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17926 I POST THIS,CARD NEAR FRONT OF.'BUILDING PERMIT NUMBEA CITY, OF CUPERTINO INSPECTION DIVISION � ���' ' JOB INSPECTION RECORD. " 7 ` ns SQ, PERMIT EXPIRATION JOB.ADD,RESS /0'e- � UNIT,# LOT#{' - • `', y� ��Y\ Ons PERMIT EXPIRES.IF WORK'' OWNER 011 I CONTRAcroRil6meNUl W - IS NOT STARTED,WITHIN INSPECTION DATE I INSPECTOR - INSPEC ION RECORD 180 DAYS OF PERMIT ISSU. ,I•. 'FOUNDATION - - ' ANCE'OR 180 DAYS FROM 'NOTE: LAST CALLED INSPECTION. LIFER, • - ALL GRADING AND DRAINAGE SHALL BE:INSTALLED <'^A.• PREGUNITE " - - TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. PERMIT VALIDATION GARAGE SLABS, � � , POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED w ,• -°''�1 1�� ,,'�ilw UNDERGROUND /SLAB - S % PLUMBING ELECTRICAL 9 ISSUANCE DATE MECHANICAL - - - - BLDG'. ELECT., PL MECR.. ( . ❑ ❑ ❑., DO NOT FOUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ - •BUILDING PERMIT WOOD FLOOR INFORMATION; PLUMBING '" , .. VALUATION aIT. , MECHANICAL', q ELECTRICAL _ - f P€ MIT TO FRAMING - - �m�.� INSULATION - .STORIES. TYPA.CONSTR, • i ,• OCC.GROUP RES UNRS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - - - 1 SO,FT FLOOR ARIA •TOTFL ACREAGE 'ROOF NOTE:NO FINAL INSP..SHALL BE MADE BEFORE . DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHE - ."REs, IND , CON PB :OI- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ - ❑ ❑ ROUGH SAN.p - nssessoas PARceL No. . PLUMBING r - ELECT.ENERGY TRACT NO PARCEL NO. TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL - MECH.ENERGY ' ELECTRICAL BUILDING ENERGY ACC.DATE .ACC,FILE NO FRAMING% ELECT,FINAL TEST; ZONING ENG,SITE NO. . INSULATION - - PLUMBING. c GAS TEST GAS x MECHANICAL FIFE SPRINK ENERGY.T 24, COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ E] "❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE , A.L U.c. INTERIOR:SHEAR FIRE DEPT. - v❑ °N❑ y No SHEETROCK GRADE - FEE SUMMARY EXTERIOR LATH BUILDING • . INTERIOR LATH - - 'TEMPORARY APPROVALS' - BLiILDwG , SCRATCH COAT ELECTRIC PLAN CHECK GAS .FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE *, OCCUPANCY OF BUI LDING IS NOT PERMITTED UNTIL BUILDING FINAL IS"SIGNED BY BUI LDING INSPECTOR; MICROFILM ARRANGE FOR INSPECTI,ON-BY PHONING 252-4505, 'ELECTRIC EL ONE WORKING DAY BEFORE'REQUIRED.INSPECTION: P�uMBING z PLEASE GIVE JOB ADDRESS WHEN.PHONING. - SEE PERMIT FOR EXPIRATION DATEMECHANICAL .- IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE p CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY ' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY w AUI LDING PROJECT I DENTI FICA N PERMIT NUMBER - BUILDING O 2 APPLICATION & PERMIT 1 (] ADDRESS I J 1O a BUILDING—ELECTRICAL—PLUMBING—MECHANICAL ;•„ OWNER'5 - PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE - O_5AJU1 f45 PHONE NOMERACTORs UTLETS-SWITCHES-RECEP 10.00/1.00 LIC.N. q34 335 LIGHTING FIXTURES. - 10.00/1.00 COTRACTORSns ADDRESS APPLIANCES-RESIDENTIAL 4.00 ` PHONE ,7j S-7S PANELS 10.00 DATE OF APPLICATION ARCHITECT" " .� PLAN CHECK FEE OR PANELS (OVER 200 AMP) 20.00 ENGINEER •' uc.NO, SIGNS TRANS. 3.00 ' ADDRESS ENG SPECIALCIRCIIIT 5.00 PERMIT VALIDATION ; ZIP - EMP.METER OR POLE INS. , - 20.00 APPLICANTS - MOTORSEE SCH. (� ' ADDRESS - - SERVICE CHANGE 20.00 'SI2�jICJ-1 ' o o LICENSED CONTRACTORS DECLARATION _ ' <t I hereby affirm that I am licensed under provisions of Chapter 9 I ISSUANCE DATE yQu (commencing with,Secfion 7000)of Division 3 of the Business and BLDG. ELECT PLG. MECH- H N z Professions Codo,a my license is in full Cor ,gnd foe' ❑ z O m — License Cle% Liu Numbe 3 bJ� - 0 w I- w Dale Contractor ¢ m E BUILDING PERMIT ¢ ¢ w - OWNER-BUILDER DECLARATION 'INFORMATION E ;LL N 1 hereby affirm that 1 ant exempt from the Contractor's License MISC.— REFER TO ORD VALUATION $/FT. H ¢ Oj Law for the following reason.(Sec.7031.5,Busine%%and Professions PERMIT ISSUANCE - 10.00 ' ,A i Code'.Any city or county which mquircea permit to construct,alter, re 2 ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. ELEC. ' O ¢ requires the applicant for such permit to file a signed statement that - TOTAL ;T p RMIT TO E $ he is licensed pursuant to the provisions of the Contractor's License Umj� H z a Law(Chapter 9(commencingwith Section 7000)of Division 3 oflhe i O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE. ¢ H$ nQ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TV ECONSTR. a3� by any applicant for a permit subjects the applicant-to a civil penalty - gL'TER-DRAIN -WATER IEA.) 5,00 of not more than five hundred dollars($500).1: ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE . 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not - intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00 Code:The Contractor's License Law does not apply to an owner of - property who build%or improves thereof,and who does such work FIXTURES-PER TRAP -,5.00 ,5,00 O„ SO.FT.FLOOR AREA TOTAL ACREAGE himselfornot hrough ownemployees,for salt, If,ho everhat the improve- GAS-EA.SYSTEM-1 INC:40UTLETS 6.00 motifs are not Intended or Offered for sale.If,however,the building or improvement is sob within dna year of completion,the owner- GAS,EA.SYSTEM-OVER 4 IEA.) - .2.00 BUILDING USE prove of will have the burden of proving that he did not buil)or im- .,RES IND DON PB Omer prove for purpose of Safe.).property, INDUSTRIAL WASTE INTER. 30.00 ❑ d as owner Of the structheexclusivelyproject Se contracting with -❑ ❑ ❑ ❑ ❑ andPro coigns rod to construct Contra the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 8.00 gssessoRB PARCEL No. and Professions Code:The Contractor's License Law does not apply to anowner of property who bulbs or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 ' the Contractor's License Law. < - TRACT NO. PARCELNO. O I am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 r PCC.DATE ACC.FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 _ I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or B certified - , copy lhereof(Sec.1100,Lab.C.l. ' Policy No. Company O ❑ Cerlified 'opy shereby rami jteJ. FIRE$PRINK ENERGY T44 Z Z A Certifl co i% Eled w' ✓ I' city inspectlon division. - O Applicant` MISC.:, REFER TO ORD. Y ' N❑ Y.E] N❑ Hy 17-M FLOOD ZONE A.L.U.C. :OP PERMIT ISSUANCE CERTIFICAT EXEMPTION FROM WORKERS' - Z ` C7� LU D COMPENSATION INSURANCE I . PLG.CONTR. LIC:NO, PLG, 1 O (This sermon need not be completed if the permit is for one I TOTAL ,C"' Y❑ ' N•❑ Y ❑ N❑ ::) Z hundred dollur%($100)or It..) U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY IjL F mil is issued,I shall not employ any person in any insurer so as to U become subject to the Workers'Compensation Laws of California. n Datc Applicam _ ALTER OR ADD TO MECH. 5.00 BUILDING } to , NOTICE TO APPLICANT: If,after making this Certificate of Lx- - ?. emotion,you should become subject to the Workeri Compensation APPLIANCE. 5.00 PLAN CHECK provisions of the Labor Code, you,must forthwith comply with 10 FEE - V Such provisions or this permit shallAIR HANDLING UNIT(TO be deemed revoked. { =12—F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR 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 S.T.U.) 8.00 MICROFILM 3097,Cie.CJ. - Lender'sNameHEATING UNIT IO VER 100,000 B.T.U.)9.50 _ ELECTRIC Lender's Address I certify that l 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 stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives'of this city to enter upon the BOILER-COMP IOVBr100,00DBTUISEEFEESCH. MECHANICAL above-mentioned property for 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 accrue again said City in consequence of the L PERMIT ISSUANCE 10.00 ran[ of Is petmi. MECH.CONT. LIC.NO. MECH. - TOT, 512 TOTAL e Signature of pylic Contractor Date OFFICE COPY