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16041 POST THIS CARD NEAR FRONT OF BUILDING ` �• " p PERMIT NUMBER ' r,. CITY' OF CUPERTINO 16041 INSPECTION DIVISION JOB INSPECTION RECORD ^�/ SID , loss— PERMIT EXPIRATION —"' JOB ADDRESS w6L4,3 Al WCL_ g UNIT# - _LOT# - PERMIT EXPIRES IF WORK ' OWNER �7� 7c—�dS7i Ci+ CONTRACTOR f7,g fOG, IS NOT STARTED WITHIN, l INSPECTION DATE INSPECTOR INSP TION RECORD 180 DAYS OF PERMIT I'm- FOUNDATION NOTE: ANCE OR 180 DAYS FROM ' UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNITE TO COOPLY WITH THE APPROVED PLANS AND CITY OFPEnnvi VALIDATION I CUPERTINO STANDARDS. GARAGESLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED $ .. UNDERGROUND /SLAB PLUMBINGi ELECTRICAL ISSUANCE DATE MECHANICAL BLDG ELECT PLG. MECN. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR- INFORMATION PLUMBING vALUAI ION LOFT. MECHANICAL ELECTRICAL PERMIT TO -• FRAMING `r`U INSULATION - sro Es TV PE CONSTR. OCC GROUP RES UNITS RSHEA 'FLOOR UNTIL ABOVE HAS BEEN SIGNED -� ROOF so FT.F000RAREA TOTAL.CHEAGE NOTE:NO FINAL INSP.SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID G BUB.DntlG USE RES IND CON PB OFING UNTIL ABOVE HAS BEEN SIGNED FINALS ATE INSP.ROUGH SAN.N- - ELECT.ENERGY TUBS&SHOWER PAN PLUMBING ENERGY TRACT No PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO FRAMING - ELECT.FINAL TEST INSULATION PLUMBING ZONING ENG SITE NO, GAS TEST GAS MECHANICAL EIRE SPRINK ENERGY T-ac COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v ❑ N1 1 ❑ N❑ EXTERIOR SHE ELECTRICAL RELEASE FLOOO ZONE A,L.U.C. INTERIOR SHEAR FIRE DEPT. v❑ No v ❑ NO SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH EELECTFRI G - INTERIOR LATH EMPORARY APPROVALS BUILDING SCRATCH COAT CPLAN CHECK'FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED CY SEISMIC FEE ' OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM LEI ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE, TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE.BALL POINT PEN ONLY --BUI LCMG PROIIEC7 1 DENT(FICATION PERNUT NUMBER - W6.11ons. APPLICATION & PERMIT 16041 DRESS - U 9 • �O,LF� BUILDING -ELECTRICAL-PLUMBING-MECHANICAL J1 OWNER'S L PLAN CHECK VALIDATION t TAME r 3 QTY. - ELECTRIC PERMIT FEE 5 1 t �� 'L so /S/�PRorvE Of �'fCONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 ' NAME LIGHTING FIXTURES 10.00/1.00 l,oNTRACT RS q� PPLIANCES-RESIDENTIAL 4.00 rE.S -yam - ((��JJ , PHONE QLD PANELS 10.00 GATE OF APPLICATION- OR RcmTECT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE - RC.NO., O ENGINEER i uc,NO SIGNS TRANS. 3.00 ARCH.ORENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS. 20 d APPLICANTS MOTORS SEE FEE SCH. ADDRESS • SERVICE CHANGE 20.00 &/v1, w O O LICENSED CONTRACTORS DECLARATION p a o U I hereby affirm that 1 am licensed under provisions of Chapter 9 O ISSUANCE DATE N a w (commencing with Section 7000)of Division 3 of the Business and DG. ELECT. PLG. MECH. H y"^ Professions Cor uul my license is in full Cor"and effect. ❑ i o w - License Cl ss Lic.Number (� ❑ 0 z I- 0- Date��.n _�Contractor Op r OE BUILD( G PERMIT ¢ ¢ w a OWNER-BUILDER DECLARATION INFORMATION '0 A O MISC.- REFER TO ORO K ; w N 1 hereby off rat that I am exempt from the Contruclor's License VALUATION S/FT. FLL0A Law far the followingreason.(Sec.7031.5,Businemand Professions PERMIT ISSUANCE 16:90-/J mw Code:Any city or county which mquiresa permit to construct,after, 2 2¢ p improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTE. LIC.NO. ELEC. /� 99 _ e. -C ¢ requires the applicant for such permit to file a signed statement that TOTAL a a2 PERMIT TO E $ he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(commencing with Section 7000)Of Division 3 of the iso Business and Professions Code)or that he is exempt therefrom and QTY: PLUMBING PERMIT FEE C'C 0- ¢ H $ Ihebasis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. n ; � by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(S500).1: ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEV ICE 4.00 Oce.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of - 1 property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE himself or through his awn employees,provided that such improve- Doubt are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owne - . .) 2.00 BUILDING USEr- GAS EASYSTEM-OVER 4 IEA builder will have the burden of proving that he did not build or im' RES IND CON PR Omer prove for purpose of sale.). - INDUSTRIALWASTE INTER. 30,00 ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSE55ORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves(hereon,and who LAWN SPRINKLERS-OVER 51EA.) 1.00 contracts for such projects with a comrac[ons)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑' I am exempt under Sec. B.&P.C.fur this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION- WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure,pitied ZONING ENG.SITE N0. .� or a certi0cate of W kers'Compensg�on sum9}p�. o a I00, /IIfcY"MY ' Company .11'Nf U ❑ Certified copy is hereby furnished. FIRE SPEAK ENERGY T-24 Z ❑ Certified copy is fled with the city inspection division. MISC.- REFER TO ORD. y❑ N❑ Y NO 0 Applicant CCCERTII%C ~ rn COI EXEMPTION FROM WORKIiRS' PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U.C. PEUJ �_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. - PLG. CL Cl (This section need not be completed if the permit is for one TOTAL Y❑ NE] Y ❑' N❑ ::) Z hundred dollars IS 100)or It-,) U O I certify that in the performance of lire work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL E- mit is issued.I shall not employ any person in any manner so as to Ow become subject to the Workers'Compensation laws of California. BUILDING . Dam Applicant ALTER OR ADD TO MECH. 5.00 } N NOTICE TO APPLICANT: If,after making this Certificate of Ex- ? eruption,you Should become subject to tire W e orkers'Compensation APPLIANCE 5,00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.P.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 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.). I HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC o� Lender's Address - �-' I certify that l have read this application and stove tlmt[he above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and B01LER-7(3H.P.or 100,000 B.T. U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses whichCONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 granting of this permit. MECH.CONT. LIC.NO. MECH. �� //� TOTAL TOTAL Signature of ApplicantlContraclor / alb OFFICE COPY