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16137 POST THIS CARD NEAR FRONT OF BUILDING RMIT NUMBER mr CITY "OF CUPERTINO ' 16137 INSPECTION DIVISION JOB INSPECTION RECORD 1 , I0071PERMIT EXPIRATION JOBADDRESS1D � v� Ad . ) _LOT# i/I n 0 /n ,• /,-m C PERMIT EXPIRES IF WORK i OWNER (�(�(�X��1l.L/(/� J CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED• PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF:I PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS •- a POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED t 't i';.A�a>.-�`�^•' , UNDERGROUND /SLAB �� { �� !� I ',. PLUMBING . . ELECTRICAL - ISSUANCE DATE MECHANICAL - BLDG ' ELEC I PLG. MECH E � [] i . 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED A BUILDING PERMIT WOOD FLOOR INFORMATION ly VALUATION $SFT. PLUMBING � ,ryy MECHANICAL 0,0 ELECTRICAL PERMIT TO FRAMING 1 �( i / i INSULATION - STORIESTYPE CONSTR, OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FL FLOOR wREw TOTAL ACREAGE • ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IND CON PR 09— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ E3ASSESSORS PARCEL NO ROUGH SAN.# 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 ELECT.FINAL TEST INSULATION PLUMBING - ZONING ENG.SITE NO. . GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY T.24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y 0 N❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZCNE ALUC INTERIOR SHEAR - FIRE DEPT.' Y❑ N❑ Y L7N❑ 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 FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT. FOR EXPIRATION DATE -. IMPORTANT! CONST.TAX - S PLEASE READ REVERSE'SIDE BEFORE �'I',Sq i{j, : I� ' TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY :• $UILDING PROJECT IDENTIFICATION PERMIT NUMBER BDILOING APPLICATION & PERMIT 16137 ADDRESS UILDING-ELECTRICAL-PLUMBING-MECHANICAL 4: O NER's. NAME / _/ DTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION 1IfA 4f0bA d0/^G PHONE CONTRACTORS NA OUTLETS-SWITCHES-RECEP 10.00/1.00 ' C- 0 SILiss r LIC.NO. LIGHTING FIXTURES 10.00/1.00 [ONTRACTOR's AODREss C.'., f,ff//d-+'N koc?) PPLIANCES-RESIDENTIAL 4,00 J /�I'I(WHDNE �I PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.N0, OR PANELS (OVER 200 AMP) 20.00 ENGINEER LIC.NO. SIGNS TRANS. 3.00 ADDRRESS ENO' SPECIAL CIRCUIT 5.00 t PERMIT VALIDATION ZIP FEMP.METER OR POLE INS. 20.00 rT- 1 rf'g-ter t��y, APPLICANTS ACOREODREss S I MOTORS SEE FEE SCH. , ^ t A SERVICE CHANGE 20.00 �TI (I Inc o o LICENSEI CONTRACTORS DECLARATION a i W I hereby at that I am licensed under provisions of Chapter 9 ISSUANCE DATE a y (commencing with Section 7000)of Division 3 of the Business and BLDG. E EC PLG. MECH. r 7 z Professions Code d 'cense I'm full force. (feet. ❑ ❑ ❑ Li., Clus aqp l.ic.Nu w w Dale. ` II 1 ContraE � / A a se BUILDING PERMIT E ¢ w OWNER-BUILDER DECLARATION MISC.- RE INFORMATION K 3 u u I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. a. o j Law for the following reason.(Sec.7031.5,Business and Professions 1- - g -PERMIT ISSUANCE /„_/n Code:Anymolish coo ntywhiny reqstruitesap prior to construct,alter, I�IVo Q a, Q ¢ improve,demolish,Or repair any$t NCt11rV,pr10!t0 its ISSIIanLe,aI30 ELEC.CONTR. LIC.NO. ELEC. ��''f1�, U e wO LL requires the applicant for such permit to file a signed statement that TOTAL fit PERMIT TO S,A he is licensed pursuant to the provisions of lite Contractor's License �� Fz > Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe 4 ao Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE H $ the basis for the alleged exemption.Any violation of$eclion 7031.5 STORIES TYPE CONSTR. a3 - by any applicant for a permit subjects the applicant toa Civil penalty ALTER-DRAIN -WATER (EA.) 5.00 ' of not more than five hundred dollars(5500).): ❑ I,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 docs such work F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve. ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, Rte owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- REB IND LOG PB Omer prove 1,aso nee of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ 11 ❑ d as owner of the property,he exclusively contracting with licensed contractors ro construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code;The Contractor's License does not apply - co an owner of property who builds r improvess thereon, thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contmctor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am 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'COMNiNSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self-insure, - ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy N..A 8j10i Lab.C.l./}+_ J L Policy ere ompany (d e / w•�/� (] ❑ Corti led copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z %t CerY1�' s�D�u filed tI the city inspection division. C-" - MISC.- REFER TO ORD. O Applicant ��--� V N� Y N[ Hy �- cMPt PERMIT ISSUANCE 10.00 FLOOOZONE A.L.U.C. = - C17RTl FIC ATI? E EXEMPTION FROM WORKERS' Ill COMPENSATION INSURANCE lite PLG.CONTR. LIC.NO. PLG. Y 0 N Y� N❑ � Z This action need not he completed if the permit is for one TOTAL hundred dollars($1001 or less.) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY manner IL F mit is issued,I shall not employ any person in any aner so as to U become subject to the Workers'Compensation Laws of California. a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING >_ to NOTICE TO APPLICANT: If,after making this Certificate of fix- - H ? emption,you should become subject to the Workers'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 10,000QF.M) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.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 pennit is issued(Sec. MICROFILM 3097,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 50 Lender's Address ELECTRIC 1 certify that I 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-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to corer 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 which -PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the m MECH.CONT. LIC.NO. MECH. TOTAL TOTAL 1 9- 50 ere o Applicant/Contractor Uate OFFICE COPY