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16216 !7 POST THIS CARD NEAR"FRONT'O F,BUIL DING PERMIT yuMBER CITY OF CUPERTI NO INSPECTION DIVISION �� JOB INSPECTION RECORD S PERMIT EXPIRATION JOB ADDRESS_oLa'L / 14/0 L-4r;E_ UNIT# _LOT# '7LL_ PERMIT EXPIRES IF WORK OWNER : I J 'Cd 0 LC CONTRACTOR ,p LCj-�( IS .NOT STARTED WITHIN INSPECTION DATE- I INSPECTOR INSPECTION RECORD 180 DAYS.OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE: - - LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF. PERpm VAr.mATION PR EGUNITE14 r-' CUPERTINO STANDARDS. GARAGE SLABS - - r POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - ,•-'✓ . UNDERGROUND /SLAB J/ ! h PLUMBING ELECTRICAL - - ISSUANCE DATE MECHANICAL - BLuc. ELECT PLG. MECH. E] ❑ E] .❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED QBUILDING PERMIT. INFORMATION PLUMBING WOOD.FLOOR 0 VALUATION SIFT. � - ��•. `\ 4 MECHANICAL y ELECTRICAL '- PERmITT FRAMINGS�� '. 'INSULATION - STORIES TYPE CONSTR. OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE S0,Fl FLooR nBEA TOTAL.ncRI:AGe DIAPHRAGM THE CONSTRUCTION TAX IS PAID- ROOF Bulun uS I IIES IND CON Ory PB on�" � APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 'D •❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.# - - - PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO, TUBS B SHOWER PANPLUMBING ENERGY _ MECHANICAL MECH.ENERGY ' - ACC.DATE ACC FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST I INSULATION PLUMBING ZONING ENG.SITE NO. - GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY TQ< l COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING w " I "o I EXTERIOR SHEAR . ELECTRICAL RELEASE � FLOOD ZONE A,L U,C. I INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ . NO SHEETROCK GRADE FEESUMMARY EXTERIOR LATH BUILDING BUILDING Q'0 INTERIOR LATH TEMPORARY APPROVAL ' - SCRATCH COAT r ELECTRIC - PLAN CHECK 0 GAS - FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY , SEISMIC FEE U �1 r OCCUPANCY OF,BUILDING IS NOT PERMITTED UNTIL BUILDING FIN ALI S SIGNED BY BUILDING INSPECTOR. MICROFILM I ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC h� ONE WORKING DAY BEFORE REQUIRED INSPECTION., PLUMBING r� O PLEASE GIVE JOB ADDRESS WHEN PHONING. z- MECHANICAL — SEE PERMIT FOR EXPIRATION DATE = 1 TAX IMPORTANT! ' coNST.. I PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. , 711( OFFICE COPY - . Pj4PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NG PRpJECTADENTI FICATION .PERMITNOMBER _. BmLmNG APPLICATION &.PERMIT - •°- �^ � ADDRESS -�' BUILDING-ELECTRICAL-PLUMBING-MECHANICAL • GI ' PLAN CHECK VALIDATION �- 11 AQTY. ELECTRIC PERMIT FEE V PHONE 6 crORs NAME UTLETS-SWITCHES-RECEP 10.00%1.00A15 - NAME - �•-yr f S16il 4LI uc.No </�9 LIGHTING FIXTURES 10.00/1.00 1; NTRACTOR'S ADDRESS /1 1 2 /•'}J APPLIANCES-RESIDENTIAL , 4.00 ' I S76 9 J lwof fl PHONE, -6- OPANELS 10.00 DATE OF APPLICATION . ARCHITECT - PLAN CHECK FEE P.C!NO. OR PANELS (OVER 200 AMP) , 20.00 ENGINEER .. LIC.NO. SIGNSTRANS. 3.00 _ARCH ENG. - ADDRESS OR SPECIAL CIRCUIT 5.00 PERMIT VALIDATION APPLIANTS zm EMP.METER OR POLE INS. 20.00 C ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00' o0C ac O'0 LICENSED CONTRACTORS DECLARATION - o u I hereby affirm that I am licensed under provisions of Chapter 9 rt m (commencing with Section 7000)of Division 3 of the Business and ISSUANCEDATE .ELECT. PLG. MECH. H w z Professions Codd`� an mylicense ism full forcq pnd xff c - ❑ ❑ ❑ ZO 0 In�, License Class G- J Lie,Number- 6_ umber Y 1"`/ _ H r `T'/' Date Contractor a SE w a OWNER-BUILDER DECLARATION - B ING PERMIT w- FORMATION 3 u m I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO'ORD u o'J Law for the following reason.(Sec.7031.5,Business and Professions - LUATION _f/FT t - PERMIT ISSUANCE 0� � Code:Any ply orcounty which requires a permit to construct,alter, 10.00 l� ac a ¢ improve,demolish,or repair any structure,prior ro its issuance,also ELEC.CONTR. LIC.NO.' ELEC. Lc Le o u requires the applicant for Such permit to file a signed Statement that TOTAL PERMIT TO N m he is licensed pursuant to the provisions of the Contractor's License �T".V/ ri Law(Chapter 9(com mencingwith Section 7000)o f Division 3 ofilm Q ' F 4D Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE la I"w the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a3 _ by any applicant for apermit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($500).): ❑ 1,as owner of the property,or my employees with wages as BACKFLOW 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,CON D. 5.00 Coder 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.Fr.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- - am is are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS6.00 - or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 R W LDING uSE prove for purpose of sale.). INDUSTRIAL WASTE INTER. - 30.00 RES' IND CON PB Other ❑ 1,as owner of the property,am exclusively contracting with '� licensed contractors to construct the project(Sec. 7044,BusinessLAWN SPRINKLERS- 1 INC 5VB600 • ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply V.B. . to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to - - theContractor'sLicenseLaw. SEWER-SANITARY-STOflM EA.200ft1 00.00 TRACT NO. PARCEL NO. ❑ 1 am exempt antler Sea ,B.&P.C.for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM. 5.00 r ,ACC.DATE ACC.FILE NO. WORKF:RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, - or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. 'oPY (Sec.3800....((.�ab.CJ�m5.2 Policy z'om{Iuny ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY TQ4 Z Z ❑ Certified`ce y is Iled wnh the city i p�p cRon division. FO Applicant jl�1� i ilr�- MISC.- REFER TO ORD. - Y[] N[3 1 Y NE] T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 1 10.00 FLOOD ZONE A.L.U.C. W > COMPENSATION INSURANCE PLG.CONTR. LIC.N0. - PLG, (1 0 (This section need not he completed if the permit is for one TOTAL YN _ Y N� D Z hundred dollars IS 100)or less.) L) O I certify that in the performance of work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY U. F mit Is Issued,I shall not employ any person in any manner so as to O Wbecome subject to the Workers'Compensation Laws of California. } y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING - W NOTICE TO APPLICANT: If,after making this Certificate of Ex- 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 5 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 10000C.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,Civ C.). HEATING UNIT ITO 100,000B.T.U.) 8.00 Lender's Name HEATINGUN IT(OV ER 100,000 B.T.U.)9.50 ' ELECTRIC - Leader's Address ' I certify that b have read this application a ad state that the above VENTILATION FAN (SINGLE) 4.00 informationrdmaceas correct. I agree to comply with all construction, county BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating m building construction, and hereby authorize representatives of thisrpo enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL JtJ' above-mentioned property for inspection purposes, (Wel agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. ape mo against liabilities,judgments, costs and expenses which CONST.TAX a any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 - ng f f this permit! MECH.CONT. LIC.NO. MECH. � r,'''.. TOTAL TOTAL 41" Signature of Applicant/Contractor Date - OFFICE COPY'