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16398 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 1639$ INSPECTION DIVISION • JOB INSPECTION RECORD • i PERMIT EXPIRATION JOB ADDRESS 40�4�0 Ian � UNIT# LOT# PERMIT EXPIRES IF WORK OWNER f}- La CONTRACTOR Uj - IS NOT STARTED WITHIN INS ECTION DA INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-' FOUNDATION ANCE OR 180 DAYS FROM i NOTE: - LASTCALLED INSPECTION. LIFER 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 . ELECT PLG. MEC.. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. - PLUMBING MECHANICAL ELECTRICALPERMIT TO FRAMING- 'O 1� `7 STORIES TYPE CONSTR. INSULATION - • ' d.t 1IT�T„. � r 1�1 OCC,GROUP RES UNITS 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 BUILDING USE ROOF SHEATHING - ' 'RES 'IND CON PB Oo", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ El El ASSESSORS PARCEL NO I . ROUGH SAN.a PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO TUBS 8 SHOWER PAN _ PLUMBING ENERGY' ,.i►. 4 _ ,I . MECHANICAL MECH.ENERGY , ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO,-' � ' FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING GAS TEST - GAS — MECHANICAL PIKE ' NK ENERGY LZA •. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ NEI 0. N[] ' L.0 C EXTERIOR SHEAR � ELECTRICAL RELEASE - FLOOD ZONEA INTERIOR SHEAR - FIRE DEPT. Y❑ N'❑ Y ❑ N❑ SHEETROCK GRADE FEESUMMARY EXTERIOR LATH IBUILDING BUILDING INTERIOR LATH - TEMPORARY APPROVALS. ' SCRATCH COAT ' - ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDINGISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUI LDING INSPECTOR. MICHOFILM ARRANGE FOR INSPECTION BY'PHONING 252-4505, BLE. J, yi ONE WORKING DAY BEFORE REQUIRED INSPECTION. SING z . PLEASE GIVE JOB ADDRESS WHEN PHONING. 1 —SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! coNST.TAx PLEASE RiEAD REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL'INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU NDI NG PROJECT I DENTI FICATI ON -PERMIT NUMBER ,ILDINGw APPLICATION & PERMIT ADDRESS BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 16398 OWNER'S PLAN CHECK VALIDATION NAM A©� ONE OTY. ELECTRIC PERMIT FEE ' • ` CONTRACTOR'S rvam �o UTLETS-SWITCHES-RECEP 10.00/1.00 �GoM MY,�3dAMG�s�No.�70 LIGHTING FIXTURES 10.00/1.00 noNe ssI Tags TyPPLIANCES-RESIDENTIAL4.00 - - L J PHONE 40- 3/4&1 PANELS 10.00 DATE OF APPLICATION ARCHITECT • PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE C,No. OR ,. ENGINEER LIC.NO. SIGNS TRANS. 3.00 AooF'Ess ENa SPECIAL CIRCUIT 5.00 PERMIT VALIDATION xlv TEMP.METER OR POLE INS. 20.00 Avvucarvrs nu MOTORS SEE FEE SCH. ADDRESS ,r V N. 1�/• SERVICE CHANGE 20.00 7 Be O LICENSED CONTRACTORS DECLARATION S/ k X u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE I" (commencing with Section 7000)of Division of me Basin ss and w Q c BLDG. ELECT. PLG. MECH. z Professions Code ns�'icenso is in full fn z o n- License Class Lic.Number 9 L- o Date--�j Contractor- - 1 E, Y E /' "�� BUILDING PE MIT M 4 OWNER-BUILDER DECLARATION c' INFORMATION xI;LL w I hereby affirm that I nn exempt from the ContractorW 0 's License MISC.- _ REFER TO ORD Ba LL o j Law for dme following reason.(Sec.7031.5,Business and Professions VALUATION $/FT, _ PERMIT ISSUANCE 10.00 Code'.Any city or county which requires a permit to construct,alter, le Be a o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.N0. ELEC. D, requires the applicant for such permit to file a signed statement that TOTAL a w w he is licensed pursuant to the provisions of tire Contractors License ^ PERMIT TO r z > Law(Chapter 9(commencing with Section 7000)of Division 3 of the a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE I fio r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant boa civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not mora than five hundred dollars($5001.): ❑ 1•as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their we 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 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,sort who does such work FIXTURES-PER TRAP 5.00 SO FT.FLOOR AREA TOTAL ACREAGE - himself or through his own employees,Provided Thal loch improve. merits are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS or improvement is sold within one year of completion,time owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or in,- RES IND CON Pe Omer . prove for purpose of sale.). INDUSTRIAL WASTE INTER - .i 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ El. ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.99ASSESSORS PARCEL NO. and Professions Code:The Comobn.r's Licenw Law does not apply to an owner of Property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IE 0 contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY•STORM EA. t/10.00 \� TRACT NO. PARCEL NO. ❑ I um exempt under Sec. ,0.&P.C.for this WATER HEATER W/VENT reason Owner Data WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK FRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self-insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation In I, 000rr ay[ce/rt i ficd _ copy�Jl ' � .j ab.0 1. 11T1 �� Polic{r��(Q ix[ pony�� 0 . ❑ Ce,fif copy lsl I famished FIRE SPRINK ENERGYTY4 Z 0 ,Jr Cetlif opy is til wv the city inspection division. MISC.- REFER TO ORD. O rtPPlican[ Y ❑ IN Y ❑ ' No CC CER FICATE 0171:Xli PTION F ROM WO R K E RS' PERMIT ISSUANCE FLOOD ZONE A.C.U.C. W COMPENSATION NSURANCE PLG.CONTE. LIC.NO. PLG, y��n1 Y❑ N❑ Y❑ N❑ CL o !This section need Out be completed if the permit is for one TOTAL D Z hundred dollars IS 100)or less.) U O 1 certify that in time performance of the work for which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,1 shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. 0 to Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING >_ N NOTICE TO APPLICANT: 11,after making this Certificate of Ex- F" Z emption,you should become subject to,the Warkere Compensation APPLIANCE 5.00 PLAN CHECK Provisions of the Labor Code, you most forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1OSMC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 BE performance of the work fur w h Ih' ermlt is issued(Sec. MICROFILM BE piniv.CJ. Iiii � K� HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name , I HEATI NG UN IT ER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC \ I certify that I 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 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 801 LER-COMP(Over 100,000 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,judgments, costs and expenses which - CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE - 10.00 m t l.IS per BQ MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Sign ure of App(cant/ nlractor Date OFFICE COPY