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16456 -POST THIS CARD NEAR FRONT OF BUILDING . - 6 • • - , PERMIT NUMBER CITY SOF, CUPERTINO PECTION DIVISION :' 16456 •JOB INSPECTION RECORD PERMIT EXPIRATION •,x JOB ADDRESS 1 a ( Z-3—/IJ. I/VJ� /r rI UNIT#. -LOT# pERM1T EXPIRES IF.WORKl OWNER Q S`L G 1 NTRACTOR IS NOT STARTED WITHIN' INSPECTION DATE I INSPtCTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU- ; FOUNDATION . . ANCE OR 180 DAYS FROM -UFER ALL- GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLEDINSPECTION. PR EGUNITE r - - 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 PLUMBING ELECTRICAL - r ISSUANCE unre MECHANICAL' • _ - BLuc. ELEcr. PLc. MECH 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION • WOOD FLOOR , PLUMBING VALUATION $/FT. � � n r MECHANICAL ELECTRICAL _ PERMIT TO 0 FRAMING - - VQ8 _ \� INSULATION" r TYPE corvsna. - �dYL . OCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 1 - ' SO.FT.FLOOH AHP TOTAL ACREAGE , "ROOF- - NOTE:NO FINAL INSP,SHALL BE MADE BEFORE 7 •a DIAPH_RA, THE,CONSTRUCTION TAX IS PAID - BUILDING USE ROOF SHEATHING - Firs IND CON PB APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE- INSP. ❑ ❑ ❑ ❑ ❑ AssE SSORS PARCEL NO ,ROUGH SAN.# PLUMBING ELECT.ENERGY TRACT NO. PARCELING, - A SHOWER PAN PLUMBING ENERGY - + MECHANICAL MECH.ENERGY ACC.DATE., .ACC.FILENO ELECTRICAL. BUILDING ENERGY - FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION - PLUMBING 3p�-�y /J � ' GAS TEST GAS 30_ • MECHANICAL FIRE SPRINK ENERGY L24 . �✓.� Y ❑ Y - COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING �' � NEI , '❑ El NEI 'EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A,L U C- INTERIOR SHEARFIRE DEPT. Y ❑ 'N❑ YL N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH IBUILDING - INTERIOR LATH - TEMPORARY APPROVALS' BUICDwG SCRATCH COAT -- - ELECTRIC PLAN CHECK -' .. - GAS . FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY'S - SEISMIC FEE , OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY,BUILDING.INSPECTOR. MICROFILM --ARRANGE FOR INSPECTION BY PHONING 252-4505,• q.` ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING F. O PLEASE GIVE JOB ADDRESS WHEN PHONING... zFOR-.SEE PERMIT EXPIRATION DATE - MECHAN CAL . IMPORTANT! y� CONST.TAX R PLEASE READ REVERSE SIDE BEFORE TOTAL, ' «��CALLING FOR FINAL INSPECTION. �!"' OFFICE COPY, APPLICANT TO FILL IN INFORMATION WITHIN REDLINES- USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION �x .PERMITNUMBER emh.DhNG - _ APPLICATION &•PERMIT A �+ ADORE 4F v , 9L BUILDING—ELECTRICAL—PLUMBING—MECHANICAL1. - OWNER'S - ' 1 'I PLAN CHECK VALIDATION "AM ,Nd �! 1. ,,J_�� OTY. ELECTRIC PERMIT FEE 1 ' g I� ? 6ltauEv `l 1 CONTR CTOR'S NAME //'' ) UTLETS-SWITCHES-RECEP 10.00/1.00 LL (U h .NAI 36 Z . ILIGHTING FIXTURES 10.00/1.00 C.ONTR C R'sPPLIANCES-RESIDENTIAL . 4.00 ADDRESS t/ + S�/ PHONE 9n--S -111 PANELS 10.00 DATE OF APPLICATION d'. ARCHITECTPANELS (OVER ZOO AMP) 20.00 .PLAN CHECK FEE P.0:N0. OR ENGINEER ' LIC.NO. ISIGNS TRANS. .3.00 ARCH.OR ENG. - SPECIAL CIRCUIT S.00 PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE,FEE SCH. ADDRESS SERVICE CHANGE I 20.00 Cl 69 woo LICENSED CONTRACTORS DECLARATION OI / v u I hereby afloat that I um licensed under provisions of Chapter 9 ISSUANCE DATE - ' N < N (commencing with Section 7000)of Division 3 ofthe Business and - - - BLDG. ELECT. PLG. MECH. r 7 2 Professions Code,And license is in full force lb e9t ❑ ❑ ❑ Z o= — License Cl. — C.n Numbs r O Date Contractor - - a Y IF BUILDING PERMIT 0w OWNER-BUILDER DECLARATION INFORMATION wo d MISC.— + REFER TO ORD a. v_r 1 hereby affirm that I so exempt from the iressador's License VALUATION $/FT. r a.0' Law for the following reason.(Sec.7031.5,ermit tocnd Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requirese permit to construct,,alter,also - caC ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. - ELEC. w requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w m he is licensed pursuant to the provisions of the Contractor's License Fii Law.(Chapter 9(commencing with Section 7000)of Division 3 of the 4 Business and Professions Code)or that he is exempt therdiom and QTY. PLUMBING PERMIT ig $ the basis for the alleged exemption.Any violation of Section 7031,5 z O IES I TYPE CONSTR. d '3 by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN.&VENT-WATER IEA.) of not more than five hundred dollars(8500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4, OCC.GROUP RES.UNITS their sole compensation,will do the work,and(he 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 does such work FIXTURES-PER TRAP x,00 SO.FT,FLOOR AREA TOTAL ACREAGE . himself or through his own employees,provided that such improve- ments are not intended oroffered for sale.If,however,the building .•GAS-EA.SYSTEM-11 NC.40UTLETS.�00 or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4(EA.I 2,00 BUILDING USE builder will have tine burden of proving that he did not build or in, RES IND CON PB Other prove for purpose of sale.). INDUSTRIALWASTE INTER.' -30.00 C1 1, ❑ ❑ ❑ ❑ 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 IEA.) 1.00 contracts for such projects with a contraclor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.2001t/10.00 .TRACT NO. PARCEL NO. ❑ lam exempt under sec. ,B.&P.C.for this WATER HEATERW/VENT �00 , ason Owner Date WATER SYSTEM - 5.00 ACC.DATE ACC.FILENO.- WORKERS'COMPENSA'r10N DECLARATION s' WATER TREATING EQUIP, 5.00 ' 1 hereby affirm that I have a certificate of consent to clginsure, - - ZONING ENG.SITE NO. ora certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.l. Policy No. Company O ❑ Certified copy is hereby furnished. I FIRE SPRINK ENERGY TQA Z (3Z Certified copy is filed with the city inspection division. MIS - REFER TO ORD. O Applicant' - CY ❑ N❑ Y ❑'_ N❑ 'I_ — PERMIT ISSUANCE fIX06 ZU PL000 zoNE - - A.L.u.c. = > CERTIFICATE OF EXEMPTION PROM WORKERS' -L COMPENSAT'IONANSURANCECONTR. LIC:NO. TIL G. D 0 (This section needno • t be completed if the permit is IP . 'or one "Z TOTAL 3�•V Y❑ N❑ Yo_ N❑ 2 hundred dollars IS 100)or less.)' - U 0 I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL h mit is issued,I shall not employ any rson in any mannerfo as to O W bee hh{��s )ppet to the Workers'Co c K mn w4 R Datel�lr_APPlicant ALTER OR ADD TO MECH. 5.00 rBN } in NOTICI7 TO APPLICANT: If,after making this Certificate of hx- H Z emption,ypd should become subject to the Workers:Compensation APPLIANCE 5.00 Prvislons'ol' the Labor Code, you must forthwith comply with such provisions or this permit shall be themed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 ' CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 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. HEATING UNIT(TO 100,000 B.T.U.) 8.003097,Civ-C.). Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address1 cefjify that I have road this application and state that the above VENTILATION'FAN (SINGLE) 4,00information is correct.I agree to comply with all city and county v t ordinances and state laws relating to building construction, and LER-713(H.P.Gr100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned properly for inspection purposes. BOI (We) agree to Save, indemnify and keep harmless the City of MISC.- " REFER TO ORD. upertino a61 at liabilities,judgments, cost. end expenses which - CONST._TAX ay in.an�(/J��p ccrue'against d Cit c rsequence of the PERMIT ISSUANCE 70.00 rantingo tll rmit. MECH.CONT. -LIC.NO. MECH. „�t1 .TOTAL � :. G- TOTAL _ re of Appllc [/Contractor ate OFFICE COPY PG AE �.; CITY Ov,CUG'e'61TINO core GAS SERVICE NOTICE Toy .k You are hereby authorized to connect the GAS service for Owner Tenant !, y� �,, O a 3 N. (c7G� Q—) U- At "FIJI New Service ;:! "�5 No. of Meters Reconnect No. of Add. Meters •Move Service Move Meter PLUMBING INSPECTOR • - . =s ten,„�;.^.'' •�, ,b .:-, .?�< t ,