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17098 7 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBEa' ' CITY OF CUPERTINO 17098 ? INSPECTION DIVISION `J.O`B. INSP E C T ION RECORD �q • .JOB ADDRESS—I L�' \J lJ 1��• UNIT# _LOT# C PERMIT!'^�1 M{{`T. PIRTION .II %FIRES IF.WORK OWNER �`,} . CONTRACTORs�,, •gPQS^- IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM'r NOTE: GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. UFER ALL PREGUNITE TO COMPLY WITH-THE APPROVED PLANS AND CITY OF PERMIl VALIDATION CUPERTINO STANDARDS. GARAGE SLABS 1?J�—T3 •I POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDt'�etrAC'•51-f�lj�< PF- UNDERGROUND /SLAB PLUMBING + Lr r 1 ELECTRICAL ISSUANCE DATE MECHANICAL - - PLUG. ELEcr. PLG. .MEC R. I IK I ❑ j . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOO RINFORMATION VALUATION SIFT. PLUMBING I(�� ' MECHANICAL - ELECTRICAL ^ PERM+r FRAMING I ""•" �' -I �.� INSULATION STORIES TYPE ComSTR. 1 - OCC.GROUP DES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED C3*- - - 'SO.FT.FLUOR AREA TOTALACREAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE - DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING aPs INo oN PP O.o.. y APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. ❑ ❑ ❑ E) ASSESSOR ARCEL NO I -ROUGH SAN.# ' PLUMBING -,y ,/ ELECT.ENERGY .TUBS&SHOWER PAN PLUMBING ENERGY -hq TRACT NU. PARCEL NO - 'Z MECHANICAL - MECH..ENERGY 2AELECTRICAL BUILDING ENERGY - ACC DATE ACC.FILE No. FRAMING I ELECT.FINAL TEST ZONING ENO.SITE NO. , INSULATION PLUMBING .Z } GAS TEST GAS , - FwE SPRINK ENEaGV T 2 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 11 "❑ ❑ "� EXTERIOR SHEAR ELECTRICAL RELEASE ,FLOOD ZONE A.L.U.o. INTERIOR SHEAR - FIRE DEPT. _�.- Y ❑ N❑ Y.L "❑, SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH BUILDING ^ � INTERIOR LATH TEMPORARY APPROVAL BUILDING "`''Gl SCRATCH COAT • ' ELECTRIC PLAN CHECK -- � ,. GAS FEE Ir NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM - r ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 16 T ' Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING a PLEASE GIVE JOB ADDRESS WHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! coNST.TAx PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY; "'APP`LTCANT TO FILL IN INFORMATION WITHIN RED LINES ­w USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION - -PERMIT NUMBER BUILDING APPLICATION & PERMIT 400RESy \ A � 1� ��nIri� 17098.., 1�( )' V i BUILDING-ELECTRICAL-PLUMBING -MECHANICAL WNER'SPLAN CHECK VALIDATION "A CITY. }Yvvve�%es NeV�4DNE 141 ELECTRIC PERMIT FEE0� Pn CONTRACTOR'S NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 i uc.140,L/3S LIGHTING FIXTURES 10.00/1.00 '2'0 G7Jr�� CONTRACTOR'S ADDRESS PPLIANCES-RESIDENTIAL 4.00 AOORE ...^`_' PHONE*1 5'7 PANELS 10.00 DATE OF APPLICATION AORnCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER - LIC. , • c.NO. SIGNS TRANS. 3.00 ARCH,OR ENG. PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 ZIP rrEMP.METER OR POLE INS. 20.00 APPLICANT'S ADDRESS MOTORS ' ' SEE FEE SCH. SERVICE CHANGE, 20.00 "t�.w�-� Pr- o2 -LICENSED CONT RACTORS DECLARATION L' yv' '�(�Z) Vl/ ` U w 1 hereby aflinn that 1 am licensed under provisions of Chapter 9 - ISSUANCE DATE n (commencing with Section 7000)of Division 3 of the Business and Q c BLDG. ELECT. PLG. MECH. H 0 i Professions Code, d my license is in full fur a fee ❑ p 00.W License lass - Lic.Number nk BC w H Date Contractor "Yff-r •tel BUILDING PERMIT '4 o a OWNER-BUILDER DECLARATION INFORMATION X ; LL E. I hereby affirm that I am exempt from the Contractor's License MISC.- _ REFER TO ORD u0¢ Law forthe followingreason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 `'' (� VALUATION $/FT. 0 -a Code:Any city or county which requires if permit to construct,alter, Q IS Q improve,dC1IlOI15I1,u!repair any 6t NCtnrl',prlll!to Its ISW ones,also ELEC.CONTR. LIC.NO. ELEC. I _�L ©/ Coo IsO u requires the applicant for such permit to file a signed statement that TOTAL IG U W - PERMIT TO $'N he is licensed pursuant to the provisions Ed the Contractor's License rz � Law(Chapter 9(coln me acing with Section 7000)of Division 3 oflhe "T7= i ao Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE a H C� the basis for the alleged exemption.Any violation of Section 7031.5 _ STORIES TYPE CONSTR. w. E � by any applicant for a permit subjects the ap plican t to a civil penal ty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars IS 500).1: ❑ 1,as owner of the property,or city employees with wages us 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(Sec. 7044, Business and Prol'essiolLs 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 S6 FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. Bents are not intended or offered for sale.If,however,it,,building GAS-EA.SYSTEM-11 6.00 I hnpnue onent is sold within one year of completion,the owner- GAS'-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or Mr. prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PS Other ❑ I,as owner of the property,am exclusively contracting with ,❑ ❑ X ❑ ❑ licensed contractors to construct the prgiCd(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSO $PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an ownei of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 . contracts for such projects with a contractor(s)licensed pursuant In SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I um exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK Ii RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby Wfaro that I have a cei-flume of ennsent to self-insum, ZONING ENG.SITE NO. 1 or a certificate of Workers'Comps u'tion Insurance,or a certilied + , P fie Cher��•pQ�1 JJ.�S- O,Lab.y - • Policy Nc�Z] 44ompany C ❑ Certified ropy is hereby fem.hed. FIRE SPRINK ENERGY T 24 Z Z m. Cert�irl �. i3-F, it with Ccity p;Caction vision. O ApplMISC.- REFER TO ORD. �'2�� Y N❑ Y ❑ - N❑ � N CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. LU > COhIPENSATION INSURANCE PLG.CONTR. LIC.NO.- PLG. CL 0 (This section need not be comPleted if the permit " for one TOTAL E W Y❑ N❑ Y E] NE] hundred dollar'(S 100)or less) 0 O 1 certify that in the performance of the..,it for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY .LL F mil is issued,I shall net employ any person in any manner So as to U become subject to the Workers'Compelnation Laws of California. 207,00 0 y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } w NOTICE TO APPLICANT: If,after making this Certificate of Ex- F Z emption,you should become subject to life 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)[00CF.M.) 4.00 _ CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER IO,000C.EM.) 6.00 SEISMIC FEE 7JI� I 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.). Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC a. 1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 information is Correct.I agree to Comely with all city and county PLUMBING ordinances and slate laws relating RI building construction, and ' BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of (tis city to enter upon the " BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL above-mentioned property for inspection purposes. (We) agreeto save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, costs and expenses which PERMIT ST.TAX may in any way accrue against said icy in consequence of the PERMIT ISSUANCE 10.00 raNin lis count. MECH.CONT. LIC.NO. MECH. TOTAL TOTAL � 4-1,0e)S' nes ore of A pplyfit/aCcuthruicto, Date OFFICE COPY