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17125 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER, CITY OF CUPERTINO 17125 INSPECTION DIVISION JOB INSPECTION_ RECORD PERMIT EXPIRATION JOB ADDRESS IOI�.`3 Ul "� P`-� UNIT# LOT 4t PERMIT�EXPIRES IF WORK OWNER - Cj CONTRACTOR - IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT'SSU. FOUNDATION ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. , UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED - PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION CUPERTINO STANDARDS. c7— tf GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING- ELECTRICAL .ISSUANCE DATE MECHANICAL BLDG ELECT. PLG. ME rJ� ❑ ❑,. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION PLUMBING WOOD FLOOR - VALUATION MECHANICAL - cocu. ' IIS ELECTRICAL PERMIT TO - FRAMING M�cH-- STORIES TYPE CONSTR. INSULATION OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '1^ . ROOF NOTE:NO FINAL INSP.SHALb'$$��4, ORE sD.FT FLooR AREA roTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAXIS. AID ROOF SHEATHING '. I BUILDING USE REs IND coN PB omI APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ n ROUGH 1155 SSORS PARCEL NO SAN* PLUMBING - ELECT.ENERGY ' TRACT NO PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC.DATE ACC,FILE NO ELECTRICAL BUILDING ENERGYFRAMING ELECT.FINAL TEST { ZONING ENG.SITE NO. INSULATION PLUMBING -7- -2 GAS TEST GAS I FIRE SPRINK: ENERGY T24 MECHANICAL 3'-j-gy - 1jw1 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� ` "EJ FLOOD ZONE 'A.L U.C, - EXTERIOR SHEAR - ELECTRICAL RELEASE ' INTERIOR SHEAR FIRE DEPT. Y� NO T'. L,, N� SHEETROCK - GRADE FEESUMMARY EXTERIOR LATH BUILDING - INTERIOR LATH TEMPORARY APPROVALS 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 H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING . Z.0 PLEASE GIVE JOB ADDRESS WHEN PHONING. = SEE,PERMIT FOR EXPIRATION DATE - MECHANICAL 150 •IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE '' ^ 'i TOTALQ CALLING FOR FINAL INSPECTION. OFFICE COPY APPI;dC ANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT'P,EN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER j� JB APPLICATION &PERMIT k ADDRESS -1 7 1 A UILDING-ELECTRICAL-PLUMBING-MECHANICAL I I G�;J OWNER'S NAME PLAN CHECK VALIDATION ONE • �' - DTV. ELECTRIC PERMIT FEE cory RAcroq's OUTLETS-SWITCHES- 10.00/1.00 NAME uc.ND. 140 LIGHTING FIXTURES .. 10.00/1.00 f,0 TRACTOR'S ADDRESS EIJ4 So4'at�/�� APPLIANCES.RESIDENTIAL 4.00 PHONE PANELS 10.00 OATS OF APPLICATION ARCHITECT a PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER ' .y CH ORuc.No. SIGNS TRANS. 3.00 . p, ADDRESS ENG. ADDRESS $pECIAL CI ROUIT S.00 • PERMIT VALIDATION -, zIP EMP. METER OR POLE INS. 260201 000 APPLICANT'a ADDRESS - MOTORS SEE FEE SCH. ¢ i SERVICE CHANGE - } 20,00 `�Q oOT Foo LICENSED CONTRACTORS DECLARATION - "�`� hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE so a n ('commencing with Section 7000)of Division 3 of the Business and r a z Professions Code,and my license is in full force and effect. BLDG. ELECT. PLO. MECH. z0 w - License Class Lac.Number. O z r Date - Contractor C�r1, Nr Of COp>:dlnfl .. ❑ ❑ Z Q y E ¢ ¢ w u OWNER-BUILDER DECLARATION BUILDING PERMIT F ;n l- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION LL o¢ Law for the following reason.(Sec.]031.5,Business and Professions - VALUATION - ad $/FT. - � � Code:Any city or county which requires a permit to construct,alter, PERMIT ISSUANCE . 10.00 ,M K ¢0O - improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.N0. Q�. i w m M requires the applicant for such permit to file a signed statement that ELEC. �� p' TOTAL PERMIT TO ' he is licensed pursuant to the provisions of the Contractor's License H z coLaw(Chapter9(commencing with Section 7000)of Division 3 oflhe �� z'o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT - ` ¢ r m ,$TORIESTYPE CONSTR.the basis for the alleged exemption.Any violation of Section 7031.5 FEE . n i .- by any applicant for a permit subjects the applicant too civilpenalty of not more than five handled dollars(5500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00 ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE -4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.ONITS intended or offered for sale(Sec. 70 ' Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law due's not apply to as owner of Property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 himself or through his own employees,provided that such improve- So.Fr.FLOOR AREA TOTAL ACREAGE _ - ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or Improvement Is sold within one year of completion, the owaer- 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 1,as ownerose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IN : CON PB Omer . ❑ d as owner of to construct he exclusively contracting Bu with - '� E. 11 ❑ licensed contractors to construct the project(Sec. does Business LAWN SPRINKLERS-i INC 5 V.B. 6.00 and Professions Code:The Contractor's License Law does not apply ASSESSORS PARCEL NO. 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 contractors)licensed pursuant to - theContractor'sLicenseLaw, SEWER-SANITARY-STORM EA.200ft/10.00 ,TRACT NO_ PARCEL ND. ❑ I um exempt under Sec. ,B.&P,C.for this reason WATER HEATER W/VENT 6.00 .. Owner Dare WATER-SYSTEM . 5.00 ' ACC.DATE ACG FILE NO. WORrm that OMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 - I hereby affirm that I Have a certificate of Insurance, orself-rtifie,or acertificate of Workers'Compensation Insurance,nr n certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.G). JPolicy No. Company 0, ❑ fortified copy is herebyy famished. FIRE$PRINK - ENERGY T-Z9 Z Z Certified Ed wi0r the city inspection division. - F O pylic MISC.- REFER TO ORD. Y ❑ N 'v Q N� -GC m CER ICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE .A.L.U.C. LU COMPENSATION INSURANCE PLG.CONTR. - LIC.NO. PLG. IL O IThis.seclion need%nm be completed if the permit is for one TOTAL Y❑ N❑ ' Y ❑ NF � Z , hundred dollars IS 100)or less.)00 I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,I'shall not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of California, Q. Date Applicant ALTER OR ADD TO MECH. 5.00 'a 'BUILDING } lin NOTICE TO APPLICANT`. If,after making this Certificate of Ex- Fz emption,'you should become subject to the Worken'Compensation APPLIANCE 500 PLAN CHECK provisions of the Labor Code, you must forth . with comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1C.EM.) 6.00 SEISMIC FEE 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. MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.1 8.00 Lender's Name Lender's Address' HEATING UNITIOVER 100,000 B.T.U.19.50 ELECTRIC - 1 certify that I have read Ills application and state that the above VENTILATION FAN (SINGLE) 4.00 ti. inform tion is correct I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby'authorize representatives of this citytoenter upon the T above-mentioned property for inspection purposes. BOI LER-COMP(Over[00,000 BTU)SEE FEE SCH. MECHANICAL .�V (We) agree to save, Indemnify add keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses whichlip, 00NST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE' 10.00 L-lJ ' ranting of this -it. MECH.CONT. LIC.NO. MECH. gnat of AppTOTAL TOTAL �J It�C7 Ilict/Ctctor anonraVale - OFFICE COPY