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16355 POST THIS CARD NEAR FRONT OF,BUILD.ING," PERMIT NUMBER'.' "CITY OF -CUPERTINO 16355 ' INSPECTION DIVISION,,'." JOB INSPECTION RECORD y)� J('� p f ' v ,PERMIT EXPIRATION - ' JOB ADDRESS - I UI 2--7 I" ' ��1T��y '�� UNIT# -LOT# `PERMIT EXPIRES IF WORK J OWNER ' Ca V I s'e 't � 'CONTRACTOR � Q L• ISNOT. STARTED WITHIN - • INSPECTION DATE INSPECTOR INSPECTIO RECORD 180 Dnvs of PERMInssu- FOUNDATIONANCE OR 180 DAYS FROM NOTE: " " LASTCALLED INSPECTION: LIFER. - ALL GRADING AND DRAINAGE SHALL.BE INSTALLED _ . TO COMPLY WITH THE APPROVED PLANS AND CITY OF ,T PERMVALIDATION , PREGUNITE' ._ CUPERTINO STANDARDS. - � ' GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED � 1 UNDERGROUND /SLAB '"jAIV"13'�9�9 �-{��-. PLUMBING City of Cupertino WLA !E ELE,CTRCAL" � ISSUANCE DATE MECHANICAL �-- aa' c , DG. ELECT. PLG.b MECR., . . Ba DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION ,VALUATION FT $I PLUMBING � � � - .� MECHANICAL' ELECTRICAL PERMIT TO FRAMING INSULATION - STORIES .TYPE Co STR. ` - OCG GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN-SIGNED ROOF • Sa FT,FLUOR AREA TOTAL ACREAGE NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGMTHE CONSTRUCTION TAXIS PAID - BUILDING USE ROOF SHEATHING_ - - • a• RE's IND. ..CONT 'PB 0"", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS• DATE INSP. ❑ ❑ '❑ ❑ ❑ ASSESSORS PAR CEL NO, ROUGH SAN.M PLUMBING, - ELECT.ENERGY - TRACT NO, PARCEL NO TUBS&SHOWER�PAN PLUMBING ENERGY '. - MECHANICAL - MECH.ENERGY ELECTRICAL- - BUILDING ENERGY - - ACC.DATE. " ACC.FILE.No. FRAMING ELECT.FINAL TEST zoNlNc ENC.SITE No. INSULATION - - PLUMBING z$' GAS TEST - . GAS � . MECHANICAL FIRE SPRINK ENERGY.T1'za: COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING E] ❑ ❑ o F . . . EXTERIOR SHEAR �� - ELECTRICAL RELEASE L000 ZONE AL.0C41 _AEF ❑ N❑ ❑ ' NO - INTERIOR SHEAR - FIRE DEPT.' SHEETROCK GRADE - FEE SUMMARY I' EXTERIOR LATH BUILDING INTERIOR LATH r - TEMPORARY APPROVALS '." - 'BUILDING , SCRATCH COAT ELECTRIC PLAN CHECK ' GAS. - FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ' OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONINGM-4505, ELECTRIC .cI.0 0: o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z ..PLEASE.GIVE JOB ADDRESS WHEN'PHONING. SEE PERMIT FOR EXPIRATION DATE — T,,, MECHANICAL IMPORTANT! CONST.-TAX PLEASTOTAL E READ"REVERSE'SIDE BEFORE CALLING FOR FINAL INSPECTION. : j. .OD I OFFICE COPY, .APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY r' BUILDING PROJECT IDENTIFICATION `PERMIT NUMBER„ 6DILDINn APPLICATION 1 L+�[[ ✓' ADDRESS O4p� I V 5 J BUILDING - ELECTRICAL-PLUMBING-MECHANICAL , OWNER'S xx NAME PLAN CHECK VALIDATION _ ~ OU OTY' ELECTRIC PERMIT FEE PHONE CONTRACTORS '1 NAME �!- 1 ep •F UTLETS-SWITCHES-RECEP 10.00/1.00 .�` CG'G 6 S' LIC.NO: 6e2q LIGHTING FIXTURES 10.00/1.00 145191. CONTRAC ADDRESS TORS W:�� 408, p APPLIANCES-RESIDENTIAL 4,00 7t� PHON��sr(/a PANELS - - 10.00 DATE OF APPLICATION OR RCHITECT PANELS (OVER 200 AMN 20.00 PLAN CHECK FEE P.C.NO. ENGINEER , LIC.No. SIGNS TRANS. 3.00 ARCH.Ess ENG' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT S MOTORS SEE FEE SCH. - CdaJT/AR SERVICE CHANGE 20.00 o ¢ 2 � °O LICENSED CONTRACTORS DIiCLARATION a v I hereby affirm that I am licensed under provisions of Chapter 9 - 13 1989, yaw (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE > D i Professions Code,Ind my license is in full fu1 apse ffecL B❑G. ELECT. PL❑G. MECH. Z O,y, License ClassCity of cupeffiflo Lie.Number 41 0 y H w Date�./...� Contractor-6' �' ¢_ rt w¢ ��•'J OWNER-BUILDER DECLARATION ' BUILDING PERMIT ° '0 MISC.- REFER TO ORD INFORMATION F. ; w I hereby Air.that 1 am exempt from the Contractor's License VALUATION u o j Law for the followingreusom.(Sec.7031.5,Business and Professions 10.00 - M PERMIT ISSUANCE w> F Code:Any city or county which requiresa permit to construct,alter, I7.'09 ¢ ¢ ¢° improve,demolish,or repair any structure,prior l0 its issuance,also ELEC.CONTR. LIC.NO. - ELEC. /�' pa( ° u requires the applicant for such permit to file a signed statement that TOTAL v V O PERMIT TO e w $ he is licensed pursuant to the provisions of the Contractor's License - r z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe 4 ° Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE `� C the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CON TR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(8500).): ❑ 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,AREA,CON D. 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 FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such inmrovc- mentsare not.imended or offered for sale.If.however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB -Omer ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00ASSESSORS 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(EA.) 1,00 contracts for such projects with a contractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ lam 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 1 hereby infirm that 1 have a certificate of consent to selGinsure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.L Policy No. Company O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T 24 Z 2 d Certifie 'o y n tiled with Lle dms • y dion division. ' Apphcam_(.�a �(f(, w{ MI$C.- REFER TO ORD. Y� N� .v � N� � O = T C17RTIFICATE OF EXEMPTION FROMOWORKF.RS' PERMIT ISSUANCE 10.00 FLOOD ZONE - A.L.U.C. LU7 COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG. Y� N� V� N[]CL O (This section need not be completed if the permit is for one TOTAL :) Z hundred dollars IS 100)or less) U O I certify that in the performuce of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY ly I- mit is issued,I shall not employ any person in any manner so as to O Wbecome subjecCto the Workers'Compensation Laws of California. Is. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING >_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex- I.. 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)000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC,FEE' I hereby affirm that there is a construction lending agency lot 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 Lenders Name HEATING UNIT 100,000 B.T.U.)9.50 ' 6 300 Lender's Address ELECTRIC I certify that I have read this application and state that Die above VENTILATION FAN (SINGLE) 4.00 . information is correct. I agree to comply with all city and coulny PLUMBING - ordinances and state laws relating to building construction, and BOILER-COMPH,P.or10O,000B.T.U.) 6.00 hereby authorize representatives of this city lu enter upon the BOILER-COMP(I3Over 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 ,PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the notin O hi permit MECH.CONT, LIC.NO. MECH. TOTAL TOTAL Si nalu e o Ap c t/Contractor ale OFFICE COPY