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16369 .► POST THISWD NEAR FRONT OF-BUILDING PERMIT NUMBER CITrOF CUPERTINO . 163:69 INSPECTION DIVISION, JOB INSPECTION RECORD • ' •' '• '. oIy� PERMIT EXPIRATION 3. /i% W o� 3 \ JOB ADDRESS lO- �'� V UNIT#. _LOT# PERMIT EXPIRES IF WORK , OWNER 0 9-Lf} ,.Ca'S' CONTRACTOR ,g,.. IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR - IN18PECTION RECORD • 180.DAYS OF PERMIT ISSU. : FOUNDATION - .•ANCE OR 180 DAYS FROM ' TGRADING LAST CALLEDINSPECTION. AND DRAINAGE SHALL BE INSTALLED UFER ALL PR EGUNITE - - TO COMPLYrDARDS.WITH THE APPROVED��N'AANND CITY OF PERMIT VALIDATION. CUPERTINO STAN GARAGE SLABS . POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED SEPI 3 988 UNDERGROUND,/SLAB ' PLUMBING CHH Of Cupertino ELECTRICAL Issua"cE DATE BL MECHANICAL - - DG ELECT I PLG. MEC.. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION S/FT. PLUMBING MECHANICAL .{ - ELECTRICAL y,-' PERMI o• Nlc ' FRAMING - �' INSULATION 'STORIES TYPE CONSTR, . - A. . .00C.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - 'ROOF' NOTE:N FLOOR,AREA TOTnL ACREAGE L INSP.SHALL BE MADE BEFORE SO , FT DIAPHRAGM THE CONSTRUCTION TAX IS PAID I 3� BUILDINGUSE ROOF SHEATHING • - ` RESIND CON Pe' Ow�, APPLY.NO ROOFING UNTIL'ABOVE HAS BEEN SIGNED FINALS DATE I ANSP. ❑ ' ❑ ❑ ❑ ❑ ROUGH SAN.# ASSF.550RS PARCE LNO. , PLUMBING _ ELECT.ENERGY - TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO MECHANICAL - MECH.ENERGY ELECTRICAL BUILDING.ENERGY ACC,,OATE ACC,FILE NO. I FRAMING - ELECT.FINAL TEST " f +t' INSULATION - PLUMBING zCNING ENG.SITE NO. GAS TEST - GAS MECHANICAL EIRE SPRINK, ENERGY T+aa COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _ ) ❑ "❑ ❑ "❑ ELECTRICAL RELEASE FLDODZONE A,L.0 C, • EXTERIOR SHEAR - . . INTERIOR SHEAR FIRE DEPT. ; Y❑ N❑ Y ❑ N❑ SHEETROCK . _ GRADE FEE SUMMARY EXTERIOR LATH - BUILDING INTERIOR .LATH 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 ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ` ELECTRIC `- F 'ONE WORKING DAY BEFORE REQUIRED INSPECTION } PLUMBING z 0 PLEASE GIVE JOB-ADDRESS WHEN PHONING. •• - ' MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST;TAX PLEASE READ REVERSE SIDE BEFOREO � CALLING•F.OR FINAL INSPECTION! 'TOTAL OFFICE COPY APPLICANT TO FILL IN INFOIWATION WITHIN REDLINES - USE BALL POINTPEN ONLY BUJ LDI NG PROJECT I DENTI FICA - PERMIT NUMBER 6DILDING APPLICATION & PE T 16369 DOREss Q 3 �, � ' BUILDING ELECTRICAL—PLUMBING—MECHANICAL I!a OWNER$ NAME _ PLAN CHECK VALIDATION • - QTV. ELECTRIC PERMIT FEE , G ONE NOAMTRAcroR's UTLETS'-SWITCHES-RECEP' 10.00/1.00 Lia No C© OD LIGHTING FIXTURES 10.00/1.00 • , ADDDR.E,SS r/o`Rs - PPLIANCES-RESIDENTIAL 4.00 - - 406 a•,ti BONE PANELS 10,00 DATE OF APP LICATIO ARCHITECT PLAN CHECK FEE P.C.-NO. oA PANELS (OVER 200 AMP) 20.00 ENGINEER LIC.NO. jSIGNS TRANS. 3.00 ARCH OR ADDRESS ENG. SPECIAL61RCUIT 5,00 PER MIT VALI DATION ZIP TEMP.METER OR POLE INS. 20.00 ADDRIESsTs MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 U /q / W 09 LICENSED CONTRACTORS DECLARATION sL 00 • <u I hereby affirm that I am licensed under provisions ofChapter 9 ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and ',d BLDG, ELECT. PLG. MECH: F i Professions Code and sy license is in full farce�Wfv. 1 ❑ z o L — License Class ey Lia Number O Y - - - Date 9�43—>S� S C p 13 19E8. BUILDING PERMITOWNiR-BUILCoUEEC LARATION D w a U INFORMATION w3:a N I hereby affirm that I am exempt from the Contractor's License 'MISC.— ERT OR u O< Law for the following reason.(Sec.7031.5,Business and Professions VALUATION —0 Code:Any city or county which requires permit to construct,alter, PERMIT ISSUANCE SeQ Q Q Improve,demolish,or repair any structure,prior to Its Issuance,also ELEC.CONTR. LIC.NO. ELEC. 0 F 0 LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT,TO _ W$ he is licensed pursuant to the provisions of the Contractor's License H Z a Law(ChaPtet9(commencing with Section 7000)of Division 3 ofthe 4 o Business and Professions-Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE " ¢ f $ the basis for the alleged exemption.Any viola ion oLeeclion malty STORIES TYPE CONSTR. i ; — by any applicant lora permit subjects lhcant toacivil penahy ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred Aollars($500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Oce.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,GOND. 5,00 Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who docs such work FIXTUR ES,PER TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. 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. builder will have the burden of proving that he did not build or int GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDINGUSE RES r IND CON PB Other Cl 1, for purpose of sale.): INDUSTRIAL WASTE INTER. -30.00 11 IN Cl El*. 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. 6.00 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(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to SEWER-SAN V-STORM EA.200ftI10.00 the Contractor's License Law. "TRACT NO. - PARCEL NO. ❑ 'lam exempt under Sec.—,B&P.C.for this WATER.HEATER W/VENT - - 6.00 reason Owner Date WATER SYSTEM 5.00ACC.OATE 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, - --ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy there f( 900,Lab.C.�T� " Policy No Company * -L Q ❑ Certiliedc yisherebyfurnlshed FIRESPRINK ENERGY T-24 Z 2 ❑ Cerlifius� P4 Fit fi city inspection division. O ApplicantT a ` ^� MISC..- REFER TO ORD. Y N i Y � IN ~ �+ PERMIT ISSUANCE 10.00 CC — CERTIFICATE EXEMPTION FROM WORKfiRS' FLOOD ZONE A.L.U.C. LLI > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL 0Z (This section need not he completed if Ilse permit is for one TOTAL - Y O N❑ Y [jN O hundred dollms($1001 or less.) U O 1 certify that in the performance of the work for which this per- QTV. 'MECHANICAL PERMIT FEE FEE SUMMARY ELF mit is issued,Label]not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of California. BUILDING M Date Applicant ALTER OR ADD TO MECH. 5.00 } to NOTICE'1'O APPLICANT: 11,after making this(:clinical,of IT condition,you should become subject to the Workers'Compensation APPLIANCE - 5.00 •t. PLAN CHECK - provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 490 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE ' 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 lire performance of the work for which this permit is issued(Sec. - MICROFILM 3097,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) .8.00 Lender's Name H EATI NG UN IT(OV ER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC I certify that I have real thisimplication and stale that the about VENTILATION FAN (SINGLE) - `t • information is correct. I agree to comply with all city and county .PLUMBING p' ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000B.T.U.) 6.00 hereby 'authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL abm ove- entioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, costs and expenses which - PERMIT ISSUANCE - fd$S �e2 CONST.TAX may in a ay ccrue against said City in consequence of the . rani - mit. MECH.CONT. LIC.NO: MECH. TOTAL TOTAL �I Signator f Applicant Contractor Date OFFICE COPY