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16617 (2)e I • POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 166.7 INSPECTION DIVISION JOB INSPECTION RECORD sg 023� PERMIT EXPIRATION / JOB ADDRESS _� I N\ �C...� UNIT# LOT# - ^��'� PERMIT EXPIRES IF WORK'S OWNER CONTRACTOR IS NOT STARTED WITHIN • 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION - NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF LASTCALLED INSPECTION.' - r UFER PR EGUNITE PERMIT vn unnnors CUPERTINO STANDARDS. /j!DR/ i ISSUANCE DATE _ GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING - - ELECTRICAL MECHANICAL - BLDG ELECT PLG. MECH. El J • 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMI INFORMATION WOOD FLOOR - VALUATION SIFT. PLUMBING MECHANICAL ELECTRICAL PERMIT TO PLO FRAMING INSULATION STORIES TYPE CONSTR.., �5CC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF NOTE: NO FINAL INSP .SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID $O FT FLooR AREA roTAL ACREAGE DIAPHRAGM - BUILDING use - ROOF,SHEATHING RES IND CON PB our, ❑ D (] ❑ 1 7' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS ASSESSORS PARCEL NO. ROUGH SAN.a PLUMBING ELECT, ENERGY TUBS 8 SHOWER, PAN - kDATEINSP. PLUMBING ENERGY TRACT NO, z.:.-. -• PARCEL NO wLErvo 1 MECHANICAL - MECH.ENERGY ELECTRICAL - BUILDING ENERGY ACC DATE ACC. FRAMING ELECT. FINAL TEST. INSULATION � PLUMBING 20rvIrvG ENGSITENO. . GAS TEST GAS ' MECHANICAL—J- FIRE SPRINK ENERGY T 24 Y N� � "� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOOO D ZONE `'Y N� A.I Up. v N INTERIOR SHEAR - FIRE DEPT. SHEETROCK, GRADE. FEE SUMMARY EXTERIOR LATH; ` BUILDING �1INTERIOR wcSCRATCH LATH. TEMPORARY APPROVALS' . COAT ELECTRIC -CHECK GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY IC FEE rELECTRIC OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUIL DING INSPECTOR.FILMARRANGE FOR INSPECTION BY PHONING 252-4505, • IL ONE WORKING DAY BEFORE REQUIRED INSPECTION. F— z PLEASE -GIVE JOB ADDRESS WHEN PHONING-. w.; t PLUMBING' —SEE PERMIT FOR EXPIRATION DATE = MECHANICAL CONST. TAX PT{ IMPORTANT! .' TOTAL 1� . PLEASE- READ REVERSE SIDE BEFORE.'" CALLING FOR FINAL INSPECTION. OFFICE COPY • i O Z z P N ir - LU 2: CL 0 D z UQ LL U Ow } N U APPLICANT TO FILL IN INFORMATION WITHIN RED LINES --USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATION APPLICATION:& PERMIT 1 -DWG -' ELECTRICAL- PLUMBING - MECHANICAL sIJO 'PERMIT NUMBER e - -� p�BUI nolpsTess VRI lGQ .FRShiON afeK Grp ,OWNER 5 +rf� E G�X V T1 V -P NE _9799 OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION T/ //3' / NAM[RAcrORs OUTLETS -SWITCHES-RECEP 10,00/1.00 LIGHTING FIXTURES - 10.00/1.00 LIC.No. CONTRACTOR ADDRESS APPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 PHONE DATE OF APPLICATION .^ ARCHITECT OR ENGINEER nn .No. 30 aE C PANELS (OVER 200 AMPI .20.00 PLAN CHECK FEE P.0 ,NO. - SIGNS TRANS. 3.00 AOGRE0R ENG. zIP M1eJ,3D SPECIAL CIRCUIT _ 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 APPLICANT rs - LLL, I MOTORS SEE FEE SCH. SERVICE CHANGE20.00 LICENSED CON TRACTORS DECLARATION I hereby affirm Ihut I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with -Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. Number _ BLDG, ELECT, PLG. I all ❑ Date Contractor BUILDING PERMIT OWNER-BUILDIiR DECLARATION I hereby affirm that I am exempt from the Contractor's License Law forlhe followingreasom(Sec. 7031.5, Business and ProfessionspERM1T Code: Any city or county which requires permit to construct, alter, Improve, demolish, Or repair any structure, pr10r to its Issuance, also requires the applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions Of the Contractor's License. Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and INFORMATION MISC. - REFER TO ORD VALUATION �� ✓/ v SIFT. ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO r p� Co V k4 t QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant toa civil penalty of not more than five hundred dollars ($500).) ALTER -DRAIN &VENT -WATER (EA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve ments are not intended or offered ]or sale. If, however, the building FIXTURES - PER TRAP 5.00 SO. FT, FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that lie did not build o r am. p ve for purpose of sale.). L as owner of the property, exclusively Bu with . .. GAS - EASYSTEM -OVER 4 IEA) 200 BUILDING US REB IND CON PB OtM1er ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. - 30.00 LAWN SPRINKLERS -1 INC5 V.B. 6.00 LAWN SPR INKLER$ - OVER 5 (EA.) 1.00 'ASSESSORS PARCEL NO. . 7044, licensed contractors: construct the project La 7044, Business he toProfessions Code: The Contractor's License s th does not apply to owner of property who builds tr improves thereon. and who tr contracts forh projects with a contractor(sl licensed pursuant m tie Contractor's License Law. SEWER -SAN ITAR V -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-, BAP.C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 - ACC. DATE ACO. FILE NO. WORKERS'COMPENSA1' ION DECLARATION , WATER TREATING EQUIP. Y ' -'-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 , 1 ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab.C,). Policy No._Company FIRESPRINK Y❑ N❑ ENERGY T 24 Y❑ N❑ ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city inspection division. Applicant MISC- CERTIFICATE OF EXEMPT' ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. PLG. CONTR. LIC. NO.PLG. TOTAL COMPENSATION INSURANCE: (This section need not be completed if the permit is for one Y C] N❑ Y ❑ N❑ QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars (S 100) or less.) I certify that in the performance of the work for which this per- mil is issued, I shall not employ any person in any manner so as to BUILDING �t� become subject to the Workers' Compensation Laws of California. Date Applicant NOTIC17 TO APPLICANT: If, after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK emption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. FEE' AIR HANDLING UNIT (TO 10=CF.M.) 4.00 AIR HANDLING UNIT (OVER 10,000C.EM.)6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT). 5.00 the perfarmance'of the work for which this permit is issued (Sec.MICROFILM 3097, Civ.C.L HEATING UNIT (TO 100,000 B.T.U.) 8.00 ' H EATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER- COMP (3 H.P. Or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEESCH. MECHANICAL hereby authorize representatives of [his city to enter upon the above-mentioned properly for inspection purposes. MISC. - 'REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the CONST. TAX PERMIT ISSUANCE ,10.00 ranting of this permit. MECH. CONT. LIC. NO. MECH. TorAL - TOTAL Signature of Applicant/Contractor Date OFFICE COPY