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16204 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER ' CITY OF CUPERTINO 16204% INSPECTION DIVISION JOB INSPECTION RECORD - PERMIT EXPIRATION;.' JOB ADDRESS laela3 N, wdL�� 0 • . "UNIT# _LOT# . • - •_ - '-PERMIT EXPIRES IF,WORK OWNER L.SC� •']'r/il••Lj" CONTRACTOR.- - -IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. " FOUNDATION . • - ANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. UFER ' "ALL GRADING AND DRAINAGE-SHALL BE INSTALLED PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION. CUPERTINO STANDARDS. GARAGE SLABS r+ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND./SLAB �. PLUMBING41 ELECTRICAL - ISSUANCE DATE fv1ECHANICAL. - BLDG. ELECT, . PLG., MECR. El o ❑' ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - i INFORMATION PLUMBING P=AT1ON $IFT, MECHANICAL - ELECTRICAL IT TO - FRAMING ' INSULATION C#I Of OupertinoTYPE CENSER. . DEC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' • ROOF - NOTE:NO FINAL INSP,SHALL BE MADE BEFORE SO FT FLGUR AREA. TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING - RES IND CON PB E,m•, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH SANA PLUMBING ELECT.ENERGY . TRACT NO. PARCEL NO ' TUBS 85HOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ELECTRICAL - BUILDING ENERGY ACC.DATE ACC FILE NO J FRAMING ELECT.FINAL TEST •'' ZONING ENG SITE NO. , INSULATION � � PLUMBING � - _ GAS TEST ' GAS - MECHANICAL - FIRESPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ❑ ., N❑ EXTERIOR SHEAR . ELECTRICAL RELEASE FLOOD ZONE ALU'C. - ❑ ❑ o INTERIOR,SHEAR - FIRE DEPT. Y ❑ NYN SHEETROCK " GRADE FEE SUMMARY EXTERIOR LATH - BUILDING - = INTERIOR-LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT JELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISN OT PERMITTED UNTIL BUILDING FINALISSIGNED BY,BUILDING INSPECTOR. MICROFILM ' ARRANGE F.OR,INSPECTION BY PHONING 252-4505, ELECTRIC 0?, IW- ONE WORKING DAY BEFORE-REQUIRED INSPECTION. PLUMBING z� PLEASE'GIVEJOBADDRESSWHENPHONING. 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 REDLINES - USE BALL POINT PEN ONLY WILDING PROACTI ENTIFICATION - ^PERMIT NUMBER BDITCINc b APPLICATION & PERMIT 16204� 0'p ADDRESS - 4 d N, LL)O — O/4 BUILDING-ELECTRICAL—PLUMBING- MECHANICAL ... ONAME wrvEH'S N !�- rr PLAN CHECK VALIDATION • r ! -� DTV. ELECTRIC PERMIT FEE - G f HONE J/ 1 NAME DR'S NAME �,� OUTLETS1AN CHES•RECEP 10.00/1.00 /4/TD/ Wr"uc.No. LIGHTINGURES 10.00/1.00 NTRACTOR'S S/�.,/ APPLIANESIDENTIAL 4.00 ADDRESS /��s � �r��r`"' ' VII-'• PHONE PANELS 10.00 DATE OF APPLICATION ' ARCHITECT - PANELS ( 200 AMP) 20.00 PLAN CHECK FEE P.C..NO. OR NGINEER uc.No. SIGNS TR3.00 AARCH,OR DDRESS ENG. SPECIAL IT 6.00 PERMIT VALIDATION ZIP EMP.MER POLE INS. - 20.00 ADDRESS MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE M o LICENSED CONTRACTORS DECLARATION � rc U I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE ., N G N (commencing with Section 7000)of Division 3 of the Business and. BLDG. ELECT.I PLG, MECH. H N z Professions Code,and my license is in toll force and effect. ❑ rp ❑ ❑ . O w — License Class Lic.Number - o H w Date Coolrac m - - ¢ Y N - - BUILDING PERMIT rc w ¢ OWNER-BUILDER DECLARATION INFORMATION wou MISC.— • REFER TO ORD 3: AP. r I hereby affirm that 1 am exempt from the Contractor's License VALUATION $/FT. .. oa Law for the followingreason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, a �D rt improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC.NO. ELEC. i O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO wE Paashe is licensed pursuant to the provisions of the Contractor's License q,�x, H z Law(Chapter 9(commencing with Section 7000)of Division 3 of the 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FE% r - ¢ I-othe basis for the alleged exemption.Any violation of Section 7031.5 � TORIES TYPE CONSTR. 'n 3— by any applicant for a permit subjects the applicant to a civil penalty of not mALTER-DRAIN&VENT-WATER (EA.) 5.00 ore than five hundred dollars($5000.)'. - �� CUPe�In ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 occ.GROUP RES.UNITStheir sole compensation,will d0 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 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. mends are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) - 2.00 BUILDING USE builder will have the burden of proving that 1m did not build or im- .RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. .30. 00 El El- ❑ 1,as owner of the property,am exclusively contracting with 0 11 licensed contractors to 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 Law dues not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00, contmcls for"ch p cr,with acomonetarist licensed pursuant to SEWER-SAN ITAR V-STORM EA.200ft/10.00 the Centmclo's.F,'(li se Law. TRACT NO. PARCEL NO. ❑ la top not,Se ,DateB.&P.C.for this WATER HEATER W/VENT . 6.00 " reason con — WATER SYSTEM 5.00 ACC.'DATE ACC:FILE NO. w RKIiRS'COMPIINSATION DECLARATION WATER TREATING EQUIP. 5.00 " y affirm that I have a certificate Of consent to self-insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a Certified copy thereof(Sec.3800,Lab.C.). Policy'No. Company O ❑ Certifiedcopyisherebyfurnished. FIRESPRINK ENERGYT-24 Z Z ❑ Certified copy is filed with the city inspection division. - O Applicant MISC.- REFER TO ORD. y ❑ N y ❑. N� ~ w -PERMIT ISSUANCE '10.00 FLOOD ZONE 'A.L.U.C. lr > CERTIFICATE E EXEMPTION FROM WORKERS' lJJ COMPENSATION INSURANCE' PLG.CONTE. LIC. PLG. Y� .. v � N❑ 0, (This section need not be completed if the permit is for one TOTAL ::) Z hundred dollar,IS 100)or less.) U O 1 certify that in the performance of lire 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 U become subject to the Worker's'Compensation Laws of California. Ed Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICE TO APPLICANT: If,after making this Certificate of h:x- f— ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most 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 AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 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,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address �! 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) • 4.00 Information n correct 1 agree to comply with all city and county BOILER_CDMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING , ordinances and slate lows relating to buildingconslruc[ion, and 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 which CONST.TAX may in any way seer ainst said Cit in consequence of the PERMIT ISSUANCE - 10.00 ranting Df tb MECH.CONT. LIGNO. - MECH. TOTAL TOTAL Igna ure o A nt/ ontrac[or - Uele OFFICE COPY '