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16255 I -POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER 'CITY OF CUPERTINO 16255 . INSPECTION DIVISION •3' JOB INSPECTION RECORD c d, D ,• PERMIT EXPIRATION 1 �.. JOB ADDRESS' /O(.Z3 !� . KAO L�Sr- R6 UNIT# _LOT# 9 PERMIT EXPIRES IF.WORK "! OWNER -lU9KQ--A--j',��Z coNTFACTOR &C/Z.,,a `( IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. I FOUNDATION NOTE: ANCE OR 180 DAYS FROM s . UFER �. ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNITE• - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLRMIr VALIDATION GARAGESLABS CUPERTINO STANDARDS. - � - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED l.,,,.,,s-r •-'"'' UNDERGROUND /SLAB PLUMBING , �•1 + Jy 6 'ELECTRICAL ISSUANCE DATE MECHANICAL - =77-177E7 PLG, MECH •• ❑ ❑' I ❑ I ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT p�O _ INFORMATION . WOOD FLOOR - r_ vn LUATION $/FT, PLUMBING - - � �`" MECHANICAL CN ELECTRICAL 1--PERMIT To 01 FRAMING '`� Ot�1V G LeC-711- - INSULATION sTDRIES TY PE CONSTR. OCC.GROUP •RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED $O.fi FLOOR AREA TOTAL ACREAGE . / ROOF . NOTE:NO FINAL INSP.SHALL BE MADE BEFORE . DIAPHRAGM THE CONSTRUCTION TAX IS PAID . BUILDING USE ROOF SHEATHING - RES IND CON PB 00— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ " ROUGH SAN.# ASSESSORS PARCEL NO. �� PLUMBING. ELECT.ENERGY TUBS B SHOWER PAN PLUMBING ENERGY. TRACT No. PARCELNo - MECHANICAL MECH.ENERGY ELECTRICAL - BUILDING ENERGY ACC DATE ACC PILE NO FRAMING - - ELECT.FINAL TEST .ZONING ENG.SITE N0. INSULATION � PLUMBING .'t/,.= n72 GAS TEST GAS - MECHANICAL FIRE SPRINK ENERGY T.?G COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED' HEATING - 'v NE Y .L_ "o .. FLOOD ZONE A.L U. EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR - FIRE DEPT. v N[3 . 1 I] NE] SHEETROCK GRADE FEE SUMMARY ' EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS '. BUILDING SCRATCH COAT ELECTRIC PLAN CHECK, GAS FEE NOITAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE, OCCUPANCY OF BUIL DING IS NOT PERMITTEDUNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM +4 ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 65b LU LUONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o� PLEASE GIVE JOB ADDRESS WHEN PHONING. z 4aI,.'• ' MECHANICAL' = SEE PERMIT FOR EXPIRATION DATE — IMPORTANT!. CONST.TAX PLEASE READ REVERSE SIDE BEFORE a:.. ? '. TOTAL CALLING FOR FINAL INSPECTION., OFFICE COPY I APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY OUI LDI NG PROJECT I IDENTIFICATION p5RMIT NUMBER - BDILpING APPLICATION & PERMIT 16255 ADISHESS SP, BUILDING ELECTRICAL-PLUMBING'-MECHANICAL �� M' e 12 N. a�L F� OWNER'S ' NAME I,r• GTY. ELECTRIC PERMIT FEEPLAN CHECK, � ' VALIDATION II c 6 CONTRACTORS NAMEL--IO UTLETS-SWITCHES-RECEP 10.00/1.00 LIC.No. LIGHTING FIXTURES- 10.00/1.0 AmmESET^OLRs PPLIANCES-RESIDENTIAL 4.00 y PHONE OI SJ(o I PANELS. - 10.00 DATE OF APPLICATION' ARCHITECT PLAN CHECK FEE R.C.NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER ' uC.No. ISIGNS TRANS. - 3.00 ARCH.OR ADDRESS ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 „ •�^ ADDRESS MOTORS SEE FEE H. G-"✓'i/'�-_,•/ ADDRESS • SERVICE CHANGE 0 0 i Fo0 o LICENSED CONTRACTORS DECLARATION <U U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE N a lu (commenting with Section 7000)of Division 3 of the Business and F m i Professions Code and my license is In full for •and effect �e BLDG. ELE PLG. - MECH. 0 0 A License Clu s�s/� Lie.Number ICA Z H 0 Dale �' Contractor-�E� {c IssW Lick I El El HJ V``7 BUILDING PERMIT M Q w OWNER-BUILDER DECLARATION INFORMATION wgH VALUATION I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD $/FT. F LL w¢ Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE - - mt Code:Any city orcounty whichrequlresapermitlneamshuet,alter, 2 ¢ ¢O improve,demolish.or repair any structure,prior to its.issuance,also ELEC.CONTR. . LIC.NO. ELEC. / i O¢ requires the apPlicanl for such permit(o file a signed statement that TOTAL a 4 PERMIT TO SV X he is licensed pursuant to the provisions of the Contractors License F z i Law(Chapter 9(commencing with Section 7000)of Division Sof the E�Z s 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE 7 I-$ the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.' d ; _ by any applicant for a permit subjects the applicant on civil penalty gLTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(85001.): ❑ 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 Profession. - DRAINS-FLOOR,ROOF,AR EA,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 hif or through his own employees,provided that such Improv 1 • memsmselare not e intended or offered for sale.Il',however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 Gr improvement is sold within one year of completion,the owner- builder will have the burden of proving that Ise did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose ofsaleJ. - INDUSTRIAL WASTE INTER3000 RES IND CON PB Othar ❑ I,as owner of the property,am exclusively contracting with . : E] 0 E] 0 E] 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 does not apply ' to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1'.00 contracts for such projects with a contractoos)licensed pursuant t0 the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ Iain exempt order Sec. ,B.&P.C.tor this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 Ace.DATE ACC.FILE NO. WORK 17RS'COMPENSA'r1ON DECLARATION WATER TREATING EQUIP. - 5.00 I hereby affirm that.1 have a certificate•ofecownt to self-insure, - ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,1.ab.C.). - ? Policy No. Company �� ' 0 ❑ trilled copy is hereby furnished. - FIRE SPRINK ENERGY T.24 Z Z Certified L1 li edl with the city inspection division. � p Applicam Coq 1.1 c-YG i MISC.-- r REFER.TO ORD. - Y N� v ❑ N❑ Ua / PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. CIiRTIFICATE OP EXEMPTION FROM WORKERS' 11 1 LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. y N v N� a. Z (This section need not be completed it the permit is for one - TOTAL L0 O hundred dollars($100)or less.) 1 certify that in the perfonnanceof the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL ♦- mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers Compensation Laws of Califomia. W Date-ApplicantBUILDING >- m NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 F Z 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 10,01MQF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 theerf3097, oC ince of the work for which this permit is issued(Sea HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC bz JT. I certify that I have read thisapplication and state that the above: VENTILATION FAN (SINGLE) 4.00 0information is correct. I agree to comply with all city and county PLUMBING ordinances and slate laws relating to building construction, and BOILER-DOW(3 H.P.or 100,000 B.T.U.) 6.00 p hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE BCH. MECHANICAL above-mentioned properly 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 am way cane against said City in consequence of the PERMIT ISSUANCE 10.00 anti o is miL MECH.CONT. LIC.NO. MECH. TOTAL I TOTAL ==pli ant tactor Date- OFFICE COPY