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16160 POST THIS CARD NEAR FRONT OF BUILDING PERMITNUMBER CITY OF .CUPERTINO 16160 INSPECTION DIVISION JOB INSPECTION RECORD 4 PERMIT EXPIRATION ^ JOBADDRESS /"00 nV. li/oLI�n UNIT# _LOT# �fp'/ PERMIT EXPIRES IF WORK OWNER _' 4/LE7_7 �µC,�/ /L i] CONTRACTOR L I/IG 7 IS NOT STARTED WITHIN INSPECTION " DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATIONANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER - 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 SIGNED - UNDERGROUND /SLAB PLUMBING ELECTRICAL - ISSUANCE DATE MECHANICAL BLDG I ELECT t PLG MEC. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 'BUILDING PERMIT Q(•} ID INFORMATION WOODFLOOR PLUMBING cCC vnTllA�larvT Ill I SIFT. MECHANICAL S61 �'� r�!ER ' ELECTRICAL p D,y,,y�1�EESO PERMIT ) FRAMING CITY D C /c*,'./u'r, �Lr STORIES TYPE CONSTR. INSULATION OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED _ 50 FT FLOOI.AREA TOTAL ACRO AGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID' , BUILDING USE ROOF SHEATHING Res TND aoN PB un,.. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ASSE5SOR5 PARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY rRnct No PARCEL Na TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC DATE ACG FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING ENG SITE NO. INSULATION PLUMBING � GAS TEST GAS FIRE SPRINK ENERGY T-24 MECHANICAL Y ❑ NED Y ❑ N[3 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EL EXTERIOR SHEAR ELECTRICAL RELEASE . INTERIOR SHEAR FIRE DEPT. YO N�zoNE ALuc ❑ v ❑ N SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING ' INTERIOR LATH TEMPO RAR APPROVAL BUILDING sy ELECTRIC PLAN'CHECK SCRATCH COAT FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE _ OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC s "' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING }I O� PLEASE GIVE JOB ADDRESS WHEN PHONING. �4 Z MECHANICAL SEE PERMIT FOR EXPIRATION DATE = IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 3V 16160 ADDRESS _ ILDING - ELECTRICAL-PLUMBING-MECHANICAL a�E6 .91a1tFe ?0, OWNER'S .f. PLAN CHECK VALIDATION "AME -T"FZ QTY. ELECTRIC PERMIT FEE ds oNTRAcroRs ��-✓lyly jC PRONE UTLETS-SWITCHES-RECEP 10.00/1.00 NAM UC.NO. 0� LIGHTING FIXTURES 10.00/1.00 wrvrRAcroes PP LI APICES-RESIDENTIAL 4.00 ADOREss ._ �� r•. PANELS 10.00 GATE OF APPLICATI ON - `/ ARCHITECT ��111 Q ��E ♦ PANELS (OVER 200 AMP)) 20,00 PLAN CRECK FEE P.O.NO. uc.No. PANELSSIGNS (OVE 3.00 ARCR.DR ENG.SS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION AR HEOR elP TEMP.METER OR POLE INS. 20.00 h�l PDRESS rsr, d `Lr0GLMOTORS SEE FEE SCH.ApDREss K/ it T SERVICE CHANGE 20.00woo LICENSI!D CONT'RACTORS DI!CLARATION . o a U v 1 hereby affirm Ihm I con licensed under provisions of Chapter 9 ISSUANCE GATE z a lconunencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. D i Professions Code, ul iy license is in full force/ alfa l'1 ❑ ❑ ❑ i O H License Clas L.,Number_/_/!/H 7on o z -H�- Dutc Contractor BUILDING PERMIT rt w< O MER-BUILDER-R DECLARATION OINFORMATION AOA" MISC.- REFER TOO mu y I hereby ullirm that 1 am exmmpt from the Commctor s License .. 0 < Law for the following reason.(Sec.7031.5,Bminessand Professions PERMIT ISSUANCE - 10.00 vawATtoN S/FT. `• - Code:Any city orcounly whichrequiresupermit toconslruet,Alter, Rto < 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /7� 0¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO u w m" he is licensed pursuant to the provisions of the Contractor's License HZQ Law.(chapter 9(commencingwith Scelio I7000)o1'Division 3 of the �'VTE�/QaQ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ r o the basis for the alleged exemption.Any violation of Section 703 L5 STORIES TYPE CONSTR. ea A ,_ by any ipplic'antfor a permit sul»ecls the applicant to a civil Penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 of not more than five hundred dollar(55001.): ❑ 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 IIIc structure is riot OCC.GROUP PES.UNITS intended or offered for sale (Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:'rhe Contractor's License Law does not apply'to an owner of property who builds or improves thereon,and who does such work F IXTURES-PER TRAP 5.00 Bp,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenotintendedorofl'ered for sale.If,however.the building GAS-EA-SYSTEM-11NC.40UTLET$ 6.00 ^` or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE 1.. builder will have the burden of proving that he did not build or int- RES IND CON PB Omer prove for purpose of sale.). INDUSTR IAL WASTE INTER. 30.00 ❑ 1,as owner of The properly,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 5(EA.) 1.00 contracts lot such projects with a.m,,mtcR0 licensed punumil to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am axempt un der Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 mason y - Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WORK IERS'COMPIENSAIION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate ofconsent Io self-insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified s r copy thereof fS".3X00,Lab.C.). Policy No._ Company- 0 ompany=_ O ❑ Certific crehp mkli FIRESPRINK ENERGY T 24 Z Z )il Certif' - W the r+wwn division. MISC.- REFER TO ORD. O, Pplicant_ -_ V❑ N❑ Y ❑ N❑ Q: LO CER1'IFICATE OIs EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. UJ > COhll'ENSATION INSURANCE PLG.CONTE, LIC.NO. PLG, C 0 (Phis section'need_not be c o,pleted if the permit is for one TOTAL V❑ N❑ Y ❑ N❑ Z) Z hundred dollars IS 100)or lc,s I U O 1 certify that in The performance of the work for which this per- DTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I Shull nut employ anY Person in any mannerso as to U become suhjcct to the Workers''Conmpcnsal ion Laws al California. U a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING s� } W NOl'10E TO APPLICANT': IL after making this Certificate of I!x- H 2 emption,you should becolne'subjeet to the Workers Comperic tion 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 10SWC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE ds'SZ I herehy affirm that There is a construction lending agency fur EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this Permit is issued(See. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address - gref� I certify that I have read This application and state That The above VENTILATION FAN (SINGLE) 4.00 t inlnrm:ninn is correct, I agree to comply with all city and county BOILER-COMP13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING J ordinances and state laws relating In building construction, and i�. hereby authorize representatives of this city to enter upon the BOILER-COMP(Over l00000 BTU)SEE FEE SCH. 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,j nents, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX cony in 'nY waY aekrue a• n. said City in consequ me of the rami nail. MECH.CONT. LIC.NO. MECH. q aTOTAL TOTAL 9`000 Signature of Applicant/ Datc OFFICE COPY