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16472 POST THIS RD NEAR FRONT OF BUILDING • , PERMIT NUMBER' OF CUPERTINO 6472 INSPECTION DIVISION JOB INSPECTION RECORD / 9 /i 4 ' / //77 /' `PERMIT EXPIRATION JOB ADDRESS'�la� 'E// N/OL�C'' '+�� UN IT lk _LOT# ' a - PERMIT EXPIRES IF WORK ' OWNER �C�SS'/O'VS CONTRACTOR - IS NOT STARTED.WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM 'NOTE: LASTCALLED INSPECTION., UFER ALL GRADING AND DRAINAGE.SHALL BE INSTALLED PREGUNITE' TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERM T VALIDATION CUPERTINO STANDARDS. ' GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED / + UNDERGROUND /SLAB PLUMBING ELECTRICAL - PA ISSUANCE DATE MECHANICALN.�L�yU[C�� ELECT PLGI MECH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDg IL DI N GG��PPERMIT, WOOD FLOOR 01 O 01 IWMFORMATION c11y PLUMBING VALUATION slPr. MECHANICAL f 'Q ada} + ELECTRICAL PERMIT' FRAMING INSULATION STORIES .TYPE CONSTR. UCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED lROOF NOTE:NO FINAL INSP:SHALL BE MADE BEFORE 10 IT PLooe ARearDTaL acREace • DIAPHRAGM THE CONSTRUCTION TAX IS PAID - _ BUILDING USE ROOF SHEATHING Res ' irvo CON PB-' oio., . APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑' 1:1 ASSESSORS PARCEL NO ROUGH SAN.# ' PLUMBING - ELECT.ENERGY TUBS&SHOWER PAN PLUMBING_ENERGY TRACT No. PARCEL No MECHANICAL MECH.ENERGY. ACG DATE ACG FILE NO 'ELECTRICAL BUILDING ENERGY FRAMING ELECT,FINAL TEST ZONING ENG.SITE NO. �INSU CATION PLUMBING GAS TEST - GAS MECHANICAL9,77•1 .Z.b' FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING i Y 0 N[:] IE] N❑' FLOODZONE A.L.U.C. EXTERIOR SHEAR ELECTRICAL RELEASE �)- _ INTERIOR SHEAR"" FIRE DEPT. °❑ N❑ ❑ NEI, 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 1OCCUPANCY SEISMIC FEE a �7 OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FIN AL ISSIGNED BY BUILDING INSPECTOR. MICROFILM. , �9� ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 1111 F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 00 PLEASE GIVE JOB ADDRESS WHEN PHONING. 3��— Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE " - CALLING FOR FINAL INSPECTION. - TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE LL POINT PEN ONLY BU I LDING PROJECT I DENTIFI N PERMITNUMBER- _ BUILDING APPLICATION & PE IT' ADp6St BUILDING —ELECTRICAL—PLUMBING—MECHANICAL 2J(o't- 16472 F 2 • OW R'S ,PLAN CHECK VALIDATION N E �JQ TV. ELECTRIC PERMIT FEE HaME TTRACTOR's ICl OUTLETS-SWITCHES 10.001-}00 # �• , 3 LIE,NO. LIGHTING FIXTURES .10.OBFi-00 {"O ADDRESS rolls - - - PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 l DATE OF APPLICATION .. ARCHITECT - OR C- LIC Q PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.AO. NGIN L D(� .NO. SIGNS TRANS.. ARCH.ORENG. PERMIT VALIDATION a D� w - SPECIAL CIRCUIT SAO K EMP..M ETER OR POLE.INS. 20.00 /1 ADDRESS aooREss MOTORS SEE FEE SCH. Ci SERVICE CHANGE 20.00 la o o LICENSED CONTRACTORS DECLARATION rt v u I hereby affirm that 1 are licensed antler provisions of Chapter 9 - 2 w ISSUANCE DATE y a w (commencing with Section 70001 of Division 3 of the Business and - BLDG. ELECT. PLG. MECH. r m z Professions Code,and my license is in full force and effect. zo i m W License Class Lio.Number _ w H J Dale CO..form, i<w a OWNER-BUILDER DECLARATION BUILDING PERMIT is e. " INFORMATION aa ; y I hereby al firm that I am exempt from the Contractor's License MISC.— REFER TO ORDCL u O Q Law for file following VALUATION $/FT. CmitF _ J grcasun.(Sec.7031.5•ermit tocnd Professions PERMIT ISSUANCE — m y improve, Any cityor cor my whiny stue are permit to construct,alter, ' a ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. EIEC. it D LL requires the applicant for SUCK permit t0 fill`a signed Statement that TOTAL(Q/ e. w m he is licensed pursuant to the provisions of the Contractors LicenseU PERMIT Ta FZQ Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe -)JCe)—/-[•V� E z D Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FE GV� H m the basis for the alleged exemption.Any violation of Section 7031.5 �11y STORIES TYPE CONSTR. n3 � 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(5500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4;00 BCC.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,AR EA,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• SQ FL FLODR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- . meats are not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM-11 NC.4 OUTLETS 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 im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE p<•Je for purpose ofsalcJ. INDUSTRIAL WASTE INTER. 30.00 RE5 IND . CON PB Omer R1 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ If used 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 properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts for such projects with a contructorls)licensed pursuant to the Contractor's Lice ase Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ .Iw er pt under Sec. ,B.&P.C.for this WATER HEATER W/VENT •6000' naso �_ own r Dare WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. _ •WORK.RS'COMPENSATIO DECLARATION WATER TREATING EQUIP, 5.00 I hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a Certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). - - Policy No. CmnPuny . O ❑ GCr(Ihl'd copy is hmehy famished' FIRE SPRINK ENERGY T-Z4 z Z ❑ Certified copy is filed with the city inspection division. O Applicant IMISC.- REFER TO ORD. v❑ N❑ v ❑ N❑ PERMIT ISSUANCE FLOOD ZONE A.L.U.C. LU y CERTIFICATE OF EXEMPTION PROM WORKERS' G. l W > COMPENSATION INSURANCE PL .CONTR. I/t�� LIC.No. PLG, (This section need not be completed if the permit is for one / N VW Q TOTAL 3 ul Y❑ N❑ Y❑ N❑ Z hundred dollars(S 100)or less.) V O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mil is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'CompensationLaws of California. - 0. Date—Applicant to ALTER OR ADD TO MECH. 500 BUILDING Ste/ Lf� } NOTICE TO APPLICANT: . T: If,after making this Certificate of Ex- T' � ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAWCHECK provisions of the Labor Code, you must forthwith comply with FEE V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) ^4:00 CONSTRUCf10N LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE. ,I herebyaffirm 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.) 8.99 —' / Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 ! 1o)- 0 Lender's Address ELECTRIC Q I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 �e4 information is correct.I agree to comply with all city and county PLUMBING r ordinances and state laws relating to building construction, and BOILER DOW(3 H.P.or 100,000 B.T.U.) 6.00 �O hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000BNI$EE FEE SCH. MECHANICAL 7J " above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the it of MISC.- REFER TO ORD, upertino against liabilities,judgments, costs and-expenses which PERMIT ISSUANCE - to-.06- -- CONST m .TAX 'a a y way accrue against said City In consequence of the rant this pen IL • MECH.CONT. LIC.NO, MECH. Sign tore of _ TOTAL '] 7 S� TOTAL d, g pelican/Contractor Date- K• OFFICE COPY