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18625 POST THIS CARD NEAR FRONT OF BUILDING.. • ' PERMIT NUMBER , CITY OF CUPERTINO 18625 INSPECTION DIVISION- - JOB INSPECTION�d RECORD CO D II . . / - 12 •� '. - • PERMIT EXPIRATION ' JOB ADVR)E SS ��G, � J Sri /5 01I " UNLTlk C_ LOT# /p�E/RMLT EXPI ES IF WORK OWNER - •CONTRACTOR .� / ��.2�, J� /i�-f �� A?!N(fT STATED WITHIN_ INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU FOUNDATION • - - ANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION: UFER - 'r ALL GRADING AND DRAINAGE SHALL BE INSTALLED: PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF: 'PERMIT VALIDATION CUPERTINO STANDARDS. - GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDDf 'UNDERGROUND /SLAB '' - ,!f•"" 1, /e, PLUMBING ELECTRICAL, ' ISSUANCE DATE MECHANICAL. BLDG. ELECT; PLG .MECH._ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR - VALUATION SIFT. PLUMBING . MECHANICAL ELECTRICAL - +,I PE FRAMING OHI TYPE CONSTH. ' INSULATION — . . ^.T. Se,SUB(UDjf oee.cuouP RES uNlrs PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE^ so.FT.FLOOR AREA TOTAL ACREAGE •�' - DIAPHRAGM THE CONSTRUCTION TAX IS PAID - �T•?/ - - N V ROOF SHEATHING BUILDING USE RRE ❑ ❑N El11PH DILt-r APPLY'NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. AssessoasPARCEL NO ROUGH SANA PLUMBING,' - ELECT.ENERGY " TRACT NO. PARCEL NO TUBS&SHOWER PAN - - � PLUMBING ENERGY MECHANICAL` MECH.ENERGY - - - ACC DATE ACC.FILE NO ELECTRICAL BUILDING ENERGY - �; FRAMING - ELECT.FINAL TEST ZONING ENG,SITE No. INSULATION PLUMBING - . GAS TEST GAS - MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "0 Y [:] "❑ EXTERIOR SHEAR ELECTRICAL:RELEASE FLOOP ZONE A.L.u.c. INTERIOR SHEAR - FIRE DEPT. - T °❑ "❑ Y ❑ V, N❑ SHEETROCK GRADE FEE SUMMARY , EXTERIOR LATH - BUILDING J l INTERIOR LATH TEMPORARY APPROVALS BUILDING . SCRATCH COAT- ELECTRIC PLAN CHECK GAS - FEE J NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICFOFI LM ARRANGE FOR INSPECTION BY PHONING 252-4505,' ELEcrdlc Y �� ONE WORKING DAY BEFORE"REQUIRED INSPECTION. PLUMBING . 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. z — SEE PERM FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE*READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY r APPLICANT TO FILL IN INFORMATION WITHIN RED LINES _ USE BALL POINT PEN ONLY, BUILDING PROJECT IDENTFICATION - �PERMITNUMBER - BUILoIN ` APPLICATION & PERMIT AOOn ESl 1 ^( BUILDING-ELECTRICAL-PLUMBING /6 ^/ =MECHANICAL - - F' , 1 V V L.I5 OW EH'is PLAN CHECK VALIDATION . NAME r-CHarv, y - 'OTY. ELECTRIC PERMIT FEE - CONTRACTOR' NAME . , p _ i JOUTLETS-SWITCHES-RECEP 10.00/1.00 n. uc.No. LIGHTING FIXTURES 10.00/1.00 c- CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 ' AO RE55 PRorvE01. Q iLPPANELS 10.001 -DATE OF APPLICATION ARCHITECTPLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) - 20.00 .. . ENGINEER uq LIC.NO. SIGNS TRANS. - 3.00 ARCH.ORENG. - PERMIT VALIDATION ADDRESS - SPECIAL CIRCUIT 5.00 ZIP EMP.METER OR POLE INS. 20.00 6 APPLICANT'S MOTORS SEE FEE SCH. r ADDRESS SERVICE CHANGE '20.00 0 0 0 LICENSED CONTRACTORS DECLARATION a i I hereby affirm that I am licensed tinder provisions of Chapter 9 - W - f 'ISSUANCE DATE I. rt m (commencing with Section 7000)of Division 3 of the Basin s and ., BLDG. ELECT." ' PLG. MECH. R w z Professions Co e, d wense is in full tor([ _ o v, - License C Lic.Number V 9 z r ra Date Contractor . ie��` . .❑ ❑ ❑ ❑ a.y f , BUILDING PERMIT - P: tc w st OWNER-BUILDER DECLARATION ,� INFORMATION F o I- I hereby affirm that 1 am exempt from the Contractor's License MISC.- REF 'IIOTORD 3 VALUATION $/FT. LL o¢ Law for lire following reason(Sec.7031.5,Business untl Professions - PERMIT ISSUANCE - 1BeB0 A° D� IS Zi Code: e,dem y demolish, county whiny structure, requires une permit o its issuan e,also , M e o improve,demolish,or repair any structure,prior to its issuance,also ECEC.CONTR. _ LIC.N0. ELEC. P�- D O .¢ re uires the titan[for such d statement that q pp C permit to file a,Con t s - TOTAL o u' p _ � PERMIT TO 't u w ro y he is licensed pursuant to the provisions of the )of License ', H z > Business and 9(commencing Professions Code)or Section is exempt t Division of nd . lie a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE 'yam it F p basis for the alleged exemption.Any violation of Section ST HIES, TYPE CONSTR. i ;m by by any applicant fora permit subjects the applicant toacivilpmalty penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(my em): r ❑ Las owner at the property,or my employees with re is nos BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work and the structure is not r intended or offered for sale sect. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Cade:The h o build of s License Law does not apply to an owner of property who buildsorimproves thereon,and who does such work FIXTURES-PER,TRAP , '", 5.00 se.ET.FLOOR AREA TOTAL ACREAGE � '- meatslare not hrough ownemployees,for sale. If,ed however,the improve- GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 AS' menu are not intended or offered y sale.IL mpleveq the building ' or improvement 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 guild or im- RES IND ' CON Re O he, th prove for purpose of e J. INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ . 1:1 • ❑ ❑ I,as owner of the property,am exclusively contracting with licensed contractors to 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 (EA.) 1.00 contracts for such projects with a contractor(,)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,B&P.C.for this WATER HEATER W/VENT 6.00 - reason Owner Date WATER SYSTEM 5.00 ACC.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 a certified copy thereof(Sec.3 00,Lab.C.). ,Tf - - - ' Policy No. Company ,0 erlil'ied cop is hereby furnished, FIRE SPRINK ENERGY T 24 ,[plaaoerG'f�ed �p BI i t the in r,do rvisioG. MISC_ -REFERTOORD. Z Q AVPiicunt \ / Y❑' N❑ Y ❑ N❑ ~ rn PERMIT ISSUANCE 10.06 , A.L.U.L. LU CERTIFICATE OF EXEMPTION FROM WORKERS' FLOOD ZONE W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Z (This section need not be completed if the permit is for one _ - TOTAL Y[:J NE] Y [:] NO hundred dollars($100)or IessJ U O 1 certify that in the performance of the work for which this per, DTV. MECHANICAL PERMIT FEE FEE SUMMARY W H mit is issued,1 shall not employ any person in any manner so as to U become subject to lire Workers Compensation Laws of California. y Dote Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICE, TO APPLICANT: It,after making this Certificate of Ex- -, emption,you should become subject to the Workers,'Compensation APPLIANCE - 5.00 PLAN'CHECKr provisions of the Labor Code, you must forthwith comply with . FEE �( V' such provisions or this permit shall be deemed revoked'. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 ' CONSTRUCTION LENDING AGENCY AIRHANDLING UNITIOVER 10=C.F.M.) 6.00 - SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 4 -� the performance of the work for which this permit is Issued(Sec. HEATINGUNIT(TO 100,000 B.T.U.) 5.00 MICROFILM 3097,Ci,C.). Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC M "� Lender's Address 1 certify that I have mad this application and state that the above VENTILATION FAN (SINGLE) 4.00 - information 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 city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. .MECHANICAL abuve-mentioned property for inspection purposes. (We) ago: to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino age sl IiuhililieS,judgments, costs and expenses which CONST.TAX may in any ay accrue agai s said C' in,, nsequence f the PERMIT ISSUANCE --10.00 - lingo t s ennit ECH.CONT. LIC.NO. TOTAL tj TOTAL y^ ignature of Applicant/Con rector Date I OFFICE COPY .f. _�( Nl4VIe � I /'e Ilk 74 Nunn. v 1 q <I Z ^ � i ❑ ❑ 6� $ It Q � s �, a ^ LI 11 m ••• n O a 'O '6 npjQ i I 0- 0 0 ? 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