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16105 (2) POST THIS CARD NEAR FRONT OF BUILDING - _ PERMIT NUMBER 1 CITY OF CUPERTINO 16105 INSPECTION DIVISION JOB INSPECTION RECORD SICf/IQ 12Jr1 l�nn - .PERMIT EXPIRATION' ' JOB ADDR ESS. 4/O d"�' [�IA� .I/Y UNIT# LOT# lVI n A A, PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INS ECTION DATE INSPECTOR INSPECTIONRECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM , NOTE; LAST CALLE INSPECTION. UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED PR EG UNITE - TO COMPLY WITH THE APPROVED PLANS AND CITU OF PERMIT VA ATION CUPERTINO STANDARDS. GARAGE SLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB pplD PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL B oc ELECT PLC. . MECR. di t0a ' ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION SIFT. i MECHANICAL ' ELECTRICAL - _ PERMrt ro FRAMING - rff�I INSULATION STORIES TYPE CONSTR DEC GROUP RES UNITS PLMSUBFLOOR UNTIL ABOVE HAS BEEN SIGNEDROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFOREso.F..FLooR alcA rorAL ACREAGE 00'Y DIATHE CONSTRUCTION TAX IS PAID ROO - BUILDINGUSE HES IND CON PBAUNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ .❑ ❑ ROUGH ASSESSORS PARCEL NO; SAN.# PLUMBING - - ELECT.ENERGY TUBS 8 SHOWER PAN - PLUMBING ENERGY TRACT NO., PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL - - BUILDING ENERGY .ACC DATE . ACC PILE NO FRAMING ELECT.FINAL TEST INSULATION -/ PLUMBING 1 ZONING ENO,SITE NO, GAS TEST GAS - MECHANICAL FIRE SPRINK ENERGYT-24✓' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ -1:1 r❑� N❑ EXTERIOR SHEAR ELECTRICAL RELEASE /—Z FLooO zoNE, - A L.u.c,> INTERIOR SHEAR FIRE DEPT. Y❑ N❑ . .v,❑ "�N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVAL BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UN TIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ryV41 7 ) o�' 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 TOTAL r CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PPERMIT NUMBED BUILDING /'-OOKrdC� APPLICATION & PERMIT 16105 PDOREBB _ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL I'` 0 NER'S '/ PLAN CHECK VALIDATION NAME S J LR`r.S TY. ELECTRIC PERMIT FEE RS CONTRACT (^�l� i �b OUTLETS-SWITCHES-RECEP 10.0011.00 NAME �/� QHS I uc,Nola � �-LIGHTING FIXTURES 10.0011.00 t forvTRACTORs eUeNC PPLIANCES-RESIDENTIAL - 4.00 - AODRE55 j4if/� } / 7 As 4&117119 04:50 PROry Z PANELS 10.00 DATE OF APPLICATION OR PANELS PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.NO. SIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL CI RCUIT 5.00 PERMIT VALIDATION AD DR ESS- � zlv EMP.METER OR POLE INS. , 20.00 APPLICANTS MOTORS. SEE FEE SCH. J, '1U � ADDRESS zrp '45 Love! SERVICE CHANGE 20.00 PAIISlit idp D o o LICENSED CONT RACTORS DECLARATION. <u u - 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE z w lcommencing with Section 7000)of Division 3 critic Business and DG. ELECT. PLG. MECH. G N i Professions Cole.�pd my license is in full tory { ❑ Z,o E, License SJ+yas/._S.T�-_Lic.Notable Cot of fru ❑ 9 a,�_w Date- ��/'f7/_pYDV_ Comractor YI YI Y BUILDING PERMIT Q Y 4 J Ic w OWNER-BUILDER DECLARATION INFORMATION K 3 LL w I hereby affirm that I um exempt from the Contractor's License MISC.- REFER TO ORD VALUATION o ¢ Law for tile Business e following reason.(Sec.7031.5,Bness and Professions PERMIT ISSUANCE - -Q-BB I w u - SIFT. L w m-` Code:Any city or county which requires permit to construct,alter, ' .> o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. 0 0 requires the applicant for such permit to file a signed statement that TOTALaB r 5D PERMIT TO ' w$ he is licensed pursuant to the provisions of the Contractor's License H z i Law(Chapter 9(commencing with Section 7000)of Division 3 of Ore a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE r O the basis for file alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR. i ; $ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN (EA.) 5.00 of not more than five hundred dollars(4500).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 Cade:The Contractor's License Law does not apply to an owner of, properly who builds or improves til ere on,and who docs such work F IXTUR ES-PER TRAP 5.00 6➢.FL FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1 6.00 meats are not Intended or offered for sale.If,however,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 build or im- RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ ' licensed contractors to construct the.project(See.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 for such projects with a contractoos)licensed pursuant to the Contractor's License Law. SEWER-SANITAR V-STORM EA.200ft110,00 TRACT NO. PARCEL NO. ❑ I um exempt under See,-,B.&P.C.for this WATER HEATER WIVENT 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 1 have a certificate ol'co isent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is fled with the city inspection division. MISC.- REFER TO ORD. Y❑ ry❑ y ❑ N❑ O Applicant � y PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. Cr > CIiRTI FICATEPE EXEMPTION FROM WORKERS' - W _ COMPIiNSATION INSURANCE PLG.CONTR. LIC.No. PLG. CL 0 (This section need not be completed it the permit is for one TOTAL Y❑ N❑ Y❑ N❑ 0 Z hundred dollars($100)or less.) ' U 0 I certify that in the Performance of the wor uc is per OTY. MECHANICAL PERMIT FEE FEE SUMMARY U. F mil is issu I hall not employ any perso a ma so as to O W becomes he Workers'ComPens' ntia, rSEISMIC LDING Date Applicant ALTER OR ADD TO MECH.' 5.00 } y NOT LICA ,. er aking this Certifj le of E, FZ emplign,you sllc ecomc subjc to the Workers'C pensution APPLIANCE 5.00 AN CHECK provisions of he Labor Code ou must forthwith comply with E U _ such provision this per mil be deemed revoked. AIR HANDLING UNIT(TO 10f100C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 FEE I hereby affrm 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. CROFILM 3097,Cie.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 Add.,, I I certify that 1 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 BAILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby authorize representatives of this city,to enter upon the 801 LER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-umntioned properly for inspection purposes. (We) aWC9,� and keep harmless the City of MISC.- REFER TO ORD. Cupertino Smen[s, costs and a Ipenses which - CONST.TAX may it anwit cc said City in con pence of the PERMIT ISSUANCE 10.00 ranting of MECH.CONT. LIC.NO. MECH. _ TOTAL TOTAL pplicanllCon r ate OFFICE COPY