'S l�1'q/� NA/�+1Ef OUTLETS-SWITCHES-RECEP 10.00/1.000 `-"ACTORS U Guc No, 17V6�7 �� LIGHTING FIXTURES 10.00/1.00 ,p ADDRESS AOO°/)REss [' - PPLIANCES-RESIDENTIAL 4.00 • C - �jy GL"'_ PHONE 9g/'aoeo PANELS - ' 10.00 / ARCHITECT DATE OF APPLICATION OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.,NO. ENGINEER LIC.NO. SIGNS TRANS. 3.00 r0 ARCH,OR ENG. ADDRESS SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP EMP. METER OR POLE INS. 20.00 AvvucANrs MOTORS ADDRESS SEE FEE H. s.OQ O a i SERVICE CHANGE 20.00 /l/ / FOO LICENSED CONTRACTORS DECLARATION rt w I hereby affirm that 1 mn licensed under provisions of Chapter 9 - y¢ (commencing with Section 7000)of Division 3 bf the Business and ISSUANCE DATE ✓ r w i Professions Code, dor icense is in'full force a d effec B G. ELECT. PLG. MECH. Z O w - LicenseCF s Lia Number ' 7 O w h w Data /4 y ,d Conhador FaGT. p rc w u OWNER-BUILDER DECLARATION LfC• J �UIL ING PERMIT w 3 u y I hereby affirm Thal 1 am exempt from the Contractor's License MISC.- REFER TOO D p X INFORMATION r u O 4 Law for the following reason.(Sec,703 1.5,Business and Professions C VALUATION $/FT. 5m� Code:Any city or county whichmgGD.r permit toconsRucLalteq PERMIT ISSUANCE �: an st p improve,,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC,NO, ELEG b D e. G ¢ requires the applicant for such permit to file'a signed statement that C2^'•L �'Q.• .�VC TOTAL p w w he is licensed pursuant to the provisions of the Contractor's License !-G[.J T PERMIT TO HiQ .. Law(Chapter 9(commencing with Section 7000)of Division 3 of the E E,D Business and Professions Code)or that he Is exempt therefrom and QTV. PLUMBING PERMIT FEE CAS Or r 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. ry 3 9 by any applicant for a permit ,to the applicant kr a civil penalty of not more th an five hundred dollars(b500).), ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ I,as owner at the property,or my employees with wages as BACK FLOW PROTECT. .00 their sole compensation,will do the work,and the structure is not DEVICE 4OCG GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contract.,',License Law does not apply to an owner of . property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenetintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11PIC.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 am- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE prove 1,aso owner of theJ. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PS Other ❑ d as owner of the property,he exclusively contracting with - ❑ ❑ ❑, ❑ ❑ licensed contractors to construct the project(Sea does Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 and Professions Code:The Contractor's License Law does not apply ASSESSORS PARCEL NO. 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 contortions)licensed pursuant to - theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. - PARCEL NO, ❑ 1 nm exempt under Sea ,B.&P.C.for This reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.OATE ACG FILE NO. WO affirm that have a ATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby ate of Ihot I have acertificate of consent o self-insure, or a certificate of Workers'Compensation Insurance,or a certified -ZONING , ENG.SITE NO. copy Carde Se Co Laby - Policy No. Company pomaded.✓bl.(G t7.J - 0 ❑ Certified copy is hereby furnished. Z CertifSSed c Ck+ is fdGd with the fl inspection division. FIRESPRINK ENERGVT- F ZO A plicant [C Jaypii 2% �,' ,C`�v p MISC- •REFER TO ORD. Y N❑ V El No CC CC to CERTIFICATE.OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 W > _ COMPENSATION INSURANCE PLG.CONTE. - LIC.NO. PLG - FLOOD ZONE A.LA .U . CIL 0 .(This section need not be completed if the permitisfor one TOTAL VN� V ry� Z.- hundred dollars IS 100)or less.) U O' I certify that in the performance of the work for which this per- QTY. FEE FEE SUMMARY IL U mit is issued, I shall not employ any person in any manner so as to MECHANICAL PERMIT O W become subject to the Workers'Compensation Laws of California. n Date-Applicant - ALTER OR ADD TO MECH. - BUILDING >_ N NOTICE TO APPLICANT: If,aftei making this Certificate of Ex- 5.00 t.. Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions,of the Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=11F,M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOWCRM.) 6.00 'SEISMIC FEE I hereby affirm Ihal there is a construction lending agMw r EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issu . MICROFILM 3097,Civ.C.L HEATING UNIT(TO 100,000�B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT 100,000 B.T.U.19.50 ELECTRIC 1 certify that 1 have read this application and state that the VENTILATION FAN (SINGLE) 4.00 • information is correct 1 agree to comply,with all city and PLUMBING ordinances and state laws relating to building constructid BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter ueaboe-mentioned property for inspection purposes, BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the f MISC.- REFER TO ORD.aper no against liabilities,judgments, cos 'nd a ense ' CONST.TAX m any way accrue against said Cit m on a PERMIT ISSUANCE 10.00ran[ia Of this permit MECH.CONT. ' LIC.NO, MECH!!/] TOTAL of Applicant/Contractor DateTOTAL IF OFFICE COPY "