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16068 POST THIS CARD-NEAR FRONT OF BUILDING + �. • PERMIT NUMBER CITY OF CUPERTINO 16068, INSPECTION DIVISION JOB INSPECTION RECORD • /�r1 2 (U �/ PERMIT EXPIRATION JOB ADDRESS' 1� �-3 N/ �� V1�� \\AAUNIT# _LOT# PERMIT EXPIRES IF WORK O*NER `/lI G4/9$O;Q_, �.� CONTRACTOR (20 T &_Z–�—C Z_iU ' IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR ASPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM - NOTE: LASTCALLED INSPECTION. , UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PeRnvr VALIDATION , CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - ..e.. .:..r .UNDERGROUND /SLAB I / PLUMBING ELECTRICAL ISSUANCE DATE ' MECHANICAL - BLDG. ELEc PIG. MECH.. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION S/FT. PLUMBING MECHANICAL ELECTRICAL , 'PERMIT TO FRAMING INSULATION STORIES TYPE CONSTR i - GCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED . ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so Fr FLOORAREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAXIS PAID BUILDING USE ROOF SHEATHING RPS "SND CON PR OR, ,' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 " ❑ ❑ " 13 ASSESSORS PARCEL NO. ROUGH SAN.# PLUMBING - ELECT.ENERGY TRACT NO PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY ! MECHANICAL - MECH.ENERGY I ELECTRICAL BUILDING ENERGY ACC,DATE ACC FILE No FRAMING - ELECT.FINAL TEST INSULATION PLUMBING - ZONING ENG.SITE NO. ' ' GAS TEST GAS _ MECHANICAL FIRE SPRINK ENERGY T-24 COVER NO WORK UNTILABOVE HAS BEEN SIGNED HEATING Y EI NY 11 NO EXTERIOR SHEAR ELECTRICAL RELEASE FL000 ZONE AL U.C. Y N� YL NEI INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH IBUILDING 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 ISNOTPERMITTEDUNTILBU ILDING FINAL IS SIGNED BY BUILDING INSPECTOR" MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC "o ~ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING . z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT,! CONST..TAX PLEASE READ REVERSE SIDE BEFORE ° CALLING FOR FINAL INSPECTION. TOTAL +lj OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY ,BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION &.PERMIT' O C;0 ADDRESS U 8 JQ/a3 BUILDING — ELECTRICAL—PLUMBING—MECHANICAL 0NER'S - -.PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE CA)1^)O5Oe ' I liL PHGNE CONTRACTOR'S NAME L) OUTLETS-SWITCHES-RECEP 10.00/1.00 40-too-too1J1p(6P_ ,t)C) F&6C, .NO. 7y 3 LIGHTING FIXTURES 10.00/1,00 ), . CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 e PHONE ( /� /ODO PANELS 10.00 DATE OF APPLICATION- ARCHIECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE F.C.NO. OR ENGINEER LIC.NO. SIGNS TRANS. 3.00 ARCW ORESS ENG. SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION ZIPADDEMP.METER ORYOLE INS. ..20.00 �-+ APPLICANTS ;;t- MOTORS _ f H SEE FEE SCH. yrOD ADDRESS SERVICE CHANGE 20.00 � o o LICENSED CONTRACTORS DECLARATION ao .. a v I hereby il... that I am licensed under provisions of Chapter 9 ISSUANCE DATE st w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELEC PLG. MECH. H w z Profession Code,an my license is in full force a d yf�e�L zorv - LlcecleC S Lic.Number I�L�L j7 - ' ❑ ❑ ❑ O as L D Dale Contractor /r)OF✓rr JO a a r s BUILDING PERMIT ¢ ¢ ¢ ¢ OWNER-BUILDER DECLARATION INFORMATION REFER TO ORD F 3 u 1 hereby affirm that I am exempt from the Contractor's License MISC.= VALUATION '$/FT. rLLOQ Law for the following reason.(See.7031.5,Businessman Professions PERMIT ISSUANCE 10.00 , C70' Code:Any city or county which requires a permit to construct,alter, rc rc < �- improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR., LIC.NO. ELEC. �J n•� O e, C1'71/(3, 7 -requires the applicant for such permit to file a signed statement that . TOTAL a Of PERMIT TO ww he is licensed pursuant to the provisions of the Contractor's License r z i Law(Chapter 9(commencing with Section 7000)of DivisioD3 of the 4 Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE ' the basis for the alleged exemption.Any violation of Section 70315 STORIES TYPE CONSTR. i ;m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(S500).1'. _ ❑ 1,as owner of the property,or my employees with wages as 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(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 - ' property who builds or improves thereon,and who does such work FIXTURES-PER TRAP' 5.00 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1 6.00 mems ore not intended or offered for sale.11,however,the building or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden .en of proving that he did not build or im- RES IND CON PB Como prove for purpose of sale.). INDUSTRIAL WASTE 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. 6.0.0 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts I'orsuch projects with a contractors)licensed pursuant to - - SEWER-SANITARY-STORM EA.200ft110.00 TRACT No. PARCEL NO. theContractor'sLicenseLaw. ❑ lam exempt under Sec. ,B.&P,C.for this WATER HEATER W/VENT - 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.-DATE ACC.FILE NO. WORK ERS'COMPISNSATION DECLARATION RPLG.CONTR. ATING EQUIP. 5.00 ' Ihereby affirm that l have a certificate of consent to sclFinxure. ZONING - ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy there f ,00 Lab.C.)- - Policy'No. O Company f�-_A" Leal r/ ZZW D- O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 ZZ $j Certifiedkkith tc �inspedion division. 4. TOTAL D. Y ❑ N❑ Y ❑ N❑ O PPli Cert yi!-' ` Fy ANCE00 FLOOD ZONE A.L.UC. CC — CERTIFICATE OF EXEMPTION FROM WORKERS' UJ > I COMPENSATION INSURANCE LIC!NO. - 'Y❑ N❑ Y❑ N❑ (L o - (This section need not be completed if the permit is for one =) Z hundred do11ars(S100)or less.) U O 1 certify ththth at in e performance of e work for which this per- CITY. - MECHANICAL PERMIT FEE FEE SUMMARY IL F mit is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'Compensmtion Laws of California. BUILDING Date Applicant 'ALTER OR ADD TO MECH. 5.00 _ } N NOTICE TO APPLICANT: If,after making this Certificate of Ex- F ? emption,you should become subject to the Workeri 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.F.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.). HEATING UNIT(TO 100,000 B.T.U.)" 8.00 ' Lender's Namc - HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 40 Lender's Address I certify'Ihal l 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 BOILER-COMP(3 H.P.or 100,000 B.T.U.)' 6.00 PLUMBING .: ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP(Over100,000BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. ' ( gree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. ertin against liabilities,judgments, cost and expenses which PERMIT ISSUANCE- 10.00 CONST.TAX ay in ny way accrue agmrrr��[��```^^^ggq•'''d Cit h co q c of th• rantin of this perntit. r / / M CH.CONT. LIC.NO. MECH. • ///, �� TOTAL TOTAL [ure of ApplicantlContIoncoo, Date �( OFFICE COPY I -