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16395 ' POST THIS CARD NEAR FRONT OF BUILDING ' ' � PERMIT NUMBER CITY OF CUPERTINO 16195 INSPECTION.DIVISION JOB INSPECTION RECORD • /�I lJ//�)'I�`p //�/� 1 _ - PERMIT EXPIRATION JOB-ADDRESS J^V I/�/�I�T"� "C'"LIv�`��✓ �D l��j',UU'NITAE _LOT# PERMIT EXPIRES IF WORK OKI, ? OWNER (/� i I1j � CONTRACTOR C/ G � IS NOT' STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS ORPERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE: LIFER � � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB S ' PLUMBING SEP15 ~k) ELECTRICAL - - t IssuANc "NTE MECHANICAL uLDG ELECT PLG- mECR CN9 of CUD (]. E DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD'FLOOR VALUATION ,. $JET, PLUMBING' - - - MECHANICAL PERMIT TO ELECTRICAL - i- „ FRAMING '• - INSULATION ,STORIES TYPECONSTR. DCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ,• `'. ROOF NOTE:NO FINAL INSP..SHALL BE MADE BEFORE sD,PT.F1.0011 ABeA rorAL ACREAee DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING - :RES IND CON PB. owr, 'I APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO; SAN.q PLUMBING _ ELECT.ENERGY TUTRACT NO, PARCEL NO.BS&SHOWER PAN PLUMBING ENERGY , � ' � MECHANICAL - MECH.ENERGY ELECTRICAL 'BUILDING ENERGY ACC,DATE. •ACC.FILE NO FRAMING ELECT.FINAL TEST ZONING ENc.SITENo. ,INSULATION PLUMBING GAS TEST GAS MECHANICAL. FIRE SPRINK ENERGY T.24 COVER NO.WO RK UNTIL ABOVE HAS BEEN SIGNED HEATING C:] "❑ [:] "❑ EXTERIOR SHEAR - - ELECTRICAL RELEASE O, F TOO 1)ZONE A,L.U,C INTERIOR SHEAR ' FIRE DEPT. Y ❑ N❑ Y ❑ N❑ SHEETROCK - GRADE • FEE SUMMARY EXTERIOR LATH - BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC — PLAN.CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC-FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, s" ELECTRIC LI ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING 1 o PLEASE GIVE JOB ADDRESS WHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL t e ... IMPORTANT! tip =. coNST.TAx PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY r _,.Af1WCANT'TO FILL IN-INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY PERMIT NUMBER. BUILDING PROJECT IDENTIFICATION I BUILDING . toll APPLICATION & PERMIT � A%0/-q- 10• 00 �Q U J BUILDING —ELECTRICAL—PLUMBING'—MECHANICAL 63(] OWNER'S . PLAN CHECK VALIDATION NAMF • CITY. ELECTRIC PERMIT FEE cJA7%0 d ' PH 40 E CONTRACTOR'S , _ NArnE .pp //.�� Cp �a UTLETS-SWITCHES-RECEP 10.00/1.00 J�e �V CL4.� `LIC.NO. / 63 LIGHTING FIXTU RES 10.00/1.00 ,( - CONTRACTORS - • APPLIANCES-RESIDENTIAL 4.00 ` AD DRESS .`'�'` 1 �1 p ,. 7/ ( F- V,6- N PHONE //�D0 PANELS 10.00 /.2+50 DATE OF APPLICATION '4 ARCHITECT - PLAN CHECK FEE P,C.N . OR . - PANELS'IOVER 200 AMP) 20.00 . - - ' ENGINEER LIC.NO. SIGNS TRANS. 3.00 ARCH.OR E.G. - -PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT ' 5.00 2,P. EMP.METER OR POLE INS., 20.00 , �r1,`'TI�, �•�•� APPLICANT'S - - MOTORS , SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 I� woo LICENSED CONTRACTORS DECLARATION < u u 1 hereby affirmythat I am licensed unBer provisions of Chapter 9 ISSUANC [SATE <n (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT PLG. MECH, r y i, Professions Cod•a and m license is in full force and effect. ❑ ❑ , 0.,—., License Cl ss Li,lsonC er 17_w] - Da[c_�—Contractor !`r)FY,p TaJ�— [ICD [ 1+' a Y s ��`� SEP 5 BUILDING PERMIT Maw ' ' OWNER-BUILDER DECLARATION - INFORMATION won H I herebyaffirm that I atm exempt'fro'm the Contractor's License MISC.— REFER T RD �e-uO< O VALUATION $/FT: F,7 o'¢ Law for the following reason,(See. uires a,Business and Professions PERMIT ISSUANCE ia Code ve,'de tyor countyir any structurep prior trees issuance, also - K at improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC,N0. ELEC. O ¢ requires the applicant for such permit to file a signed statement that f�+• YE TOTAL 2, 7 LO PERMIT TO - 4 x a- he is licensed pursuant to the provisions of the Contractor's License H z i Law(Chapter 9(eommencingwith Section 7000)of Division 3 of the a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE W the basis for the alleged exemption.Any violation of Section 7031.5' STORIES -TYPE CONSTR, a.;m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($500)): ❑ 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,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 FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. • . ments an not intended or offered for sale.If,howevegdhe building GAS EA.SYSTEM-11 NC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 - BUILDING USE. builder will have the burden of proving that he did not build or im- RES IND CON PB Other prove for purpose of saleJ. I INDUSTRIAL WASTE INTER. ' 30.00 ❑ I,as owner of the property,am exclusively contracting with F-1 1:1 El 1:1 C]licensed'contraetorS 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 contractor(s)licensed pursuant to $EWER-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 Data WATER SYSTEM .5.00 ACO.DATE ACC.FILE NO. . WORKERS'COMPE-NSATION DECLARATION WATER TREATING EQUIP.' 5.00 1 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 thatS .3800,I.A.C.). - PolicyNo Company f6 �f-IALfG^ D. ❑ Certified copy is hereby furnished. - FIRE SPRINK ENERGY T-24 Car[Ge❑ o y is filed with the tinspecHon division. Z z0 Applicant C si�i'.�r„rzn �;si'� MISC.- REFER TO ORD.D. Y'Q INC_' Y ❑ IN F y PERMIT ISSUANCE -10.00 FLOOD ZONE A.L.U.C. �'— •CERTIFICATEENSATIN INS FROM WORKERS' W �' � � COMPENSATION INSURANCE PLG.CONTR. - LIC.N0. PLG. ' CIE. D (This Section need not be completed If the permit is for one TOTAL Y❑ N❑ V❑ N❑. I D Z hundred dollars(SIOD car[a..) FEE SUMMARY (� O I certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE U. F• mit+is issued,1 shall not employ any person in any Insurer so as to , U become subjeeflo the Workers'Compensation Laws of California. m Date 4 Applicant' ALTER OR ADD TO MECH. 5.00 BUILDIN'G >%N 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 - U suchprovisionsor this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4,00 'CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C@M.)'6.00 SEISMIC FEE' I 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 CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name - HEATING UNIT(OVER 100,000 B.T.U.)9.50 .ELECTRIC /_ 7a Lender's Address -Vl�: 0 I Certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) l 4.00 .' information,is correct. Lagree to comply with all city and county PLUMBING'ordinances and state laws relating to building 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 100,000 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. ' am liabilities,judgments, costs ex ns which CONST.TAX ay in a coat accrue against sa�I City a se n t'the PERMIT ISSUANCE 10.00 ranting this permit n / ' ME ,GONT. LIC.NO. :e TOTAL TOTAL �O I azure of Applicant/Contractor Date W OFFICE COPY