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16511 POST THIS CARD'NEAR 'FRONT OF BUILDING PERMIT NUMBER " CITY OF CUPERTINO 16511 INSPECTION DIVISION JOB INSPECTION RECORD • ,, 1; ,�/T /ld o _ PERMIT EXPIRATION JOB ADDRESS I63 /cL3 N e '/\ Q UNIT# _LOT# - PERMIT EXPIRES IF WORK OWNER >FJ->\/.j� E6r,, �s'f r CONTRACTOR El ,ls.-, IS NOT STARTED WITHIN ; INSPECTION DATE INSPECTOR INSPECTION RECORD 18o DAVs DF 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 CIN OF PERMITEynuoanoN CUPERTINO STANDARDS. W . GARAGE SLABS- _ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - ' UNDERGROUND/SLAB PLUMBING 1 , ELECTRICALISSUANCE DATE BLDG, ELECT .PLG. MECK MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED WING PERMIT ,WING WOOD FLOOR . VALUA TIgµ S,FT. PLUMBING ' MECHANICAL PENMIT TO ELECTRICAL m' — / FRAMING c L4-cT STORIES TYPE CONSTR INSULATION OCG GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.Fr FLOOR AREA TOTaLac REALE DIAPHRAGM. THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING DES . IND CON PB 00", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - FINALS - DATE. INSP. ASSESSOR SPARCEL NO, ROUGH SAN.N PLUMBING - ELECT.ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT No PARCEL No, I MECHANICAL - MECH.ENERGY ACC DATE ACC,FILE NO. ELECTRICAL BUILDING ENERGY FRAMING - ELECT.FINAL TEST zowNc ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE SPH INK ENERGY T 24 MECHANICAL Y ❑ NE] I ❑ N[j COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLODD ZONE ALUC. EXTERIOR SHEAR • ' ELECTRICAL RELEASE y NE] YL No, INTERIOR SHEAR FIRE DEPT: 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 NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICLU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS'WHEN PHONING. . — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.rnx PLEASE READ REVERSE SIDE BEFORE . TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDING PROJECT I DENTI FICATI ON PERMIT NUMBER BUILDING . . APPLICATION & PERMIT �� ADDfi ESS 0rZ3 , w:tF 94 �o BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME &r QTY. ELECTRIC PERMIT FEE S-f PNONE CONTRAC fl$ NAME C -!.O UTLETS-SWITCHES-RECEP 10.00/1.00 IJ-7.v .�e'l �' tffC MC LIC.NO. ]Ca730 LIGHTING FIXTURES 10.00/1.00 CONTRACTO 'S - AOORESS � �J'($..((�-/ APPLIANCES-RESIDENTIAL 4.00 167ele PHONE /�YT PANELS -10.00 DATE OF APPLICATION �- ARCHITECT PLAN CHECK FEE P.Pd NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER .. �w� I uc.No. SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION ADDRESS QQ SPECIALCIRCUIT 5.00 /,3 /�q✓.,j�A /�✓� zIP EMP.METER OR POLE INS. '20.00 APPLICANTS / MOTORS SEE FEE SCH. - ADDRESS ^� 3393�a CRS_ aL a] SERVICE CHANGE 20.00 w o o LICENSED CONTRACTORS DECLARATION a U w I hereby affirm (list 1 am licensed under provisions of Chapter 9 L.1650A/NCE OATE y a N (commencing wish Section 7000)of Division 3 of the Business and BBBEEEpppppp OT. PLG. MECH. r D z Professions Code,y4nId my license is in full force'�u 1�c t. U1 ❑ ❑ z 0�,- License Ce L-g Lic.Number T x`67 - u 9 N r Dote '--T !--COntractor� a x f BUILDING PERMIT ¢ ¢ si OWNER-BUILDER DECLARATION o d 0 INFORMATION E ; n r I hereby aflirm that 1 am exempt from the Comructor's Li se MISC.- REFER TO ORD w - VALUATION $/FT. HUDj Law for the following reason.(Sec.7031.5,Businessund Pro cions f PERMIT ISSUANCE 1 . Code:Any cityorcounty which requires a permit to cons cq alter, - ¢ K Q �, improve,demolish,or repair any structure,prior to its seance,also ELEC.CONTR. LIC.ND. ELEC. 7Q ¢ [eQOlfes the applicant IOr 6IIC1(Ierllllt t0 file a Slgll' FWIL'ml'nt MIDI � �� Com(= E 73 ` [/ PERMIT TO . sc W m LL V K/r USGiL'rL TOTAL (y he is licensed pursuant to the provisions of the ntmctor's License H z a Law(Chapter9(commencing with Section 70 lot Uivision3ofthe ELL' f 4 D Business and Professions Code)or that he' exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ 1-m the basis for the alleged exemption.An Iolation of Section 703 LS STORIES TYPE CONSTR. n3 - by any applicant tura permit subject capPlicnnt toacivil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred Jol' s($S00).): ' ❑ I,as owner of the proper or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will o the work,and the structure is not intended or offered for su (Sec. 7044, Business and Profesumis DRAINS-FLOOR,ROOF,AREA,COND. 5,00 Code:The Contractor's colic Law does not apply to an owner of • property who hullds 0 Improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE himself or through own employees,provided that such improve. .Cuts are not into ded or offered for sale If.however.the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will In a the burden of proving that he did not build or im- RES IND CON PB Other prove for pu ow of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as wncr Of the propatY.am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed mlmctors m construct the project(Sec. 7044,Business LAWN'SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Pr essions Code:The Contractor's License Law does not apply to an wner of property who builds or improves thereon,and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00 con acts forsuehprojeLwith acontracmr(s)IicensL•d pursuam to SEWER-SANITARY-STORM EA.200f1/10.00 (h Contrac(ur's License Law. TRACT NO. PARCEL NO. I um exempt under Sec. ,Ii.&P.C.for this WATER HEATER W/VENT 6.00 ason Owner Dote WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSA'I'ION 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 thereoff Lab.C.L REO.Rtc-C Policy No mpany Q Certified copy is hereby I'Llyished. FIRE SPRINK ENERGY T 24 Z Z Certifd y�UPY is Iile�Jiy Y inspection division. p Aplicamr. r�•�1. - MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ Fy PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU CERTIFICATE E SATION INS FROM WORKERS' W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. ' CL o (This section need not be Completed if the as,nn it is for one TOTAL Y❑ N❑ I 'Y ❑ N❑ =) Z hundred dollars(5100)or less) U O 1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL f- mit is issued,I shall not employ any person in any manner so as to U becol a uh'e it Io lie Workers'C;;tnsution Laws of California. M Duica At.pIICa11i_f4�1 ALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE TO APPLICANT: II',after making this Certificate of Ex- -Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply will FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 4.00 CONSTRUCTION LENDING A : Y AIR HANDLING UNIT(OVER 10J000C.FM.) 6.00 SEISMIC FEE 1 hereby affirm that there is a con ction leading agency for EXHAUST HOOD(WITH DUCT) 5.00 the peNbrmance of the work for ch this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.). Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 7� Lender's Address . ( certify lbat ave read this application and state that The above VENTILATION FAN (SINGLE) 4.00 information correct. I agree to comply with all city and county PLUMBING ordinanc and state laws retch to ing construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 Sereb authorize represen es o i city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL In -mentioned prope or in ye oa purposes. (We) agree to Sr , inden nlland keep harmless the City of MISC.- REFER TO ORD. Cupertino agsins labiht{es j,, menti, costs and expenses which CONST.TAX may in any wace it said City in Consequence of the PERMIT ISSUANCE 10.00 ran'o IN MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Signature ofApplicant/Contractor Date h OFFICE COPY