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16428 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16426 INSPECTION DIVISION JOB INSPECTION RECORD 7 , b`: p �d/ WI'/ PER IT EXPIRATION JOBADDRESS d/(foc'b u'R_ lll� _UNIT.l, _LOT# PERMIT EXPIRES IF WORK awrvER L. coNTRACTOR �Lr y� S7 ,IS NOT STARTED WITHIN I INSPECTION DATE INSPECTOR IINSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - - ANCE OR 180 DAYS FROM NOTE; LAST CALLED INSPECTION. LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION _ CUPERTINO STANDARDS. GARAGE SLABS ti� SC.• POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED C4 UNDERGROUND /SLAB PLUMBING _ e ' ELECTRICAL D hISSUANCE UArE MECHANICAL - LUG. ELECT PL G. MECH. ®� \ �.❑ El. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED C\ BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION s/FT. PLUMBING MECHANICAL 1 O �V. ELECTRICAL // PERMITb`TO FRAMING p. - oo F, d �i 1'o& INSULATION sTDR IES TYPE CONSTR OCC GROUP ' RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' SO Fr FLOOR aREA rcrAl.ACHFACE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID I '2 J - ROOF SHEATHING RES ' IND aDCON USE Diu., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. © ❑ ❑ ❑ ❑ ROUGH SAN.q AS,SE550RS PARCEL NO PLUMBING ELECT.ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY - 'TRACT NO PARCEL NO MECHANICAL. MECH.ENERGY E I,ECTRICAL ACC.DATE ACC FILE NO. � - .a _ BUILDING ENERGY ' FRAMING OL, ELECT.FINAL TEST ZONING ENC,SITE NO. INSULATION, PLUMBING ' GAS TEST GAS FIRE SPRINK ENERGY T 2E' � MECHANICAL Y ❑ N Y ❑ NCj COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR. ELECTRICAL RELEASE FLOOD ZONE A.L UC. INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ N❑ SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH BUILDING T BUILDING " INTERIOR LATH TEMPORARN APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK ' - GAS - .FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED jOCCUPANcY . SEISMIC FEE 7 ,' OCCUPANCYOF BUILDING ISNOTPERMITTE DUNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. E I. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC (p F— ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL -IMPORTANT! CONST,TAX PLEASE READ REVERSE SIDE BEFORE ? a 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 Iss "DRESS APPLICATION & PERMIT 6428_ A "1 I OvD BUILDING -ELECTRICAL-PLUMBING-MECHANICAL , OWNS. /- PLAN CHECK VA LIGATION Lie "SOH LC DNE QTY. ELECTRIC PERMIT FEE �• �� TR S Z, NAMERAcroRs OUTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 ADDRR'EES^SSTOR'S �/j..-�y� t/, /�/ �Y, PPLIANCES-RESIDENTIAL 4.00 -y V� �i'-RITC"L AV CPHONE 44'%-3J / PANELS - 10.00 DATE OF APPLICATION��., ADR "REcr - - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE C.NO. ENGINEER �O(3�VW�IS LIC.NO. L3 SIGNS TRANS. 3.00 ARCH,OR END. - SPECIALCIRCUIT S.00 PERMIT VALIDATION ADDRW'1 O C.�OA•S z,p"/q40xJ TEMP.METER OR POLE INS. .20.00 APPLICANT'S MOTORS - SEE FEE SCH. ADDRESS 1 `�Dv( SERVICE CHANGE 20.00 X Z LICENSLI)CONTRACTORS UECLARA'FION ¢ v 1 hereby affirm that 1 am licensed under provisions of Clmpter 9 ^ISSUANCE DATE to (commencing with Section 7000)of Division 3 of the Business and a BLDG. ELECT. PLG. MECH. ' H i Professions CoA nntl my license is In full foterftd. ❑ ❑ ❑ Z 00. - Licens• 0 Lie.Number GG o z - o Date t. Contractor ¢ y3 pppb� ¢ ¢ a OWNER-BUILDER DECLARATION BUILDING PERMIT - o a u INFORMATION X ; LL I- 1 hereby.uffnn that 1 um exempt from [lie Contractor's License MISC.- REFER TO ORD LL 0 st Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT. H - PERMIT ISSUANCE X10,00- . �« Code:Any city or county which requires a permit to construct,,also pr¢ 0 ImpfOVe,demn11511,O!repair any Stfllelnle.prior IO its 155118neC,also ELEC.CONTE. UG.NO. ELEC /- 0 u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO E $ he is licensed pursuant to the provisions of the Contractor's License ,,,}}T ei Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �DDLn �tt�s 11 f i o Business and I'mN,siuns Code)or Ilett lie is exempt therel'ronl and OTY. PLUMBING PERMIT FEE wl VVV--- V Yt. re 1-$ the basis for the alleged exmnptian.Any viulalion of Section 7031.5 STORIES TYPE CONSTR. a ; by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER IEA.15.00 ofno[more than five hundred dollars($500),): ❑ I,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 nor trtended or offered far sale (Sec. 7044, Business and Professions DRAINS.FLOOR,ROOF,AR EA,COND. 5.00 Code:'fhe Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AR A TOTAL ACREAGE himselfre et ince his own employees. le.11,ho ev such ibuildi c f ./t.7 - mentsarenotintendedonciiieoyces. molded that s thebuildingGAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or im- - . BUILDING USE prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Ohne, ❑ I,as owner of the properly,am exclusively contracting wish C1 C1 1:1 ❑ 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 Conlraclnr'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 conlmdots)licensed pursuant to SEWER-SAN ITARYSTORM EA,200ft/10.00 the am exe License Law. TRACT N0. PARCEL NO. [ ❑ I am exempt under Sec..,H.&P.C.fur this reason WATER HEATER W/VENT 6.00 Owner _ hate WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 - I hereby affirm that I have a certificate'it con sen[to wh.insurc, ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE N0. copy(hereof1 0 Policy N2A[{. � GN•tCIrf._1_ O ❑ Certified co yes hereby umished. FIRE SPRINK ENERGY T$4 Z Z er[ified Is f h the city inspection division. MISC.- REFER TO ORD. O A plicanl _ Y E] NE] I Y C] N[3 CC y CERTIFICATE OF EXEMPT[ON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTE, LIC.NO. PLG. 0- Z( This sectio. need not be completed if the permit is for one ❑TOTAL Y N 0 Y [3N hundred dollars(5100)or IaSs.) U O 1 certify that in the perfornwnce of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL I. mil is issued,I shall not employ any person in any manner so as In O U become subject to the Workers'Compensation Laws of California. Date Applicant BUILDING �� 65Va ALTER OR ADD TO MECH. 5.00 >- W NOTICE TO APPLICANT: 11,after making[his Certificate of Ex- 2 emptiun,you should become subject to the Workers'Compensation APPLIANCE J 5.00 PLAN CHECK provisions of the Labor Cade, you most forthwith comply with FEE U such provisions or this permit shall he deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.EM.) 6.00 SEISMIC FEE ,7(() 1 hereby affirm that there is a construction landing agency for EXHAUST HOOD(WITH DUCT) 5.00 Hie performance of the work for which this permit is issued(Sec. - MICROFILM 3097,Civ.C.). q HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name ,f ', HEATING UNIT 100,000 B.T.U.)9.50 Lender's Address ELECTRIC 1 certify that I have read this application andsmle that the abo`Jc VENTILATION FAN (SINGLE) 4,00 information is correct. I agree to comply with all city and county PLUMBING ordinancesand 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 t above-mentioned property for inspection purposes. BOI LER-COMP (Oerv100,000 BTU)SEE FEE.SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against Iiahili(ies,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in a way accrue against said City i consequence of the ranting is pe it. MECH.CONT. LIC.NO. MECH. C Ir TOTAL TOTAL 3 oZ0 Signa are of Applicant/Contractor -(Jte OFFICE COPY