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16217 .POST THIS CARD NEAR FRONT OF BUILDING CITY- OF .CUPERTINO.: R Me ER 16217 4 INSPECTION DIVISION. _ ` L JOB INSPECTION R CORD ' ; PEA IT EXPIRATION z JOB ADDRESS 101 2— N, vy"D�r ICJ- UNIT# LOT# '( // ,' � '. ' PERMIT EXPIRES IF WORK 'OWNER 'B $ y-'LI/L� coNTRAcroR IS NOT STARTED WITHIN ! INSPECTION • DATE- I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION NOTE: ANCE OR 180 DAYS FROM - - LASTCALLED INSPECTION. UFER _ / ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION < ,PREGUNITE CUPERTINO STANDARDS. . -' GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ��,I ,pp J({ • - PLUMBINGV>�c .^ ELECTRICAL - 5 ISSUANCE unre - ' MECHANICAL; .. (zy� 2, RLnc.• ELEr,T, vlc.. - MECR. 72.GiZcT Nl ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION ,$/FT. ' y�1 �•/';' MECHANICALS' /. � �'• J(✓, ELECTRICAL _ - PERMIT To FRAMING INSULATION - E;`, STORIES " rRRvPEomsrR. OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED V�� I,-N ' . ROOF: NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO,FTFLOOR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID /RuaDlrvc USE ROOFSHEATHING RES IND CON PBon6• i .� APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ' ASSESSORS PARCEL NO. ROUGH SAN.N PLUMBING ELECT.ENERGY TUBS'&SHOWERPAN PLUMBING ENERGY TRACT No PARCEL No MECHANICAL - MECH.ENERGY ' ACC DnrE. Acc.FILE No. ELECTRICAL' —) BUILDING ENERGY FRAMING - ELECT.FINALTEST INSULATION - PLUMBING - ZONING ENC.SITE No. GASITEST • GAS ' MECHANICAL 2 _ 'R I.SPRwK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING a� C rkrcatz Y K N E] ` E] N[] SHEAR ELECTRICALR 00 Loop zorvE aL;u C. INTERIOR SHEAR FIRE DEPT. Y❑ N❑ YL , ,ND SHEETROCK ' - . GRADE FEE SUMMARY EXTERIOR LATH, BUILDING, —ZV ,INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK . - GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY _ SEISMIC FE 4 OCCUPANCY OF BUILDING ISNOT.PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM , ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. - PLUMBING - oPLEASE'GIVE JOB ADDRESS WHEN PHONING. Z ' = SEE PERMIT FOR EXPIRATION DATE - MECHANICAL 1 IMPORTANT! ` a2 CONST.TAX PLEASE READ REVERSE SIDE BEFORE' "'.;y , ,' ' - - TOTAL 'CALLING FOR FINAL INSPECTION: OFFICE COPY Y• ' APPLI •AN TO Fli L IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY - ERPL.DINdPROJECT IDENTIFICATION PERMIT NUMBER a.ILDING -APPLICATION & PERMIT 621 ADOREssI 12� s �� .I BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S t)� PLAN CHECK VALIDATION - rvnmE a�,J� OTy, ELECTRIC PERMIT FEE �j�j PHGNE ghb- Fb . 15 e CONTRACTOR'S NArE UTLETS-SWITCHES-RECEP 10.0011.00 tJLIc.NG. LIGHTING FIXTURES 10.00/1.00 . CONTRACTOR'S - PAN PPLIANCES-RESIDENTIAL 4.00 OREss ``77 - VPHONE 4 PANELS 10.00 DATE OF APPLICATION PLAN CHECK FEE P,C.NO. ARCHITECT OR ' �,^ PANELS (OVER 200 AMP) 20.00 ' ENGINEE �/ SIGNS TRANS. 3.00 ARCH,OR ENG. PERMIT VALIDATION ADDRESS 11 SPECIALCIRCUIT 5.00 l � • zIv LO EMP.METER OR POLE INS. 20,00. 17 'S Com/ APPLICANT ADD REs MOTORS SEE FEE SCH. I (J SERVICE CHANGE 20.00 ��p 4T SERVICE VL LICENSED CONTRACTORS DECLARATION <U,w I hereby of that 1 am licensed under provisions of Chapter 9. - ISSUANCE DATE ., a w (commencing with Section 7000)of Division 3 of the Business and •v r w z Professions Code,and my license is in full force and effect s, - BLDG. ELECT. PLG. MECH.❑ ❑ ❑ 0 ia,W FEB License Class Lic.Number H DateContractor a Y fBUILDING PERMIT OWNER-BUILDER DECLARATION - A o a o - INFORMATION X ; m I hereby affirm that 1 am exempt from the mcniractor's License MISC.- REFER TO ORD .. 00 J Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT. - PERMIT ISSUANCE 10.00 `Fw >f Cade:Anymolish coo ntywhiny requires ep rior toots ishan..also P/�2) //5 r0, ¢ ¢ a D IlllprOVe,demolish,Or repair any sllllCtarl`,prior to its ISallunee.llla0 ELEG.CONTR. LIC.ND. ELEC. 0(/ __ -' i w m M requires the applicant for such permit to file a signed statement that TOTAL ' PERMIT TO ' he is licensed pursuant to the provisions of the Contractor's License r / r z Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe s o Business and Professions Code)or Him he is exempt therefrom and ¢ I- a the basis for the alleged exemption.Any violation of Section 7031.5 QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR.i-gam by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5,00 of not more than five hundred dollars(5500).): ❑ 1,as owner of the property,or my employees with wages as BACK F LOW 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 SQ.FT.FLOOR AREA TOTAL ACREAGE s himself or through his own employees,provided that such improve- 771 A mems 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 IEA.) 2.00 BUILDING USE ' ( builder will have the burden of proving that he did not build or no. 'V a'* prove for purpose of sale.). - INDUSTRIALWASTE INTER. 30.00 - RES IND CON PB _Oer O I,as owner of the property,am exclusively contracting with ❑ El ❑ m❑ Mnsed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. Professions Code:.The Contractor's License Luw does not apply to an owner of propertywho builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) - 1.00 s` contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00 reason' Owner - Date WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent sell-insure. ZONING ENG.SITE NO. the or a certificate of Workers'Compensation Insurance,or or a certified copy lheresf(Sec.380.Lab.C.). Policy No. ' y Company ' Q ' ❑ Certified copy isherebyfiled furnished, th FIRE SPRINK ENERGY T.14 Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. �yt p Applicant. Y InL N❑ V ❑ N❑ ~ �_ PERMIT ISSUANCE 10,00 .FLOOD ZONE A.L.U.C. ' Lu CERTII'IGATE E 9ATIO_T ION FROM WORKERS' ' . (L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. YQ NC] Y❑ N❑ 0 Z TOTAL(Phis section need not be completed if the permit is for one hundred dollars IS 100)or less.) U O' I Ixrtify 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 U becomesubjecl to the Workers'Compensation Caws of California. BUILDING t� y Date-Applicant - - ALTER OR ADD TO MECH. 5.00 >_ to NOTICE TO APPLICANT': If,after making this Certificate of IN- - L.. Z emplisn,you should become subject m 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.F.M.) 6.00 SEISMICFEE t�a YS (hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 ' the performance of the work rm-which this permit is issued(Sec. - MICROFILM .--_�- 3097,Civ.C.). ` HEATING UNIT(TO 100,000 B.T.U.) 8.00 - Lender's Nam Leader's Add ss H EATI N G UN IT IOV ER 100,000 B.T.U.)9.50 ELECTRIC Yn::6•- 1 certify that I 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 countyPLUMBING ordinances ani state laws relating tobuilding construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.)'6.00 �+ hereby authorize representatives of this city to enter upon the BOILER-COMP Over 100,0008TUl SEE FEE SCH. MECHANICAL above-meWqlic.otjc. � f n r ores.(We) ake harmless the City of MISC.- REFER TO ORD.upertino is, Sts and expeses which CONST.TAX ay in'aid ty in consequence of the PERMIT ISSUANCE - 10.00 antingo - MECH.CONT. LIC.NO. MECH. I241iC/ TOTALTOTALSign rer Dute l/ OFFICE COPY