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17452 POST THIS-CARD NEAR FRONT OF BUILDING PERMIT'Nl1MBER . CITY• OF CUPERTINO 1 ?452 'INSPECTION DIVISION JOB;INSPECTION REC R PERMIT EXPIRATION JOB ADDRESS. t '�.. Vy p UNIT# _LOT# {' ' _ PERMIT EXPIRES IF;W6 ' OWNER '• �� coNTRAcroR �' ISNOT STARTED WITHIN„ INSPECTION DATE INSPECTOR INSPECTION R CORD 180 DAYS OF PERMITdSSU. FOUNDATION NOTE: - - - ' ANCE OR 180,DAYS-IROM'- UFERALL;GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. PREGUNITE - - TO COMPLY'WITH THE'APPROVED PLANS AND CITY OF EU-, VALIDATION .GARAGESLABS CUPERTINO STANDARDS. `. . � � POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _ ' 3+ ." UNDERGROUND /SLAB } ' PLUMBING MAR 210.. ' ELECTRICALS .. - ISSUANCE DATE ' MECHANICAL; - BLocELECT PL(:., mECR.. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING, VALUATION g/FT. q J�� 9 MECHANICAL /1:"J`''• 0— ELECTRICAL -' PERNUT TO FRAMING IA- INSULATION -. - STO TYPE CONSTR'. 'OCC,GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BjSIGNED �. ROOFso ii FLOOR AREA iOTALACREAGE PNOTE: NAL INSP.SHALL BE MADE BEFORE DIAPHRAGMRUCTION TAX IS PAID ROOF SHEATHING' BUILDI G USE HES' I�D CON PB GO— r. APPLY-NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSMMECHANICAL� - E-,0 ` I] ❑ ❑ ASSESS ORS PARCEL NO, . ROUGH ' SANA PLUMBING ELECT.ENERG TUBS&'SHOWER PAN PLUMBING'ENTRACT NO. PARCEL No MECHANICAL MECH.ENERGY ' ELECTRICAL ' BUILDING ENE "ACC,DATE .ACC FILE NO FRAMING ELECT.FINAL T - INSULATION - PLUMBING ENG SITE NO. . GASTEST - - GASFIRE SPRINK ' ENERGY T-2a COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ❑ NE EXTERIOR.SHEAR - ELECTRICAL RFLooD ioNe' A.L u.c. INTERIOR SHEAR ,.. FIRE DEPT:. YO N❑ YL N❑ SHEETROCK GRADE - FEE SUMMARY EXTERIOR LATH : . • - BUILDING �p-- INTERIOR LATH',,, . - ItMVUHAKYAPPROVALS91 BUILDING SCRATCH COAT ELECTRIC ' -.PLAN CHECK . _ GAS _ FEE '-�—m•-....... NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY .a • SEISMIC FEE Ire OCCUPANCY OF BUILDING IS NOT,PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ^++•-.--,*—•w- • w ,ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC I_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ZOPLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL SEE SEE PE',FIM IT;EOR EXPIRATION DATE ENTAXIMPORTANT!PLEASE READ REVERSESIDEBEFORE AL CALLING FOR FINAL INSPECTION. � ;� OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTIFICATION -PERMIT NUMBER aDILON APPLICATION & PERMIT A 17452 ADDRESS, O �r D .tee BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ,. OWN 'S PLAN CHECK VALIDATION NAME T OTY. ELECTRIC PERMIT FEE • HONE cENT ACTOns UTLETS-SWITCHES-RECEP 10.00/1.00 NAM CCPJDM m.N�/ �� LIGHTING FIXTURES 0,00/1.00 CONTRACTORS /• PPLIANCES-RESIDENTIAL 4.00 ADDRESS ^ `f �' iiia U/Hf]INE/ ( PANELS 10.00 DATE OF APPLICATION ARCHITECTPANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NNO, DR ENGINEER Sac.NO. SIGNS TRANS. - 3.00 nooaess ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ��I� IIP EMP.METER OR POLE INS. 20.00 3_Zd ADDRESS TS E� - I MOTORS - SEE FEE SCH. 3G &LratuUS SERVICE CHANGE 20.00 .[z1(_ (J. wO o LICENSED CONTRACTORS DECLARATION G T I �� a u La u I.hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE w<a (Commencing with Section 7000)Of Division 3 of the Business BLDG. ELECT. PLG. MECH. H 7 i Professions CoJ a t cense is in full f0 u/I R. ❑ ❑ ❑ 'Z O= LicerllyyClasJZ Liu.Num citf Of �--__W 9 z Date--��---- Contras 9V {r{1�117f�IRp ¢ y f ,BUILDING PERMIT ¢ ¢ w OWNER-BUILDER DECLARATION ( INFORMATION 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD 3 u y y' P VALUATION $/FT. F ¢ 04 Law for the following reason.(Sec.7031,5,Business and Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires permit to construct,alter, ¢ ¢ ¢o improve,demolish,or repair any stricture,prior to its issuance,also ELEC.CONTE. C.N0. ELEC. U VLJ ¢ requires the applicant for such permit to file a signed statement that TOTAL „ PERMIT TO w $ he is licensed pursuant to the provisions of the Contractor's License - ec z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe 4 O Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE ¢ H o the basis for the alleged exemption.Any violation of Section 7031.5 STOR TYPE CONSTR. , u ;m by any applicant for a permit subjects the applicant toacivilpenalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(5500).1: . ❑ I,aseof the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP REB.UNITS their sole compensation,will do the work,and the structure is not - intended or offered ]or sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contractor's License Law does not apply t0 an owner oI - property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 - SO.FT FLOOR AREA ,TOTAL ACREAGE himself or through his own employees,provided that such improve-• t ments are not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM-1 6.00 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 200 BUILDING USE builder will have the burden of proving that he did not build nine- . . . RES IND CON PB ' Omar provcfor PurpOseof S4IC.). INDUSTRIAL WASTE INTER. - 30.00 ❑ El ❑ ❑ I,as owner of the property,am exclusively contracting with 11 licensed contractors m construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 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 contructous)licensed Pursrant to SEWER-SANITARY-STORM EA.200ttI10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACG.FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure. ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy thereof(Sec.3800,Lab Cgamy .vM7_.�� .. Policy No.- Company-�1-� Q ❑ Certified copy is hereby famished. FIRE SPRINK ENERGY T34 Z O A-6erti ' d py is file Iloj iy inspection division. MISC.- REFER TO ORD. ❑ V N V N 1-- y Y- PERMIT ISSUANCE 10.00 FLOOD zorvE A.L.u,c. W__ CERTIFICATE OF Ii XEMPTION FROM WORKERS' _ COMPENSATION INSURANCE PLG.CONTE, LIC.NO. I.G.P d O (This section need not be completed if the permit is for one _ TOTAL V F] N� Y NC] 0 Z hundred dollars IS 100)or less.) U O I certify that in the performance of the work for which this per- QTYMECHANICAL PERMIT FEE FEE SUMMARY IL F mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Com ensation Laws of California. U w Date-Applicant p BUILDING 1r00 aALTER OR ADD TO MECH. 5.00 } N NOTICE TO APPLICANT: If,after making this Certificate of F-x- F ? unplioon,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK' provisions of the Labor Cole, you const forthwith comply with FEE U AIR HANDLING UNIT(TO 10,000QF.M) 4.00 such provisions or this permit shall be deemed revoked N CONSTRUCTION LENDING AGENCYAIR HANDLING UNIT(OVER 10=C.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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097.Civ.C.). - Lcadcr'sName HEATING UNIT IOV ER 100,000 B.T.U.)9.50 ELECTRIC -- Lender's Address I certify Drat I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply Willi all city and county PLUMBING - ordinances and state laws relating to building construction, and BOILER-OOMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property let inspection purposes. (We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way a against said City in consequence of the PERMIT ISSUANCE 10.00 rafliif Of this pe MECH.CONT. LIC.NO. MECH. //O��G�tt6 `�' -ZU��/ TOTAL TOTALSS� Signature of Applicant/Contractor Date OFFICE COPY