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16214 (2) 4 POST THIS CARD NEAR FRONT OF BUIIfDING PERMIT NUMBER -CITY OF CUPERTINO 16214 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS r� �L'Ly`J -�L UNIT#. _LOT# PERMIT EXPIRES IF WORK OWNER -i• 7lVo f1• CONTRACTOR' V'}-L #7-6— , IS NOT STARTED WITHIN INSPECTION_ DATE INSPECTOR �IN, TION RECORD 180 DAYS OF PERMIT ISSU FOUNDATION - ANCE OR 180.DAVS;FROM NOTE:. LASTCALLED INSPECTION. ' UF,ER ALL GRADING AND DRAINAGE SHALL BE INSTALLED x�•;- TO COMPLY WITH THE APPROVED PLANS AND CIN OF Peu Mlr,vnuoanoua PREGUNITE Y: .�. CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - v ' . UNDERGROUND /SLAB PLUMBING j (. ELECTRICAL ISSUANCE RATE MECHANICAL .. - aLCG. ELECT PLG. MECH., ❑ ❑ ❑ El 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMITNFORMATION I 'WOOD FLOOR VALUATION siET. PLUMBING, MECHANICAL ELECTRICAL .. PERMIT TO FRAMING INSULATION STCRIES TYPE CONSTR. � " iU CCC GROUP;` RE 1MT5 PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO,FT FLOOR AREA TOTAU�CRFAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORbN ap' . DIAPHRAGM THE CONSTRUCTION TAX IS PAID awLOwr,USE ROOF SHEATHING mO coN Pe'" o,nr„ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS - DATE I P. - El ❑ E P161I]IIIRl PAHCEL NO ROUGH SAN.# �• lvOQ PLUMBING ELECT.ENERGY TUBS&SHOWER PAN - PLUMBING ENERGY -TRACT NO. PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL - BUILDING ENERGY ACC.DATE ACC.FILE No, FRAMING ELECT.FINAL TEST. ZONING,, ENG.SITENO.y_I - INSULATION PLUMBING ' GAS TEST GAS • FIR ER ! 'ENERGY T2 MECHANICAL ,: COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE AL,WC. - INTERIOR SHEAR FIRE DEPT. Y❑ 'NE) ° ❑ N❑' SHEETROCK - GRADE Fa SUMMARY EXTERIOR LATH - BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING'•- SCRATCH COAT. ELECTRIC " - PLAN CHECK -. GAS - FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM. ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Ic. F ONE WORKING DAY BEFORE REQUIRED"INSPECTION. PLUMBING o PLEASE GIVE JOB ADDRESS WHEN PHONING. z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL . CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NumaER EDI_mNG APPLICATION & PERMIT q ADDRESS I ,P BUILDING —ELECTRICAL—PLUMBING—MECHANICAL «. DIANE.. PLAN CHECK VALIDATION AME ONE , NZ`->� , DTV. ELECTRIC PERMIT FEE • NAMERacTORs OUTLETS-SWITCHES-RECEP 10.00/1.00 LIGNO LIGHTING FIXTURES 10.00/1.00 , c R,1croRs ADDRESS APPLIANCES-RESIDENTIAL 4.00 ' Iq ��J� \I Ilc-t PHONE PANELS 10.00 DATE OF APPLICATION + ARCHITECT p.n '•Ly�C PANELS (OVER ZOO AMPI 20.00 PLAN CHECK FEE P.G NO OR ENGINEER uc.NO SIGNS TRANS. 3.00 ARCH.OR ENG, SPECIALCIRCUIT 5.00 PERMIT VALIDATION ADDRESS zIP EMP.METER OR POLE INS. 20,00 APPLICANT MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 ,I(� ,a or� LICENSED CONTRACTORS DECLARATION < U u I hereby affirm that I um licensed under provisions of Chapter 9 ISSUANCE DATE y s- (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H w i Professions Code an license is in full force License Ch Lie.Number ❑' ❑ ❑ 9 H Date contractor a BUILDING PERMIT ¢ a, w G OWNER-BUILDER DECLARATION - - INFORMATION wod ° - MISC.— REFER TO ORD. S,� r I hereby affirm that I am exempt from the Coal.ador's License VALUATION $/FT. H LL o J Law for the following reason.(Sec.703 L5,Business and Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, R ¢ s- improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT T wm he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(e mmencing with Section 7000)of Division 3 of theAl 4 D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ H o tire basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).): ❑ Las 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,AR EA,COND. 5.00 Code:The Contractors License Law does not apply to an owner of property who builds Or Improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 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 build or int- RES IND CON 'PB Omer prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct it,, project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner.Iproperty who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to SEWER-SAN ITAR V-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ l am exempt under See ,B.&P.C.for(his 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, FON I VNG ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified ropy tire,of ce. S ab Policy No an y—L17. 1��•�� OW O D rtifted copy is hereby furnished. FIRE SPRINK ENERGY T24 Z Z Certified Is y-is fled with the C y, ' c-tion vision. 0 AP ppflot MISC..- REFER TO p •§\ ❑ IN y ❑ IN C:] ~ 6 PERMIT ISSUANCE "10.00 QQ FLOOD ZONE A.L.U.C. Cc CERTIFICATE OF EXEMPTION FROM WORKER L7 COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG, p'`� V❑ N❑ V❑ N❑ CL O (This section need not be completed if the permit is for one TOTAL ::) Z hundred dollars($100)or less.) L) O I certify that in the performance of tte work ror which this per- CITY' MECHANICAL PERMIT FEE FEE SUMMARY IL H mit is issued,I shall not employ any person in any manner so as to U become subject to the Worker,'Compensation Laws of California. La Date Applicant - ALTER OR ADD TO MECH. 5.00 . BUILDING } H NOTICE. 1'0 APPLICANT: If,after making this Certificate of Ex- F. ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 'PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall he deemed revoked AIR HANDLING UNIT(TO 10=C.F.NL) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 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(Sea HEATING UNIT(TO 100,000 B.T.U.) MICROFILM 3097,Civ.CJ, Lender's Name Lender's Address H EATI N G UN IT(OV ER 100,000 B.T.U.) ELECTRIC I certify that I have read this application and slate 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 Oban,1OD,D00 BTU)SEE FEESCH. 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 asperse,which PERMIT ISSUANCE CONST.TAX may i�, t. d City in consequence of the ant O rytEl]H-� LIC.NO. MECH. _ �« UIY\l TOTAL!1 /VTr—�f TOTAL S t Dete �••• V�� OFFICE COPY