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16623 POST THIS CARD NEAR FRONT OF.BUILDING - PEAMIT,NUMBER • GITY OFCUPERTINO . 16623 .' INSPECTION DIVISION JOB INSPECTION RECORD 'PERMIT EXPIRATION JOB ADDRESS V( L_--7. /K U✓ B ( UNIT# LOT# , I J � PERMIT EXPIRES IF;WORK ' OWNER (Te �� P ,ONTRACTOR�OS T�U�IO IS NOT• STARTED•WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM - NOTE: UFER ALL GRADING'AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF tl PERMIT VAUUATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ` - akzunq,ilAaL.Z- ELECTRICAL - �� ISSUANCE DATE MECHANICAL BLDG ELECT.I PLG. MECR DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD,FLOOR VALUATION $/FT, PLUMBING ee MECHANICAL ELECTRICAL - aeaml FRAMING - P INSULATION ZOR1Es I TYPE CONSTEr, OCC GROUP RES UNITS PLACE.NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 5p FT 1'1.0011 AREA 10TAL ACREAGE ROOF NOTE:NO FINAL INSP,SHALL BE rhaMADE BEFORE, - DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING 4qS ,,,NO CON PB APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH - SAN.N ASSESSORS PARCEL NO. PLUMBING. ELECT.'ENERGY TUBS&SHOWER PAN ' - PLUMBING ENERGY _ TRACT NO, PARCEL.NO MECHANICAL L MECR ENERGY ELECTRICAL BUILDING ENERGY - ACC DATE ACC.FILL NO FRAMING _ ELECT.FI NAL TEST - zow"c ENG.SITE No. INSULATION PLUMBING _ GAS TEST - GAS . MECHANICAL FIRE SPRINK ENERGY LI9 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y Q "� EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE, A.L U C. INTERIOR SHEAR FIRE DEPT. Y❑ N❑ r ❑ N SHEETROCK GRADE - FEE SUMMARY EXTERIOR LATH' BUILDING INTERIOR LATH : " TEMPORARY•APPROVALS sulLDwc. py SCRATCH COAT, ELECTRIC PLAN CHECK GAS - FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM, ARRANGE FOR INSPECTION-BY PHONING 252-4505, ELECTRIC j if.0 ' ~� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING M? i Z PLEASE GIVE JOB ADDRESS WHEN PHONING. • i ', MECHANICAL -'SEE PERMIT FOR.EXPIRATION 'DATE - IMPORTANT! CONST.TAX " , PLEASE READ REVERSE SIDE BEFORE o ' TOTALc CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY `..- BUILDING PROJECT )DENTI FICATION .PERMIT NUMBER ` aUR_mNG APPLICATION & PERMIT ✓1 ADDRESS 16623 "/" T �O BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ... OWNER'S PLAN CHECK VALIDATI NAfTE S`sp CITU. ELECTRIC PERMIT FEE Q FRorvE TJ a// CONTRACTORS• ' (D rvA E OUTLETS-SWITCHES-RECEP 10.00/1.00 aat0 fF- "C.No. LIGHTING FIXTURES 10,00/1.00 � CONTRACTORS yds. APPLIANCES-RESIDENTIAL 4.00 ADDRESS ) ` Mg2/p(Y- PHONE 2/ 4` PANELS 10-0011. $ DATE OF APPLICATION ! ARCHITECT PANELS (OVER 200 AMP) 29,09 PLAN CHECK FEE , - OR ENGINEEP S4O 11 S/g71c.rvo.� 1�112� SIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION h ZIP EMP.METER OR POLE INS.' 20.00 1 [ r APPLICANTS MOTORS - SEE FEE SCH. ( G ADDRESS SERVICE CHANGE 20.00 x _ a o o LICENSED CONTRACTORS DECLARATION V ¢v PA I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE - as Q w (commencing with Section 7000)of Division 3 of the Rusinem and vALbG. ELECT. PLG. 'MECH. E. D. ' <S Professions Code,and my license is in full force and effect El' C2 i i D License Class Lic.Number 9 I:w Date Contractor �� Q BUILDING PERMIT ¢ ¢w OWNER-BUILDER DECLARATION INFORMATION w ; LL r 'I hereby affirm that I am exempt from the Contractor's License MISC--' ; D u O¢ Law for the following reason.(Sec,703 1.5,Business and Professions PERMIT ISSUANCE _ ��+ .00 VALUATION S/FT. r - Code:Any city or county Which quires a permit to construct,alter, '� �d QQ Improve,demolish,or repair any structure,prior to Its Issuance,also ELEC.CONTR. LIC.NO. ELEC. �/p� - DLL requires the applicant for such permit to file a signed statement that TOTAL s ( V PERMIT o K m he is licensed pursuant to the provisions of the Contractor's License F zi Law(Chapter 9(commencing with Section 7000)Of Division 3 ofthe a: Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE Tr ¢=$ the basis for the alleged exemption.Any violation of Section 7031.5 STOPIES TYPE CONSTR. a3 � by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 - I- Of not more than five hundred dollars(8500).):, ❑ I,as owner of the property,or my employees with wagesas BACK FLOW PROTECT.DEVICE 4.00 oCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is net intended or offered.for sale USE, 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00 ' Code:The Contolcto r's,License Law does not apply to an owner of property who builds or improves thereon,and who does such workFIXTURES-PER TRAP 5.00 '00 SQ FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- entsarenot intended oroffered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS '6.00 m • or Improver ent is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVERA(EA.) 2.00 BUILDING USE builder will have the burden of proving that Ire.dill not build or am- REG IND. CON PB Onher prove for purpose of sale.). INDLISTRIAL WASTE INTER. 30.00 ❑ 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 Cade:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who ILAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to - theContractor'sLicenseLaw. SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCELNO. ❑ I am exempt under Sec.-,B.&P.C.fur this WATER HEATER VOWEIff 6.00 ;k,V D reason Owner Doe WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATINGEQUIP. 5.00 `\ I hereby affirm that 1 have a certificate of consent to sell 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 Ccrli" r pl'C py IS I1EW fun ished. - FIRE SPRINK ENERGY T�2< z Z If Ed copy is file the city inspection division. MISC.- REFER TO ORD. V ❑ NE] Y ❑ N� O A li it CC V5 CP:RTI FI TE OF IA . 1PTION FROM WORKERS' - PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. UJ > COMPEN TION INSURANCE PLG.CONTR. LIC.No. _ PLO. ,OD Y❑ N❑ v❑ IN 1-1 1 O (This section of bee if the permit is for one =) Z hundred dollars IS 100)or less.)' U O 1 certify that in the performance of the work I'or 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'Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 FSEF "d } N NOTICE TO APPLICANT: If,after making this Certificate of Ex- � z emption,you should'become subject to the Workers'Compensation APPLIANCE 5.00 K provisions of the Labor Code, you Most forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT'(TO 10=11F.M.) 4.00 p CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0MC.FM.) 6.00 E !- f I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 3097,Civ.CJ. - Lender'sName Address Lender's Address HEATING UNIT(OVER 160,000 B.T.U.)950 ELECTRIC 70 1 certify 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-CQMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING. a ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP fOVBr 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) ye, indemnify and keep harmless the City of MISC.- REFER TO ORD. Ca no against lis lities,judgments, costs and expenses which CONST.TAX ay in any way,seer a fff...must said City in consequence of the PERMIT ISSUANCE.- 10.00 rantiag of this count. MECH.CONT, LIC.NO. MECH. .O TOTAL TOTAL ('�3s Signatur f Appli t/Conlractor U� c J ` OFFICE COPY