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16032 POST THIS CARD NEAR FRONT OF BUILDING :• CITY OF CUPERTINO PERMIT rvII BER INSPECTION DIVISION 16032 9 JOB INSPECTION RECORD JOB ADDRESS 0/ 3 .h/0 — �� ` S' PERMIT EXPIRATION UNIT# .LOT# - �' •� PERMIT EXPIRES IF WORK OWNER �I� CO CONTRgCTOR y(/�'�, ' INSPECTION '0—&Tc�/4 � IS, NOT STARTED WITHIN � DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM UFER NOTE: LASTCALLED INSPECTION. ALL GRADING AND DRAINAGE SHALL BE�INSTALLED P REGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERnor VALIDATION GARAGE SLABS CUPERTINO STANDARDS. _ C, . POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .., UNDERGROUND /SLAB PLUMBING ' ELECTRICAL q �� 1 v`• t.( t MECHANICAL - - b Issuq"cE ugrel` - LDG ELECT PLG. MECH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ BUILDING PERMIT WOOD FLOOR IN FORMA710N� PLUMBING VALUATION SIFT. MECHANICAL ELECTRICAL VER AIII t0 FRAMINGEL -cl ' d 1 ' INSULATION STORIES TYPE CONSTR. ; ' - OCC GROUP RES UNIT $ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so FT FLooA AREA TDTAL At REALE . DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING ewLDING,USE HES IND CON PB Olen APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ROUGH SAN.N ASSESSORS VARCEL NO, PLUMBING I '� ELECT.ENERGY TUBS&SHOWER PAN- PLUMBING ENERGY ?RAC?No. PAncEL No - MECHANICAL MECH.ENERGY ` ELECTRICAL BUILDING ENERGY ACC DgrE Acc.FILE rvo FRAMING ELECT.FINAL TEST - INSULATION PLUMBING - - zoNlNc ENc.s,rE No. GAS TEST MECHANfG.QL FIRE SPRINK .ENERGY T.)C COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑. N❑ NE EXTERIOR SHEAR - - ELECTRICAL RELEASE FLOOD ZONE A U.C. INTERIOR SHEAR - FIRE DEPT. v �Nt ❑ NE]SHEETROCK GRADE EXTERIOR 'LATH BUILDING FEE SUMMARY INTERIOR LATH TEMPORARY APPROVALS 6uILDING SCRATCH COAT - ELECTRIC PLAN CHECK GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC . o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! coNST..TAX PLEASE READ REVERSE SIDE BEFORE ° CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY I/- ;C#PLICANT TO FELL IN INFORMATION WITHIN REDLINES — USE BALL POINT PEN ONLY IV BUI LDI NG PROJECT I DENTI FICATIONPERMIT NUMBER a°IE°INGo APPLICATION & PERMIT 16032 G^ aooREss 27 MBUILDING—ELECTRICAL—PLUMBING—MECHANICAL O NER ' PHGNE ELECTRIC PERMINq2 t PLAN CHECK VALIDATION �j 5'e,,45'e,,4DTV. T FEE 4/ttiO�.or LONTRgCTOR3 - -. — N UTLETS-SWITCHES-RECEP 10,00/1.00 LIC.No. ,2I LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S —� AD DRESS S C 9.SUs / `/3'' PPLIANCES-RESIDENTIAL 4.00 gRCRITEc, J I.P PHONE/ WttT� PANELS 10.00 DATE OF APPLICATION ENGINEER °R PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.:NO. - Llc.rvo. SIGNS TRANS. 3.00 ARCH.OR ENG. - ADDRESS SPECIALCIRCUIT 5,()0 PERMIT Val DATION zIP EMP. METER OR POLE INS. 2W ADDRESS A OREss MOTORS SEE F D ¢i - SERVICE CHANGE '20. 0 e ( ,02 LICENSED CONTRACTORS DECLARATION ell ��(/ w M 0 W I hereby affirm that I am licensed under provisions of Chapter 9 - p " y rt e (commencing with Section 7000)of Division 3 of the Business and Vf� U ISSUANCE DATE F = z Professions Code, d license is in full for d effect •N BLDG. ELECT. PLG. MECH. z O y License Class 4 w r w, Oate�� - ' _Contructor� _ El a Y E J BUILDING PERMIT E ¢w OWNER-BUILDER DECLARATION' �i CL w ;' H I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD INFORMATION F a- 0 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE VALUATION S/FT, E m i Code:Any city or county which requires a permit to construct,alter, OZ ¢ ¢,p improve,demolish,or report any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. 0¢ requires the applicant for such permit to file a signed statement that ELEC. / V `• he is licensed pursuant to the provisions of the Contractors License TOTAL PERMIT TO F z a Law(chapter 9(commenciagwlth Section 7000)of Division 3 ofthe q 0 Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE w m' the basis for the alleged exemption.Any violation of Section 7031.5 n ; by any applicant for a permit subjects the applicant too civil penalty STORIES TYPE CONSTR. of not more than five huntlred dollars(5500).}. ALTER-DRAIN.& VENT-WATER (EA.) 5.00 • ❑ I,as owner of the property,or my employees with wages as their sole compensation,will do the work,and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP .RES.UNITS intended or offered for sale(Sec. 7044, Business and of Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner property who builds or improves tlmreon,and who docs such work FIXTURES-PER TRAP 5,00 himself or through his own employees,provided that such improve ' sD.Fr.FLOOR AREA rOrAL ACREAGE mems are not intended or offered for sale..lf,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year ofcomple[ion,the owner- builder will have the buNen of proving 01att a did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE prove for puwner.f thr ip INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other .❑ d as owner of the property,he exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(See, 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 wish a contractors)licensed pursuant to the Contractor's pLicense Sce. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. . ❑ lam exempt under Seca ,B.&P.C.for this WATER HEATER W/VENT reason 6.00 Owner Date WATER SYSTEM 5'00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION. WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofconsent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0. copy thereof(Sec.3800,Lab.0 I 1 �, Policy No. Company�AbAe -•vel O ❑ Certified copy is hereby furnished. Z Z Applicant copy is fled ith the city inspection division. FIRE SPRINK ENERGY T-24 - O /ILLI MISC.- REFER TO ORD. CCrn f�j 000/ f PERMIT ISSUANCE Y N� v N� I: TIFIC OMP X-. PTION FROM WORKERS' 10.00 FLOOD ZONE A.L.U.C. " W � COMPENSATION INSURANCE PILO.CONTR. LIC.NO. - PLG. d 0 (This section need not be completed if the permit is for one TOTAL Y N� Y N� Z hundred dollars IS 100)or less) U O 1 certify that in the performance of the work for which this per. W U mit is issued,I shall not employ any person in any manner an as to GTY. MECHANICAL PERMIT FEE FEE SUMMARY O L) become subject to the Workers'Compensation Laws of California. y Dale.AppliNOT APPLICANT: I ALTER OR ADD TO MECH. BUILDING } r7 NOTICE TO APPLICANT: If,after to the ark Certificate sa ion 5.00 Z emption,you should become subject to the Workers'Compensation App LIANCE '+ 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 ITO 10,0000 F.M,) 4,00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT IOVER 10p00C.FNL) 6.00 SEISMIC FEE I hereby a(finn that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permiLis issued(Sec. MICROFILM 3097,r's Na). HEATING UNIT(TO 100,000B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4,00 information a correct.I agree to comply with all city and county PLUMBING hereby es and state laws relating to is building construction, and BOILER•COMP(3 H.P.Or 100,0008.T.U.) 6.00 hereby authorize representatives ec this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP IOscr 100,000 BTU)SEE FEE SCH.. MECHANICAL up (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORDertino against liabilities,judgments, costs and expenses which CONST.TAX ay in an way accrue against said City in consequence of the PERMIT ISSUANCE - 10.00 . go his perm' Q• MECH.CONT. LIC.NO. MECH. —p TOTAL TOTAL no um o ppli'ant/Contractor Date , OFFICE COPY