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16588 �.. POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER "CITY OF CUPERTINO 1658 INSPECTION DIVISION JOB INSPECTION RECORD y/ PERMIT EXPIRATION • JOB ADDRESS � V ( Z.3 1 " ` -�( ,�—�UNIT# _ � ._LOT# �� MIY 7EXPIAES'IF WORK OWNER S A CONTRACTOR t ws : Go X,aT IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITETO COMPLY WITH THE APPROVED PLANS AND CIT.OF PERMIT VAUDATION GARAGE SLABS CUPERTINO STANDARDS'. • - - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _ UNDERGROUND /SLAB �r!,�,,tti,G,L PLUMBING GG.� 4� ELECTRICAL ISSUANCE FPLc.,:DATE MECHANICAL . - .. Bloc ELEcr. mec« : ❑ 0 I ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION .SIFT. PLUMBING MECHANICAL ELECTRICAL .. - PERMIT IT) - FRAMING IT %,Ik, J) STORIE TYPE CONSTR. INSULATION + . OCC GROUP RES.UNITS PLACE NO.SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so Fr,FLOOD AREA TOTAL ACREAGE DIAPHRAGM I ITHE CONSTRUCTION TAXIS PAID - , BUILDING USE ROOF SHEATHING - I IRCS IND CON PBS 00" APPLYNOROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. L ❑ L' ❑ L ROUGH SAN.p nssEssons PARCEi.No . PLUMBING - ELECT.ENERGY - TRACT NO, PAR CEL NO • TUBS&SHOWER PAN � � �� PLUMBING ENERGY � ". i MECHANICAL MECH.ENERGY I .ELECTRICAL BUILDING ENERGY ACC DATE AFC FILE NO, FRAMING ELECT.FINAL TEST ZONING, ENG SITE NO. INSULATION. - - _ PLUMBING GAS TEST.; GAS ' MECHANICAL FIRE SPRINK ENERGY T1a- COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y OO N. L., N� EXTERIOR SHEAR ELECTRICAL RELEASE FLooD Porvt, - A.Luc. INTERIOR SHEAR FIRE DEPT. - Y❑ NL •Y L NEI SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING - INTERIOR LATH TEMPO RARY.APPROVALS BUILDING SCRATCH COAT. ELECTRIC PLAN-CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED 19CCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-450 ELECTRIC al . F ONE WORKING DAY BEFORE REQUIRED I,NSPECTION.. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. —,SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.rn,x PL'E'ASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FICATION -PERMITNUMBER BUILDING APPLICATION & PERMIT' 1 ADDRESS 1 8 8 �� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL • 8 Q OWNER'S � - NAME -� DTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION `R S S PHONE CONTRACTOR'S rvnME // UTLETS-SWITCHES-RECEP 10.00/7.00 e LO c.No. .3 LIGHTING FIXTURES 10.00/1.00 DScroR's ADDRESS PPLIANCES-RESIDENTIAL 4.00 AD L PRONE 3S PANELS .10.00 DATE OF APPLICATION + ARCHITECT PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 Ali 20.00 ENGINEER ' uc.No. SIGNS TRANS. 3.00 ' ADDRESS ENG, PERMIT 5.00 ,PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20,00 10.5 APPLICANTS - Amon Ess E MOTORS SEE FE SERVICE CHANGE 20.000.00 � w o o LICENSED CONTRACTORS DECLARATION a i w 1 hereby affirm that 1 um licensed under provisions of Chapter,9 yy y/ ISSUANCE DATE 1 ' < A (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECN. F y A Professions Code,and my license is in full force and effect. ❑ ❑ ❑ o i g O License Class Lie.Number Data.Contractor st OCT 11 i s - BUILDING PERMIT ¢ le OWNER-BUILDER DECLARATION M MISC.- 0 INFORMATION _ X g u 1 hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. F u O¢, Law for the following reason.(Sec.7031.5.Businessund Professions PERMIT ISSUANCE• 10.00 112 Code:Any city or ace my which requires a permit to construct,alter, - m�2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELZ O ¢ requires the applicant for such permit m TA file a signed statement that TOTAL i- PER a MIT T - w m` he is licensed pursuant to the provisions of the Contractor's License lb aZT Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �y,A� �(� < Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢F the basis for the alleged exemption.Any violation of Section 7031.5 STORIE1 TYPE CONSTR. - byanyapplicantforapermitSubjectstheapplicanttoacivilpenalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(5500).1: ' '❑ 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,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 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such Improve- ments are not intended oroffered for rule.l f,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 t or improvement is sold within one year of completion,lire owncr- builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE RES IND CON PB' ONer prove for purpose of sale.). I N D USTR I AL W ASTE INTER. 30.00 ❑ as owner of the property,hexclusively contracting with ❑. El El1:1 ❑ licensedd contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. to an Professions of Code:The Contractor's License Law does not who to tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such License L with u contractions)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ Iam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 - reason • Owner Data WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSA'1'ION DECLARATION WATER TREATING EQUIP. 5.00 I 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 thereof(Sec.3800,Lab.C.). Policy No. Company O • ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z ❑ Certified copy is filed.with the city inspection division. MISC.- REFER TO ORD. ' Q Applicant Y ❑ N❑' Y ❑ N❑ CC rn PERMIT ISSUANCE 70.00 FLOOD ZONE A.L.0 C. CERTIFICATE OF EXEMPTION PROM WORKERS' Ui COMPENSATION INSURANCE PLG.CONTR: LIC.NO. PLG. Y N Y N d Q (This section need not be completed if the permit is for ane TOTAL ❑ ❑ ❑ ❑ 0 Z hundred dollars(S 100)or less.) U_O 1 certify that in the performance of the work foi which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY . LL h mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compervation Laws of California. Ida Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } m NOTICIi TO APPLICANT: If,after making this Certificate of Ex- f- ? 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 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER IOAODC.EM.) 6.00 SEISMIC FEE . I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the peNbrmance of the work for which this permit is issued(Sec MICROFILM 3097,Civ.C.). HEATING UNIT TO 100,000 B.T.U.) 6.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC -L.;) 1 cettity that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00 ' PLUMBING Urdlnances,and slate.laws relating to building con radion, and hereby authorize representatives of this city to enter upon'tha BOILER-COMP (Over 1DO,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. - upertino against liabilities,judgments, costs and expenses which CONST.TAX agains Pan y in y way accrue t - id City in consequence o the PERMIT ISSUANCE 10.00 ran[i� th' permit. MECH.-CONT. LIC.NO. MECH. �6 /1 TOTAL TOTAL pv ignalure of A is t 'ontractor ate X OFFICE COPY ' '