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16423
POST THIS RD NEAR FRONT OF BUILDING • PER NUMBER CIITOF- CUPERTINO 16423 INSPECTION DIVISION • JOB INSPECTION RECORD i ll`` PERMITTEXPIRATION TION - JOB ADDRESS 161,23 N WOLFe ;/6 UNIT# _LOT# /� O /+ �) PERMIT EXPIRES IF WORK R Il- OWNE �C/1\ V$- & CONTRACTOR &oLA,-:v -S7 (UzzI IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. I UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION CUPERTINO STANDARDS. -GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED G. .�.. M. UNDERGROUND /SLAB - r. , I PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT, PLG. MECR © ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED toBUILDING PERMIT WOOD FLOOR INFORMATION - - WATION SIFT. PLUMBING t, MECHANICAL �d ELECTRICAL 1uvw. - PERMIT TO V. FRAMING - (V 'C�'" llh ,ICQ\41 INSULATION STORIES TYPE CONSTR. OCG GROOF RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED . ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sp.FT.PLOOR AREA TOTAL ACRFAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RFS IND CON PB Oma APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS . DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN# PLUMBING ELECT,ENERGY TUBS&SHOWER PAN PLUMBING ENERGY - TRACT No PARCEL No MECHANICAL - MECH.ENERGY - ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE No FRAMING ELECT.FINAL TEST ' INSULATION PLUMBING - 20NING ENG.SITE NO. � - �� GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING El ElE] NE] EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE, A Uc. INTERIOR SHEAR FIRE DEPT, Y El N01 Y ❑ No 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 FEES OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM. _ LU , ARRANGE FOR INSPECTION BY PHONING 252-4505, .'+ `-n�, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBINGo PLEASE GIVE JOB ADDRESS WHEN PHONING. ` - SEE PERMIT FOR EXPIRATION DATE - i ` MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE s I xT k TOTAL GI CALLING FOR FINAL INSPECTION. OFFICE COPY I r APPLICANT TO FILL IN INFONATION WITHIN RED LINES - USE BILL POINT PEN ONLY BUILDING PROJECT I DENTI FICA APPLICATION & PEWT 7 16423 • puamnc V I � NUMBER AooREss' PERMIT /D/ � BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ..- OWNER'S NAME IFCILZAI ;C• PLAN CHECK VALIDAT 1N? �I•�,II QTY�4 19 . ELECTRIC PERMIT FEE 33 CONTRACTOR'S f / t NAM OUTLETS-SWITCHES-RECEP 10.00/1.00 �dE,v t LIGHTING FIXTURES 10.00/1.00 DNTEACTGR's ADDRESS �A� L L1 PPLIANCES-RESIDENTIAL 4.00 14.0 •moi asv$ PHONE4/S so 6 PANELS 10.00 DATE OF APPLICATION• ARCHITECT PLAN CHECK FEE P,.C.NO. OR _1JAr1JLA_ r("1e KI QJ2:y PANELS (OVER 200 AMP) 20.00 - ENGINEER LIC, �1 c.NO. SIGNS TRANS. 3.00 AR CH,OR ENG. I{, SPECIAL CIRCUIT S.QQ PERMIT VALIDATION AOOnESS p��L �A��T HILi- 44 zl94:5 EMP.METER OR POLE INS. 20.00 c/�' APPLICANT'S \ /}LADDRESS 193� CC�dL-IIImPFZ. MOTORS SEE FEE SCH. U%f I ,/iir-t9F 94010- SERVICE CHANGE 20.00 woo LICENSED CONTRACTORS DECLARATION - a U I hereby affirm that 1 am licensed under provisimR ofChapter 9 ISSUANCE DATE yz"' (commencing with Section 7000)of Division 3 of the Business and ¢ c B ELECT. PLG. MECH. H in i Professions CoJ an my tic se is in full forst',V- fefox z o m - License C xy, y Lic.Number �p D o L H w� Date Contractor_�GXam II (r- ¢ -f UG DING PERMIT ¢ o a OWNER-BUILUfiR DECLARATION INFORMATION K y I hereby affirm that I am exempt from[he Contractor's License MISC.- REFER TO ORD w nu VALUATION $/FT. o¢ Law for the following reason(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 W0 -i Code:Any city Or County whichrequiresa permit toconslRmLaller, ¢ ¢00 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.N0, ELEC. aa wD LL 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 Fit Law(Chapter 9(commencing with Section 7000)of Division 3 of the �AI--IC VL• 'All' \I . ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ro the basis for the alleged exemption.Any violation of$ection 7031.5 STORIES, TYPE CONSTR. a ;m by any applicant for a permit subjects the applicant toe civil penalty ALTER-DRAIN -WATER'(EA.) 5.00 of not more than five hundred dollars(S500).): ❑ I,as owner of the properly,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 ITT 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 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. mentsare not intended or offered for sale.l L however,the building GAS-EA.SYSTEM-11NC.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 lie did not build or im- BUILDING USE prove lot purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Gore, ❑ 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 Contractors 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 contmeiots)licensed pursuant to SEWER-SAN V-STORM EA.200f[/10.00 the Contractor's License Law. TRACT N0, PARCEL NO. ❑ I am exempt under Sec. ,BARC.for this WATER HEATER W/VENT - 6.00 reason Owner Data WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 ' 1 hereby affirm that I have a certificate of consent to self-insum, or a certificate of Workers'Compensation Insurance,or a cartil'Icd ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). ? Policy No. Company A It, e,. O� �Q,C Cert is(orreb furnished. - FIRE SPRINK ENERGY T 24 Z Z ❑ Certified op is with �he cily inspection division. 0 Applicant � _f_o_f__ _ MISC.- REFER TO ORD. Cl ❑ ❑ ❑ CC CERTIFICATE OF EXEMPTION FROM WORKERS' ~ y - PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. N LL > COMPENSATION INSURANCE PLG.CONTE. ❑C.NO. PLG. C' O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑ D Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL 17 mit is issued,I shall not employ any person in any tanner so as to U become subject to the Workers'Compensution Laws of California. O L Date Applicant BUILDING } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5,00 F Z 29 7 eruption,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 AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE SL _ 1 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.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that I have read this application unit stale that the above VENTILATION FAN (SINGLE) '4.00 . information is correct. I agree to comply with all city and countyBOILER-ODNP(3 H.P.Dr 100,0008.T.U.) 6.00 PLUMBING ordinances and slate laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BT6)SEE FEESCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. aper tino against liabilities,judgme is, costs and expenses which - PERMIT ISSUANCE 10.00 CONST.TAX, ay in any way accrue nsl ity in con aqua ce of the anti fthia permit MECH.CONT. LIC.NO. MECH. 4 o p� TOTAL TOTAL I of Appbcanl/ I«aclorJ D Ve OFFICE COPY