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16939 POST THIS CARD NEAR FRONT OF BUILDING",, PERMIT NUMBER � } - CITY OF CUPERTINO1fi939 << INSPECTION DIVISION ! JOB INSPECTION i RECORD /� ////''`` 'PERMIT EXPIRATION JOB ADDRESS D Z3 W A I'Froe 1T-" UNIT# _LOT# ' PERMIT EXPIRES IF WORK ,; OWNER (� s CONTR AcroR Q ( (e_ ' IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - :ANCE OR 180 DAYS FROM; NOTE: LAST CALLED INSPECTION. I UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF -7-PERMIT VALIDATION CUPERTINO,STANDARDS. - GARAGE SLABS •'1`- POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING' C �U.�.G(,'.(• • ELECTRICAL - ISSUANCE DATE MECHANICAL - - BLDG ELECT,I PLG. MECH o 0 ❑ ; DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING - VALUATION slcr. MECHANICAL - • - T ELECTRICAL � PERM14 O�I i FRAMING - INSULATION �^^ Sr RIES TYPE CONSTR. Vy VM OCC GROUP RES UNITS city of Cupertino PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED $O'FCFLOOR AREP TOTPL HCREHGE • " ROOF NOTE'NO FINAL INSP,SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAXIS PAID ROOF SHEATHING . RES IND CON uSEPB O Y t APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP,. ❑ ❑ ❑ ❑ ❑ 'i ASSESSORS PARCEL NO. ROUGH SAN.a PLUMBING - ELECT.ENERGY rRACT No. PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY - MECHANICAL MECH,ENERGY- ELECTRICAL BUILDING ENERGY .ACC DATE -ACC.FILE NO FRAMING ELECT.FINAL TEST PLUMBING ZONING ENG.SITE NO INSULATION - � , GAS TEST GAS MECHANICAL FIRE SPR INK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ " ❑ "❑ EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD ZONE A,LUC. INTERIOR�SHEAR FIRE DEPT, Y E-] N❑ Y ❑ ru❑, SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH - TEMPORARY APPROVALS BUILDING ' SCRATCH COAT - ELECTRIC . S .PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANLCY SEISMIC FEE , OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL;BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR: `MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. } z PLEASE GIVE JOB ADDRESS WHEN PHONING. . :PLUMBING - SEE PERMIT FOR EXPI.RATION•DATE. MECHANICAL . $`' _x�- I IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION.' TOTAL` OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION 11 ERMIT NumBER r'= BUIL G APPLICATION & PERMIT ADDRESS r /1 �y - 1 ^h/9 .23 '.( /�` (r)�) BUILDING-ELECTRICAL-PLUMBING-MECHANICAL .' 1 V V OWrvER's 1` PLAN CHECK VALIDATION NAME QTV. ELECTRIC PERMIT FEE ^ PHONE .. . CONTRACTOR'S Ng OUTLETS-SWITCHES=RECEP 10.00/1.00 . I LIGHTING FIXTURES 10.00/1.00 noosu ss roR's ` PPLIANCES-RESIDENTIAL . 4.00 .fy PHONE 5 PANELS 10.00 DATE OF APPLICATION C HIT ECT ^ - PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 _ ' ENGINEER y _ - - LIC.No. 'SIGNS TRANS. _ 3.00 ADDRESS ENG. SPECIAL CIRCUIT .5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT'$ ADDRESS AMOTORS SEE FEE SCH. -1 SERVICE CHANGE 20.00 �•i�Av ;"` •C_ woo LICENSED CONTRACTORS DECLARATION SE i W I hereby affirm that 1 am licensed under provisions of Chapter 9I$SOANCE DATE Z y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.- - Z Professions Co d my license IS In full force' ff f - - oi o License Class Lia NumberD El a m .Wi Date Contractor a OWNER-BUILDER DECLARATION e. BUILDING PERMIT .y ¢ °a" - MISC.- R FER INFORMATION w ; 00 u w I hereby affirm that 1 am exempt from,the Contractor's License VALUATION $/FT. ,. O at Law for the following reason.(Sec.7031.5,Business and Professions I_ _ PERMIT ISSUANCE - - 10.00 _ Code:Any city or county which requires a permit to construct,alter, ac < improve,demolish,or repair any structure prior[o its issuance,also ELEC.CONTR. ,'LIC.NO. ELEC. - ^ O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO n w m he is licensed pursuant to the provisions of the Contractor's License - ' Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe M /, i o Business and Professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE l lee✓\ a H e the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR. a35 by any applicant fora permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 ' of not more than five hundred dollars(8500).): ❑ I,as owner of the property,or my employees with wages as -BACK FLOW PROTECT. DEVICE 4.00 DCC.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 to an owner of property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00• S0.FT.FLooR AREA TOTAL ACREAGE mhimself or through his own employees,provided that such improve- eats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 - 1 or improvement is sold within one year of completion,the owner- builder .will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). - INDUSTRIALWASTE INTER. 30.00 RES IND CON PB Other ❑ 1,as owner of the property,am exclusively contracting with ❑' ❑' ❑- ❑ ❑ licensedcontractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply r to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 64EA.) 1.00 , contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ftI10.00 the Contractor's License Law. TRACT N0: PARCEL NO. ❑ lam exempt under Sec.-,BAP.C.]or this WATER HEATER W/VENT 6.00 reason - Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE No. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby a1Tum that I have a certificate of consent to set Ginscre, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy there f ec.3 Lab.C.1.11 _ - - colicy No. ,L.I, f(�•�1' Il ,tea_ O ❑ Certi ed copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ''QQ Certlfled copy 's II with the c 'fis cYon d' isioa MISC.- REFER TO ORD: Q Alfplical" Y❑ N❑ Y ❑ N❑ PERMIT ISSUANCE - 10.00 LU - CF.RTIPICAMPENSATION INS FROM WORKERS' FLOOD ZONE A.L.U.C. 1 Q COMPENSATION INSURANCE PLG.CONTR. LIC.NO. _ TOTAL Y❑ N❑ Y❑ -N❑ Z) Z (This section need not be completed if the permit is for one hundred dollars($100)or less) U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY U. F mit is issued,I shall not employ any person In any manner so as to U W beecone subject to the Workers'Compensation Laws of California. Date" Applicant ALTER OR ADD TO MECH. 5A0 �� BUILDING } ran NOTICE. TO APPLICANT: If,after making this Certificate of Ex- Z 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 10,000C.F.M.) 4.0 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 104000.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT)' 5.00 the 3097,Ci, Cance of the work for which this permit is issued(Sea HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name HEATI NG UN IT ER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address - I certify that I 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 qjEa ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000BTU)SEE FEESCH. MECHANICAL. above-mentioned property for inspection purposes. Wed agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ay in any way Seems against said City in consequence of the' x ranting of thin error MECH.CONT. LIC.NO. MECH. /2�1TOTA3 p D TOTAL v Signature of pplicant/Contractor Date 6 OFFICE COPY