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16683 POST THIS D NEAR FRONT OF BUILDING . PERMIT NUMBER • • CITOF CUPERTINO 16683' INSPECTION DIVISION ' JOB INSPECTION RECORD . - . 3 PERMIT EXPIRATION JOB ADDRESS /01kJdZ NIT14* LOT# PERMIT EXPIRES IF WORK OWNER S��K2� - CONTRACTOR ,(/fj. L IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR NSPECTION RECORD 180.DAYS OF PERMIT ISSU-' FOUNDATIONANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER - ALL GRADING AND DRAINAGE.SHALL BE INSTALLED PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION _ CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ' I ELECTRICAL- - ISSUANCE DATE MECHANICAL BLDG. ELL I PLG. nnecR:. ❑ ,❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WINFORMATION WOOD FLOOR VALUATIONSIFT. PLUMBING MECHANICAL ELECTRICAL PERMIT TO L[? FRAMING ' STONIES TVv[WNSTa, INSULATION city V OCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED eev . _ ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE SO,FT FLOOR nacA TOTAL ACREAGE DIAPHRAGMTHE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING ' - - . 'RES wu CON PB 00", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 11 ❑ ❑ ❑ ' ASSESSORS PARCIiL NO ROUGH SAN.p PLUMBING ELECT,ENERGY TRACT NO PARCEL NO. TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC,DATE ACC FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST PLUMBING ZONING ENG.SITE NO. INSULATION �� ' GAS TEST GAS 7 MECHANICAL FIRE SPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v ❑ Nv ❑ N[] EXTERIOR SHEAR- ELECTRICAL RELEASE FLOOOZONE A.L U.0 INTERIOR SHEAR FIRE DEPT. - 'V❑ N❑ v ❑ N❑ SHEETROCK GRADE FEE SUMMARY - EXTERIOR LATH BUILDING �•• INTERIOR LATH TEMPORARY APPROVAL BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE'FOR INSPECTION BY PHONING 252-4505, ELECTRIC LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. = SEE PERMIT FOR EXPIRATION DATE = MECHANICAL IMPORTANT! CONST,TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFOMATION WITHIN RED LINES - USE PILLL POINT PEN ONLY s" PERMIT NUMBER _ BUILDING PROJECT IDENTI FICA rr aDtm um ^ / - APPLICATION & PE T- 161 '6 303 ` ADDRESS a e v1 BUILDING — ELECTRICAL—PLUMBING—MECHANICAL "' . IJ 0 OW" R3 to CC_-/Ji /O f3�Y1 p ^ - PLAN CHECK VALIDATION NA J —f✓ C7 QTY. ELECTRIC PERMIT FEE , . (^I� PHONE CONTRACTORS rvnmE 22/ OUTLETS-SWITCHES-RECEP 10.00/1.00 , LIGHTING FIXTURES 10.00/1,00 16NTRACTCIRS. APPLIANCES-RESIDENTIAL :4.00 A 55 `� 1 u Q vHOrvE ��J�S{. PANELS •10.00 DATE OF APPLICATION• i OR PANELS PANELS,(OVER 200 AMP) -20,08 PLAN CHECK FEE P.C.NO, OR ENGINEER ' LIC.NO. SIGNS TRANS. 3.00 AD oA °s ENG. SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION ZIP TEMP.METER.OR.POLE INS. ; 20.00 q� �✓r APPU ESE MOTORS. .SEE FEE'SCH: ADDRESS . SERVICE CHANGE ,20:00 ! woo LICENSED CONTRACTORS DECLARATION 4 U u 1 hereby affirm that I am licensed under provisions of Chapter i) ISSUANCE DATE �- H ¢ H (commencing with Section 7000)of Division 3 of the Business and - - BLDG. ELECT. PLG. MECH, w-o Z Professions CodyAa�n�j my license is in full fo 1 d flnR�.� Z,o — License Class—{�—�(oP.{-='�Lic.Number b X _❑ ❑, ❑ o y H w Date__,l�-L-.f-1Lr'Conlrucmr - ..f' m s c - BUILDING PERMIT w u OWNER-BUILDER DECLARATION INFORMATION KO e. 1 hereby affirm that I am exempt Crain the Contractors License MISC.- REFER TO ORD w 3 VALUATION $/FT. F a-o st Law for the fallowing reason.(Sec.7031.5,Busmessand Professions PERMIT ISSUANCE - '10.00 Code:Any city or county which requires a permit to construct,alter, 2 Q 0 imprnv'e,demolish,or repair any structure,prior to its issuance,also ELEC,CONTE. LIC.NO. - ELEC. D S, requires the applicant for such permit to file a signed statement that TOTAL n _ PERMITTO Z he i(Chapter 9(copursuant to the provisions of the )of Division License ' H Z i Lawasiness dProfosion,Codeng )or Section is exempt theron3 of the + .?Lg a th era basis far Professions erupt or that he is exempt actio rant and QTY. PLUMBING PERMIT FEE ¢ rm the basisfor the allegedexemption.Any violation.fo action malty STORIES TYPE CONSTR. i ; � by any applicant fora permit subjects the applicant toucivil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($500).): ❑ 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,AREA,COND. 5.00 Code:The Contractor's License Law does not apply t0 an owner of mi property who builds nr Improves thereon,and who doe,Such work FIXTURES-PER TRAP, 5.00 5,.FT,FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve- menta are not intended or offered for sale.If,however,the building, GAS-EA.SVSTEM-11NC.40UTLETS.9.OQ or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 200 BUILDING USE builder will have the burden of proving that he did not build or ins . . . - RES .IND CON PB Other . . prove for purpose of sale.). INDUSTRIAL WASTE INTER300 ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044, Business LAWN SPRINKLERS-I INC 5 V.B. 6.0 ABSESSORSPARCEL N0. and Professions Code:The Contractor's License Law does not apply -to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.010 contacts for such projects with a eontractor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/1 Q& Q ACT No. PARCELNO. ❑ lam exempt under Sec.—,B.&P.C.for this WATER HEATER W/VENT 6.00 . -.,on Owner - Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 ,. 1 hereby affirm that I have a certificate of consent to selhinsure, ZONING ENGSITE NO. or a certificate of Workers'Compensation Insurance,or a certified . .. copy thereof(Sec.3800,Lab.C.). - Policy No. Company , 0 11 Certified copy isltereby furnished. FIRE SPRINKENERGY T-24 Z 2 ❑ Certified.copy is Bled with the city inspection division. O Applicant - MISCREFER TO ORD. Y ❑ NNE] Y ❑ N❑ 0: to CERTI FICAI'F.O F EXEMPTION FROM WO R K Ii RS' PERMIT ISSUANCE t FLOOD ZONE A.L.U,C. LUCOMPENSATION INSURANCE PL ON R. �F 9! Z TOTAL p`� I[:] N❑ V C] N❑ CL 0 This section need not be completed if the permit is for one / ev hundred doll...IS 100)or less:) U O , 1 certify that in the performance of lire work for,which this per- QTY. MECHANICAL PERMIT - FEE FEE SUMMARY LL f7 mit is issued,I shall not employ any era n any manner so as to U hecome u¢� et�pptn Work ers'Co to w Datel.�r'(. S�L-Applicant::� =r ALTER OR ADD TO MECH. 5.00 . BUILDING } ti NOT CE TO APPLICANT: If,after making this Certificate of Iex- �.... ? 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 LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.EM.) 6.00 SEISMIC FEE - 1 hereby affirm 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C,j. ' Lender's Name - Lender's Address HEATI NG UN IT(OV ER 100,000 B.T-..U.)9.50 ELECTRIC I certify that[,have read this application all state that the above VENTILATION FAN (SINGLE) 4.00 - in is correct. I agree to comply with all city and county PLUMBING -�. ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon Bre BID R7 (Over 1110,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agrto save, Indemnity and keep harmless the City o1' MISC.- ee REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in ny way accrue .gains aid Clty iPERMIT ISSUANCE 10.00 s consequence of the rand o is,per '. MECH.CONT. LIC.NO. MECH. TOTAL TOTAL ' nature of plicanl/Contract. Date- OFFICE COPY