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15979 POST THIS CARD NEAR FRONT OF BUILDING PERMIrNUMRER ,r CITY OFPCUPERTINO 15978 INSPECTION DI VISION ` JOB INSPECTION RECORD ` PERMIT EXPIRATION JOB ADDRESS� 1d3 /V WO LirE _PL7, ' UNIT# '_LOT# PERMIT EXPIRES IF WORK OWNER �OQ/fl"_ �EIS'1�S CONTRACTOR �LEL R./ IS NOT STARTED WITHIN I , . INSPECTION - DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU FOUNDATION' ANCE OR 180 DAYS FROM I NOTE: LASTCALLED INSPECTION. ; UFER ALL GRADING.AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION _ CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 1 UNDERGROUND /SLAB PLUMBING t,,,!• .%Jiy , r ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT PLG. .MECR E] ❑ ❑ I DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR NFORMATIQN ATION $IFT. PLUMBING v MECHANICAL - `•'k ELECTRICAL PERMIT TO. FRAMING INSULATION - -STORIES TYPE CONSTR. OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn.FT FLooR aRea TOTAL acREacs DIAPHRAGM THE CONSTRUCTION TAX IS PAID i BUILDING USE ROOF SHEATHING'. RES IDD CON Pe oma, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. E3 ❑ Q� 13 ❑ ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT,ENERGY TUBS 8 SHOWERPAN PLUMBING ENERGY TRACT NO. PARCEL'NO MECHANICAL MECH.ENERGY ELECTRICALACC DATE ACC,FILE NO. ' BUILDING ENERGY - FRAMING - ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION � PLUMBING GAS TEST _ GAS ' MECHANICAL FIRE SPRINK ENERGY T24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING I "[] ' EXTERIOR SHEAR � - ELECTRICAL RELEASE FLOOOZONEALL UC. INTERIOR SHEAR FIRE DEPT. Y❑ NQ' Y ❑ NEI SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING - INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 70 eo0 ' '. Iw-� • ONE WORKING DAY BEFORE REQUIRED INSPECTION. j;; PLUMBING . z PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! '' CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL-INSPECTION. TOTAL OFFICE COPY APPLICANT ;-O FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FICATION - - PERMIT NUMBER aplLolNG APPLICATION & PERMIT �� gXpRE55 [J, IdOLFEZQ� f ALC BUILDING—ELECTRICAL—PLUMBING—MECHANICAL C.• OWNER'S NAME PLAN CHECK VALIDATION 4RIA VeR US �,S•�7/u• DTV• ELECTRIC PERMIT FEE - PHONE NAME CTOR3 NAME OUTLETS-SWITCHES-RECEP 10;OB/i-00 a4,� EL e�ei� uc.N $$�j3s b LIGHTING FIXTURES 10vOBH BO O'U CONTRgCT°R'S IVN ./p/ �1y��p APPLIANCES-RESIDENTIAL .;4.00 N 1�0JeA UT6 PHONE 73//v,J7 PANELS gRCHITECT 19.90 / 0 DATE OF APPLICATION °R PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER AENG. LIC.NO. SIGNS TRANS. 3.00 ADDRESS SPECIAL CIRCUIT 5.00PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 ANT'E ADDRESS MOTORS 11AP SEE FEE SCH. S � SERVICE CHANGE 20.00 F0p(/• ' 2 oo LICENSED CONTRACTORS DECLARATION u w I hereby affirm that I am licensed under provisions of Chapter 7x4AzrK 0 �/✓� ; w¢ (commencing with Section 7000)of Division 3 of the Business and I ISSUANCE DATE F N o i Professions Code,and my license is in full farce unit effect. BLDG. ELECT. I PLG. MECH. p i L C License Class Lie.Number FL H J Date Contractor ❑ ❑ Q Y 1 Q ¢ ac w OWNER-BUILDER DECLARATION t+� BUILDING PERMIT w ;LL N I hereby affirm that 1 um exempt from the Contractor's License MISC.— REFER TOO INFORMATION r � y J Law for the fallowing masrnl.(Sec.7031.5,Business and Professimis PERMIT ISSUANCE '4(1"00 •VALUATION $/FT. Amy Code:Any city or county which rcyuiresapermit toconsVud,alter, ¢ c a improve,demolish.or repair any Stmcture,prior to its issuance,also ELEC.CONTR. LIC„NO. ELEC. o LL requires[he applicant for such permit to file a signer)statement that TOTAL (� ;L01 w w he is licensed pursuant m theprovisions of the Contractor's LicensePERMIT TO iia Law(Chapter9fcommencingwith Section 70001ofDivision3of the 'I 4 D Business and Professions Code)or[haL he is exempt therefrom and DTV. PLUMBING PERMIT FEE �L ¢r the basis for the alleged exemption,Any violation Of Sed ion 7031.5 STORIES TYPE CONSTR. i3 � by any applicant fora permit suhjectsthe applicant loacivilpenalty ALTER-DRAIN'&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(E500).): ❑ I,as owner of the pmperty,or my employees with wages !IS BACK FLOW PROTECT.DEV ICE 4.00 - their sole compensation,will Jo the work,and the structure is not - (TC.GROUP RES.UNITS intendeJ or offercJ for sale (Sec. 7044, Business and Professions of DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law dyes not apply m an owner • property who builds or improves thereon,and who Joe,such work FIXTURES-PER TRAP 5.00 himself or through his own employees,provided that such Improve- - SD.FT.FLOOR AREA TOTAL ACREAGE merits are not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner,. builder will have the burden of proving that Ile did not build or im. GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 - RES IND CDN PB Dme. ❑ ,1,as owner of the property,am exclusively contracting with ❑ ,❑ ❑ ❑ ❑ licensed contractors to construct the project ISec. 7044,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 contmctor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA:2001t/10.00 TRALT NO. PARCEL NO. reason nl um exempt under Sec. ,e.&P.C.for this WATER HEATER W/VENT - 6.00 Owner Date - WATER SYSTEM' 5.00 ACC.DATE ACC.FILE NO. WORKF'RS'COMPENSA'FION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(See.3800,ntLab.C.). i �� n ' Policy No, Copu , ,_ c/ /A 7iC Certified coppy is hereby furnishe -- - - Z Z ❑ Cerli ��r Rpy flet wl it nspection Ai on. FIRESPRINK ENERGYT24 AD on. MISC.- -' REFER TO ORD. Y❑ N❑ Y ❑ -N❑ F,.ON PERMIT ISSUANCE CERTIFICATE OF EXEMPTION FROM WORKERS' I 10,00 LU 5 - COMPENSATION INSURANCE FLOOD ZONE A.LD.C. - PLGCONTR. LIC.NO, - C O (This suction need not be completed . PLO if the permit Is for one TOTAL y'O N❑ y ❑ N❑ O hundred dollars IS 100)or less.) - I certify that h the performance of the work for which this per. OTY MECHANICAL PERMIT FEE FEE SUMMARY O 0 U - mit is issuednot employ any parson in a manner so a to m become subject ctt toto t the Workers'Compensation Law s of Culil'ornia. a Date Appllcam ALTER OR ADD TO MECH. BUILDING >_ m NOTICE TO APPLICANT: If,after making this Certificate of Ex- 5.00 F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10p00C.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.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(See. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,900 B.T.U,)9.50 ELECTRIC - Q �= . ( certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 - information is correct.1 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COW(3 H.P.or 100,000 B.T.U.) 6.00 . hereby authorize representatives of this city to anter upon the above-mentioned property for inspection purposes. BOILER-COMP IOvar 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- ' REFER TOORD. uper.Duo against liabilities,judgments, costs and expenses which _may gr l�n SPY hµ' vi fly in cons uence of the PERMIT ISSUANCE 10,00 CONST.TAX g pert t MECH.CONT. LIC.NO, MECH. 3GA TOTAL TOTAL Ignature of Applica t/Contractor Date - OFFICE COPY