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16930 (2) POST THIS CARD-NEAR FRONT OF BUILDING PERM Ir NUMBER CITY OF CUPERTINO6JqQ3O INSPECTION DIVISION ' JOB INSPECTION RECORD �C{ I ,PIRATION• JOB ADDRESS P IArI Dd UY• UNIT# -LOT# E MIT X I EIF ORK ' cq ..1-§' P A OWNER . �'r"1'- CONTRACTOR, IS OT STARTED YITHIN INSOECTI N D TE I INSPECTOR INSPECTION RECORD `188 ogvs OF PERMIT ISSU- FOUNDATIONANCE OR 180'DAYS FROM ,NOTE: LAST CALLED INSPECTION. UFER,' ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE - - 70 COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. - 1 GARAGE SLABS' - - •J.- - �J,I, `C POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB919pq PLUMBING - - - ELECTRICAL _ r ISSUANCE DATE MECHANICAL' BLDG. .ELECT PLC, MECR.; 'El ❑. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION .WOOD FLOOR- ' .VALUATION sTFr. PLUMBING ' ' .. • a " 4 r..l .. _ MECHANICAL' .„ - - ,• • • � � Ye�U53� ELECTRICAL _ - - - { MI rO ff.+�..,R• FRAMING T - �+Vv�' INSULATION STORIES TYPL,CONSTR OCC.GROUP RES UNITS_ - PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE Sa.rr FLOOR AREA TOTAL ACRFAGt f, DIAPHRAGM .+ w THE CONSTRUCTION TAXIS PAID HUI LOING USE •` ROOF SHEATHING HES INcoN PB om.. ' -APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 1-1 El 0 El- ASSESSORS PARCEL NO . ROUGH SAN.N PLUMBING" ELECT.ENERGY - - TUBS 8 SHOWER PAN ,. PLUMBING ENERGY TRACT No, PARCEL No MECHANICAL MECH.ENERGY ' I ELECTRICAL ,. p' BUILDING ENERGY - Acc.DATE ACC.PILE No. ' FRAMING ELECT.FINAL TEST ` ZONING - ENG.SITE NO. INSULATION � - _ PLUMBING GAS TEST , GAS • MECHANICAL FIRE SPRINK , ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NO NEI . - 'EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A UC. a INTERIOR SHEAR FIRE DEPT. Y❑ "� Y.❑ "� ' SHEETROCK - GRADE ,�. FEE SUMMARY ~ EXTERIOR LATH BUILDING �: .INTERIOR LATH i TEMPORARY APPROVALS BUILDING - SCRATCHCOAT - ELECTRIC PLAN CHECK I GAS FEE - II NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE 1 OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED By BUILDING INSPECTOR. MICROFILM w ARRANGE FOR INSPECTION BY PHONING'252-4505;. ELECTRIC. t o) ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. . \ — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CON ST.TAX . PLEASE READ REVERSESIDE,BEFORE TOTAL lJlr CALLING FOR FINAL'INSPECTION,. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY BULLOING PROJECT IDENTIFICATION r PERMIT NUMBER BUILDING APPLICATION & PERMIT3 q ^O A R SSI BUILDING'-ELECTRICAL-PLUMBING -MECHANICAL 1' Nw 'r -- 69 av-S ts6 PLAN CHECK VALIDATION CITY. ELECTRIC PERMIT FEE 8 k CONTRACTOR'S a rx `~ NAME - UTLETS-SWITCHES-RECEP 10.00/1.00 U,VV LIC NO - LIGHTING FIXTURES 10.00/1.00 2E Du ^ Z ADDRESS Tons - PPLIANCES-RESIDENTIAL 4.00 R E PHONE PANELS .10.00 DATE OF APPLICATION ' ARCHITECT PLAN CHECK FEE P.CiNO. OR - PANELS (OVER 200 AMP) 20.00 ' ENGINEER LIC.NO. ISIGNS TRANS. 3.00 . ADDRESS ENG' - SPECIALCIRCUIT 5.00 PERMIT VALIDATION' ZIP TEMP.METER OR POLE INS. 20.00 - (�Q ADDRESS (ll MOTORS . SEE FEE SCH. �. ADDRESS [( . SERVICE CHANGE 20.00 wo O LICENSED CONTRACTORS DECLARATION - U U I hereby affirm that I am licensed under provisions of Chapter 9 .ISSUANCE DATE '- FH a w (commencing with Section 7000)of Division 3 of the Business and ,JG. ELECT. PLG. MECH. H H i Professions Code,and my license is in full force and ufl'ebl. B ❑ 0 w W License Class Lic.Number o -- 9,A H J Date Contractor < m f ft,1f Cupertino BUILDING PERMIT ¢ ¢w ¢ OWNER-BUILDER DECLARATION a U MISC.- REFER TO ORE) INFORMATION z ; I- 1 hereby affirm that I am exempt from the Contractors License ' 1O u o¢ Law for the,following reason.(Sec.7031.5.Business and Professions VALUATION r - y PERMIT,ISSUANCE 10.00 L41� Q Code:Any mulish county whiny structure permit o its is ante,her, :? ¢ ¢ < improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH: LIC.NO. ELEC. (� wD u requires the applicant for such permit to file a signed statement that TOTAL 'PERMIT TO $ he is licensed pursuant to the provisions of the Contractor's License ii Law(Chapter 9(commencing with Section 7000)of0ivision 3 of the ¢ a Business and Professions Code)or that he is exempt therefrom andQTV. i PLUMBING PERMIT FEE the basis for the alleged exemption.Any violation of5ection 7031.5 _ 'STORIES TYPE CONSTA. by any applicant for a permit subjects the applicant to a civil penalty f ALTER-DRAIN IEA.) 5.00 of not more than five hundred dollars(8500).): ' ❑ 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 of offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONO. 5.00 Code:The Contractor's Lkense Law does not apply to an owner of property who builds or improves_thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve- .lots are not intended or offered forsale.IL however,the building GAS-EA.SYSTEM•11NC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- ' GAS-EASYSTEM-OVER 4 (EA.) 200 BUILDING USE builder will have tile . . . e burden of proving that he did not build or int- RES IND CON PB Omer prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 ❑ I,as owner of the property,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(hereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ' contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law.• I SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. ,PARCEL NO. ❑ lam exempt under Sec. ,B.&BC.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.GATE ACD.FILE NO, r WORKERS'COMPENSAT10N DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate ofconsent to self-insure. ZONING ENG.SITE N0. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company 0 ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T 24 z Z ❑ Certified copy is filed with the city inspeclion division. F- O MISC.- - REFER TO ORD. ❑ , ❑ ❑ ❑ Applicant y N v N va PERMIT ISSUANCE 10.00 - CT FICA FF,OF IiXF;MP1'ION FROM WORKERS' FLOOOZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTR. .LIC.N0. PLG: - j Z IThis Section need not be completed if the pencil is for ,no 'TOTAL Y❑ NF] Y❑ N[] hundred dollars($100)or less.) .U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL.PERMIT FEE FEE SUMMARY IL U mil is issued,I shall not employ any person In any manner so as to O L) become subject to the Workers'Compensation Laws of California. y Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING �Zs DD } N NOTICE. 1'0 APPLICANT': II',after making this Certificate of lis F. emption,you should become subject to the Workets'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000QF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE F 1 hereby affirm that Iherc is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC 0h Lender's Address OV I certify that I have read this application'and state 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 100,0008.T.U.) 6.00 hereby authorize representatives of this city toenter upon the / above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. uperiino against liabilities,judgments, costs and expenses which CONST.TAX may in any way.accrue against said City in consequence of the - PER MIT ISSUANCE 10.00 ranting of this permit. MECH.CONT. , LIC.NO,, - MECH. TOTAL TOTAL Signature of Applicant/Contractor Date - OFFICE COPY