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16161 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER '1 CITY OF CUPERTINO 16161 INSPECTION DIVISION JOB INSPECTION RECORD ' / ��J PERMIT EXPIRATION JOB ADDRESS_�a�d3 N• WOL,>r� lJ UNIT# LOT# ' PERMIT EXPIRES IF WORK OWNER CONTRACTOR fI-' ,e�, �' �,L' IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 1Bo'Dnvs OF PERMIT Issue' FOUNDATION - ANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. i LIFER ALL GRADING AND. DRAINAGE SHALL BE INSTALLED PREGUNITE - TO,COMPLY WITH THE APPROVED PLANS AND CIN OFA, PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING - - _f-•i �• � "• Q ELECTRICAL - ISSUANCE GATE MECHANICAL BLDG ELECT, PLG. MECH- , �o El o El PIG. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED y BuaDINc PERMIT WOOD FLOOR - INFORMATION PLUMBING � @0�\ unnON /FT. MECHANICAL PERMIT i0'�• ' ELECTRICAL FRAMING � �• INSULATION STORIES TYPE CONSTR. DCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED $O.FT iIOOR APED TOTAL FCREAGf • ROOF. ' ' NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID -BUILDING USE ROOF SHEATHING RES - IND CON PB 0m1' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ 0 . 1:1 ASSESSORS PARCEL NO ROUGH SAN.# , PLUMBING ELECT.ENERGY ' TUBS&SHOWERPAN PLUMBING ENERGY TRACT No PARCEL NO I MECHANICAL MECH.ENERGY' ' ELECTRICALBUILDING ENERGY ACC DATE ACC FILE.NO _ FRAMING - ELECT.FINAL TEST zommc ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE SPR INK ENERGY T 2a MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y NQ r E] NQ fLOOU 20NEA:L U.C. ' EXTERIOR SHEAR - ELECTRICAL RELEASE v � Na v L-1 "� INTERIOR SHEAR FIRE DEPT. - SHEETROCK - GRADE - FEE SUMMARY EXTERIOR LATH BUILDING .. - INTERIOR'LATH °' TEMPORARY APPROVALS IBUILDING SCRATCH COAT• ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPA vcv SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM„ AlLu N, ARRANGE FOR INSPECTION BY PHONING 252-4505, e ELECTRIC,, . ONE WORKING DAY BEFORE REQUIRED INSPECTION. " PLUMBING o.� PLEASE GIVE JOB ADDRESS WHEN PHONING. z- - SEE PERMIT FOR EXPIRATION DATE.- :Y MECHANICAL „ . j , IMPORTANT! con's? rnx PLEASE READ REVERSE-SIDE BEFORE �a Ix ' OT a= . {� z AL _ CALLING FOR FINAL INSPECTION. TOT OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY _ .BUILDING PROSECT IDENTIFICATION PERMITNUMBER , APPLICATION & PERMIT ` aulLalrvsCLy , 3 ,j. , , .� 161 .61 AooRE 0( ® , BUILDING-ELECTRICAL-PLUMBING-MECHANICAL E: .11 OWNER'S n`-ne- 11 ", �-• PLAN CHECK VALIDATION�l-- yIs-ti9u-6n TV. ELECTRIC PERMIT FEE •. PHONE NTRACTOR'S N Prtk't �P UTLETS-SWITCHES-RECEP 10.00/1.00 Ah�knq D.ev P uc.No. sa,LtoI LIGHTING FIXTURES 10.00/1.00 f ONTRACTOR 51 Q0I 0. yet ALJ-Q. PPLIANCES-RESIDENTIAL 4.00 ooREss l .g LI I'fC I6LS CPM r;C OrvtaJ'f�6�'6 PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR E PANELS (OVER 200 AMP) 20.00 ENGINEER "'..,1 uc.xo. SIGNS TRANS. 3.00 ADDRESS ENG' SPECIALCIRCUIT 5.0Q PERMIT VALIDATION zm TEMP.METER OR POLE INS. 20.00 O ,r ADDREPUCSNr$ MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE wo 0 '09 LICENSED CONTRACTORS DECLARATION a"0 a i w 1 hereby affirm that 1 am licensed under provisions of Chaplet 9 ISSUANCE DATE N a t. (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, PLG. MECH. H w z Professions Code, d my license is in full foref]n effegl. �Q ❑ ❑ z o m License Class Lic.Number y PZ 4;1 0 zr w Date Contractor A JQ y s r BUILDING PERMIT Or a a OWNER-BUILDER DECLARATION S, w " REFER T D INFORMATION a'x ; a y 1 hereby affirm that I um exempt from the Contractor's License MISC.- .. oa Law for the following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE 3&00 _ VALUATION Code:Any city or county which requires apermit reconstruct,alter, ac Q¢ p Improve,demolish,or repair any structure,prior to nsmmuce,also ELEC.CONTR. LIC.NO. ELEC. t wO u requires the applicant for such permit to file a signed statement that TOTAL v - PERMIT TO .9 he is licensed pursuant to the provisions of the Contractor's License 47 HiQ Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe a 0 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE X I- g the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR, i ; _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not marc than five hundred dollars(4500).): ❑ 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,AR EA,COND. 5.00 Code.The Contractor's License Law does not apply to an owner of properly who builds Or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTAL ACREAGE himselforthroughintends ownemployees,fors, le.If,ed that however, the improve- GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00 . mints are not intended oroffiewithin ton year o If,howeveq the owner. Or improvement is sold within one year of lie diclio t the owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that hC did not build or ire- RES IND CON PB DOE, prove for purpose of sale.).p INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ ❑ d as owner of the properly,he reject(Sc contracting with licensed contractors to construct the project La 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The who Contractor's License Law docs not apply to tr owner of property who builds t r improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such cenecta with a contradorts)licensed pursuant m SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT N0. PARCEL NO. ❑ lame%emplunder Sec. ,B,&I'.C'I'orthis WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.GATE ACC.FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofconsent to self-insure, - ZONING or a certificate of Workers'Compensation Inlsur-ance,or a certified ENG.SITE NO, copy thereof(Sec,3800,Lab.C.L . .5 CUµCI Policy No. Company I `1 0 ❑ Certified copy ishereby furnished. .,-FIRESPRINK ENERGY T-24 Z Z ❑ Certified pops is fileJ�j with the city inspection division. MISC.- REFER TO ORD. O PPlicant_,_L.-(/.,,_/_(.,,r„-G�/,.�.�s Y ❑ N❑ Y ❑ N❑ KN CERTCIF�IC-A/THOF EEXXEMMPTION h'IROOM`W-ORKERS' PERMIT ISSUANCE 10.00 FLOOOZONE A.L.U.C. LU > COMPENSATION INSURANCE - PLG.CONTR. LIC.NO. PLG. n' O CI his section need not be completed if the'perout is for one TOTAL Y❑ IN Y❑ N❑ D Z hundred dollars(SI00)orlcM.) U O I certify that in the'performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to O become subject to the Workers'Compensation Laws of California. i Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING } N NOTICE TO APPLICANT': if after making this Cen l'icate of Ex- ♦- Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions Of the Labor Cade, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.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 Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 q Lender's Address ELECTRIC pl�pZ� 1 certify that 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 PLUMBING ordinances and,state laws relating to building construction, and BOILER-CON9P 13 H.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. uperfino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ay in any way accrue against said City in consequence of the treating this peII � MECH.CONT. LIC.NO. TOTAL (��yJ'�^-�'fr .91161,66_ TOTAL Signature of Applicant/Contractor Date OFFICE COPY