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16955 POST THIS CARD NEAWFRONT OF BUILDING„ PERMIT NUMBER 'CITY. OF`CUPERTINO 16955 INSPECTION DIVISION JOB INSPECTION RECORD p (� PERMIT EXPIRATION JOBADDRESS ' _ 'UNIT# ' _LOT# /1 PERMIT EXPIRES IF WORK • ` OWNER ', �C J CONTRACTOR Ae ib IS NOT STARTED WITHIN I INSPECTION DATE INSPECTOR INSPECTION REC RD 180''13AYS OF PERMIT ISSU. F FOUNDATION NOTE: - ANCE OR'480 DAYS FROM UF.ER. . - ALL GRADING AND DRAINAGE SHALL-BE INSTALLED LAST.CALLED INSPECTION:. PREGUNITE TO COMPLYWITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION ,I CUPER71N0 STANDARDS. GARAGE SLABS 'a POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 19 UNDERGROUND /SLAB,, PLUMBING ELECTRICAL WY of Cupertino - ' ' - ISSUANCE.UATE.DAT E ' MECHANICAL - BLDG I ELECT. PLG. . MECH. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - - suaDlNc PERMIT WOOD.FLOOR ' - INFORMATION PLUMBING. - „ - VALUATION $/BT. MECHANICAL - ELECTRICALI PEgqhh±IT TO FRAMING INSULATION STORIES fVPE CONSTR. I " OCC:GROUP :RES UNITS . PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOFiSO FT.FLOOR AREA TOTAL ACREAGE NOTE'NO FINAL INSP.SHALL BE MADE BEFORE - , DIAPHRAGM THE CONSTRUCTION TAX IS PAID, ROOF SHEATHING BUILDING USE e HFS IND CON PB . 00,,, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP: . ❑ ❑ ❑ ❑' ❑ ASSESSORS PARCELING. 'ROUGH - SAN.k� PLUMBING' ELECT.ENERGY • TUBS&SHOWER PAN PLUMBING ENERGY TRACT No. PARCEL No MECHANICAL , - MECH.ENERGY - ELECTRICAL BUILDING ENERGY Acc.OaTE - Ac .,FILE NO FRAMING, - ELECT.FINALTEST - INSULATION PLUMBING 'mNING ENG.SITE No. GAS TEST GAS - MECHANICAL FI RE SPHINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEISIG ED HEATING y ❑ N❑ ❑ N❑' EXTERIOR SHEAR ' ELECTRICAL RELEASE - - FLOODZONF 'ALUC, INTERIOR SHEAR FI RE DEPT. `"❑ N❑ `" ❑' 'N❑ SHEETROCK;... GRADE FEE SUMMARY EXTERIOR LATH , ` BUILDING, .. - INTERIOR- LATH ', R, TEMPORARY APPROVALS 'BUILDING ' SCRATCH COAT ELECTRIC 'P L'AN'CHECK . GAS - .. FEE.. F NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS'NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. pjICROFILM .. LU `, ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC r ~O�;' ONE WORKING DAY BEFORE,REQUIRED INSPECTION ' PLUMBING:;: 1D, Z PLEASE GIVE-JOB ADDRESS WHEN PHONING. ' ` — SEE PERMIT FOR EXPIRATION DATE — ,.;' MECHANICAL IMPORTANT! . 4 1` 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 PERMITNUMBER .. ,. BUILDING I APPLICATION & PERMIT Ce q ^o C J BUILDING -ELECTRICAL-'PLUMBING-MECHANICAL NAMERS , Sp ly'�^e l•D PLAN CHECK VALIOATION- OTY. ELECTRIC PERMIT FEE vRorvE ONTRACTOfl'S OUTLETS-SWITCHES=RECEP . 10.00/1.00 - ��/�� -` / LIGHTING FIXTURES 10.00/1.00 " CONTRACTOR'S ADDRESS -'rte-� APPLIANCES-.RESIDENTIAL "4,00 - Sar4fL1 PANELS 10.00 DATE OF APPLICATION A CRITE T - - PLAN CHECK FEE P.C.N0. OR - - PANELS (OVER 200 AMP)' 20.00 .. ENGINEER _ LIC.NO, SIGNSTRAN§. 3.00 ARCH.OR ENG, PERMIT VALID ADDRESS • SPECIALCIRCUIT 5.00 A ON �i�/' z'Ir EMP.METER OR POLE INS.. 20.00 �l� V nooriess Ta MOTORS - 'SEE FEE SCH. VQ.LYIC��. SERVICE CHANGE 20.00 ^_ w02 LICENSED CONTRACTORS DECLARATION - a0 I hereby affirm•that 1 am licensed under provisions of Chapter 9 2 w ISSUANCE DATE y a (commencing with Section 7000)of Division 3 of the Business and r m 2 Professions Co a 99t1YY license is in full force and elle t. / _ BLDG. -ELECT, tP�L--G.. MECH. o 0 m O License Class (a_UL.Number , IXI H w Date 7 -//_ r1L CoNracfor 1 I� Y 5.� 142 �°'- Cidp of Cupertino ¢ ¢w a OWNER-BUILDER UF. RATI V p BUILDING PERMIT o A INFORMATION X ; LL y 1 hereby affirm that I am exemptfromthe Contractor's License MISC.- - REFER TO ORD u 0¢ Law for the following reason.(Sea 703 1,5,Business and Professions - VALUATION $/FT.- E - PERMIT ISSUANCE '' 10.00 Code;Any city or county which structure, permit to construct,after, 2 K Q 0 improve,demolish,of fepalr any shudure,prior to i6 issuance,also ELEC.CONTR. LIC.NO.- ELEC. a O LL requires the applicant for such permit to ilia a signed statement that TOTAL I PERMIT TO w rn he is licensed pursuant to ere provisions of the Contractor's License - I H z > Law(Chapter 9(commencing with Section 7000)of Division 3 of the [ //' 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN$VENTWATER IEA) 5.00 " of not more than five hundred dollar,($500).): - : - ❑ 1,as owner of the property,or my employees with wages as . BACK FLOW PROTECT:'DEV,ICE 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,GOND. 5.00 Code:The Contractor's License Law does not apply to an owner of - property who boilds'or improves thereon,and who dues such work FIXTURES-,PER TRAP' 5.00 0 D• himself or through his own employees,provided that such improve- SO.FT.FLOOR AREA TOTAL ACREAGE - : ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1,INC.40UTLETS 6.00 _ or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or inn- GAS-EA,SYSTEM-OVER 4 (EA.) 2.00 . BUILDING USE prove for purpose of sale.). RES IND CON PB Other. ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ _❑ ❑ licensed contractors 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, . , to an owner of property who builds or improves thereon,and who - LAWN SPRINKLERS-OVER�5(EA.), 1.00 contracts for such projects with a co'utraetor(s)licensed pursuant to - theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00;Za D/ . - reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKF.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, Or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO, copy thereof(Sec.3800,Leb.C.). Policy No. Company _ - 0 '❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24 Z Z ❑ Certified copy is filed with the city inspection division. - ❑ ❑ ❑ ❑ • . � 0 Applicant MISC.- REFER TO ORD. Y' N Y N w CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 ZLp -FLOOD ZONE A.L.U.C. LU COMPENSATION INSURANCE PLG.CONTR. LIC.No, PLG. 1 D (This Section need not be completed if the permit is for one TOTAL �ten V❑ N❑ Y❑ N❑ Z hundred dollars($100)or less) 'U 0 I certify that in the performance of the work for which this pe OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F- mit is issued,I shall not employ any person in any manner so o beco ubj t t a Workers'Compeati � Trf�slrI Q i Dater '�1 Applicant nsms's BUILDING ; } to NOTICE TO AP (CANT' fur m: ng this Certificm .x- ALTER OR ADD TO MECH. 5.00 Z emption,you should be� L subject) 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=C.F.M.) 6.00 SEISMIC FEE ' 1 hereby affirm that there is a construction leading agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sea MICROFILM 3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 'ELECTRIC " I 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 .PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP Over 100,000 BTUI-SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes: (We) agree to save, indemnify and,keep harmless the City of MISC.- - REFER TO ORD. - , Cupertino against liabilities,judgments, costs and expenses which' PERMIT ISSUANCE' 10001CONST.TAX ay in any way erre against said try in Consequence of the cooling of this mit MECH.CONT. - LIC.NO. MECH. 112-1p-eV TOTAL •1 nature Applicant/Cootmc i Date - - TOTAL 72D:0� OFFICE COPY ,