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16911 1 POST THIS CARD NEAR FRONT OF.BU,ILDING PERMIT NUMBER CITY OF CUPERTINO 16911 INSPECTION DIVISION JOB INSPECTION'REC SDS ZO p7 PERMIT EXP TRI) JOB ADDRESS _V ( Z� N. W 0 /•(.'� Ltl UNIT# LOT# g�D ` S MIT EXPIRES IF WO OWNER .0.-S CONTRACTOR'S Co�� IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: . UFER. ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDA ION CUPERTINO STANDARDSf GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED AN 1 UNDERGROUND /SLAB 61989 PLUMBING ELECTRICAL City Of CDperbno , ISSUANCE DATE MECHANICAL, � .,/`„ BLDG ELECT. PLG. MECH ❑ ❑ ' ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED a �1 �1� J�hl BUILDING N ORMATI ON WOOD FLOOR VALUATION $/FT. PLUMBING OF �1'/a2(.z �.1'fl-.t I• �I, }�%'�•3a MECHANICAL PERMIT TO ELECTRICAL FRAMING - - - �'— -#A B IrW STORIES TYP CONSTR, INSULATION • OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED $O.FT FLOOR AREA TOTALACREAGE ROOF " NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILOI NG USE ROOF SHEATHING RES IND ON PB 011,11APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ E3 ❑ ❑ ❑ • ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY ' •. TUBS&SHOWER PAN PLUMBING ENERGY TRACT No. PARceL No MECHANICAL MECH.ENERGY I ELECTRICAL BUILDING ENERGY ACC.DATE ACC.PILE NO FRAMING —'L(p—. ELECT.FINALTEST ZONING ENG.SITE NO. INSULATION PLUMBING `.7,.ef7j GAS TEST GAS MECHANICAL' FIRE SPRINK ENERGY T-IA -' 7-Bt/ Tss Y ❑ IN Y ❑ "❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE ,.� - FLOOD ZONE A.L UC. INTERIOR SHEAR FIRE DEPT. Y❑ "❑ v L N❑ SHEETROCK - GRADE ... FEE SUMMARY EXTERIOR LATH BUILDING - INTERIOR LATH TEMPORARY APPROVAL BUILDING ®�r0 SCRATCH COAT ELECTRIC PLAN CHECK, GAS FEE '�e'a.•�. i NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEISMIC FEE ` y OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC IL E REQUIRED INSPECTION.ONE WORKING DAY BEFORON. H• PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. • Z MECHANICAL -^•�'� — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL 2f ,Zr CALLING FOR FINAL INSPECTION. OFFICE COPY „ VAPPLICANT TO FILL 1N INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION - PERM IT NUMBER BODILDING �qC, APPLICATION &.PERMIT ADRECI"2 OJS.' `-6 tq:IC. IOIz3 ti.J o• ...16911 ' BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ' ;i N ' p� �1 �f- - NAME QG,,n/111D3 yV1C• PLAN CHECK VALIDATION PHONE / .f .�r, QTY. ELECTRIC PERMIT FEE comrRAcroRs UTLETS-SWITCHES-RECEP . 0/1.00 100 / lG•q 4�0 �a� ., NAME LIC.NO. LIGHTING FIXTURES ` 10.00/1.00 ADDRESS rolls APPLIANCES-RESIDENTIAL 4.00 ARCHITECT PHONE PANELS 10.00 DATE OF APPLICATION i.:..." DRPANELS (OVER 200 AMP) '20.00 PLAN CHECK FEE PP,NO. ENGINEER LIC,No7?/ SIGNS TRANS. 3.00 ARCH.OR ENG. ADOREss ' '3'T�>eLa.Qi Cr ly_U'T SPECIAL CIRCUIT 5.00 PERMIT VALIDATION- �A3f�00.56u'fl,'- nP -TEMP.METER OR POLE INS, ` 20.00 APPLICANT'S �j - ADDRESS�py'" Sob MOTORS . SEE FEE SCH. I -�^v. ' // i a- 59S ' SERVICE CHANGE 20,00 r o a Foo LICENSED CONTRACTORS DECLARATION ¢ u I hereby affirm that 1 am licensed under provisions of Chapter 9 �ANIE.ATI<wIcommeacing with Section 7000)of Division 3 of the Business and 198�1 LDG. ELECT. PLG. MECH. H m w Professions Code,and my license is in full force and effect. - ' Z o w - License Class Lic.Number o AIH au Date ❑ ❑ ❑ . r m ar _ Contractor = ¢ w u OWNER-BUILDER DECLARATION I GC Of CU BUILDING PERMIT ED '- ; u.w r- - I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD - INFORMATION u 0 4 Law for the following reason.(Sec.7031,5,Business ind Professions - VALUATION r _ PERMIT ISSUANCE 10.00 /FT. ac, Code:Any city or county which reyuiresa permit to construct alter, 17 000 3�JN ¢ ¢ 4 o Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. . ELEC. i CI a requires the applicant for such permit to file a signed statement that - TOTAL PERMIT TO w m he is licensed pursuant to the provisions of the Contractor's License - ,• FZQLaw(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe �"�'-{'�C�, s z D Business and Professions Code)-1'hat he is exempt therefrom and OTY. PLUMBING PERMIT FEE I '�}-- ` V. ¢ r m' the basis for the allege)exemption.Any violation of Section 7031.5 STORIES TYPE DNSTR. n 3.- by any applicant fora permit subjectsthe$500).licant toacivil penalty ALTER-DRAIN 5.00 of not more than five hundred dollars(my em): - ❑ o as owner at the property,or my,and tires with wages as BACK FLOW PROTECT.DEVICE 4.00 their sole COmpenaalion,will do the work,and[hb structum is or OCC.GROUP " RES.UNITS intended or offered for side (Sec. 7044,Business'mrd Professions. DRAINS-FLOOR„ROOF,AREA,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 50'FT.FLOOR AREA TOTAL ACREAGE himself re through his own employees,provided that such improve-building or ets improvemenetnt tended or Within red one or year l however, thhe e GAS-EA:SVSTEM-11NC.40UTLETS 6,00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) .2.00 builder wi ave the burden of proving that he did no[build or am- BUILDING USE prove purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pa Omar as owner of lire property,am exclusively contracting with ❑. ❑ ❑ ❑ licensed contnnvia" to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 g55ES50Ra PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thercon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for Such projects with a contractor(s)licensed pursuant to . , the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 rggeT NO: PARCEL No. r,/ ❑ lam exempt under Sec. ,B.&P.C.for this reason WATER HEATER W/VENT r 6.00 r Owner Dote WATER SYSTEM - 5'00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. - 5.00 I hereby affirm that I have a certificate of consent to Self-insum, or a certificate of Workers'Compensation Insurance,or certified .ZONING ENG.SITE NO. copy'hem.f(Sce.3800,Lab.C.L O ,r ` Polycy No. Coripany I V •t En l S/C - - V F Certified copy is hereby,furnished. FIRE SPRINK ENERGY T-Z4' Z Z' ❑ Cerlifi� oly Is,til�wi[h mty inspection division. Applicant l:L 7N �7f- MISC.- REFER TO ORD. YE] NE] Y [D N� � ~ rn I PERMIT ISSUANCE M. CERTIFICATE OF EXEMPTION FROM WORKERS' 10.00 FLOOD ZONE A.L.U.C. - UJ > COMPENSATION INSURANCE PLG.CONTE. uC.NO. PLG. CL G (This section need not be completed if the permit is for one - TOTAL Y 0 N� Y ❑�,, N�, t D Z hundred dollars 01100)or less,) U 0 1 certify that in the performance ofthe work for which this per- GTV. MECHANICAL PERMIT .FEE FEE SUMMARY LL F- mi'is issued,1 shall not employ any person in any manner so as to O W become subject to lire Workers'Compensation Laws of California. - - 0.W Date Applicant ALTER OR ADD TO MECH. '5.00 BUILDING e?'OLrO } 0. NOTICE TO APPLICANT: If,otter making Ihis 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 U Such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 r FEE, I CONSTRUCTION LENDING AGENCY - gIRHANDLING )NIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 6-eZr 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, 3097,Civ C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM - Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U,)9.50 ELECTRIC ( certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4,00 information is correct. I agree to comply with all city and county PLUMBING �- ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives,inspection this city es enter upon the BOILER-COMP (Over 100,00.0 BTU)SEE FEE SCH. MECHANICAL above-mentioned prepetlyfor tativs,of tnpurposes. '(We) agree to save, indemnify and keep harmless•the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, casts and expenses which CONST.TAX ay in any way accrue against said City in consequence of the PERMIT ISSUANCE ' 10.00 ' to yPaiq of this per i MECH.CONT. LIG NO. MECH. tyres✓Q t 11�3i • D� TOTAL TOTAL ��x2 1 Signature of App cant/Contractor I Lane ?2, r I OFFICE.COPY