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16569 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF. CUPERTINO 16569 INSPECTION DIVISION " JOWINSPECTION RECORD / �J PERMIT EXPIRATION JOB ADDRESS E� ( � C'' I���Y l D f" -UNIT# LOT .p, �'ERMIf EXP RES IF WORK OWNER CONTRACTOR . ISNOT STARTED.WITHIN ' INSPECTION DATE INSPECTOR INSPECTION RECORD ,1BO.DAYSOFPERMITISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. UFER 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 -rca-Zm. tc 52 �l4:cv Oo UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG ELECT. ,PP�ErGG5 MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION,do SIFT. PLUMBING - In `j MECHANICAL r lY ELECTRICAL PAID _ ter` PERMIT TO/�y+� FRAMING E 4vvL _ /� wv INSULATION - • STORIES TYPE CONSTR. : My of GupefteRe OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.FT BOOR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAXIS PAID• I ROOF SHEATHING. Iles IND LDCON LEE 011- T APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El El 0 ❑ 0 I ASSESSORS PARCEL NO ROUGH SAN.k PLUMBING ELECT.ENERGY - ' TRACT NO PARCEL NO. TUBS 8 SHOWER PAN , PLUMBING ENERGY MECHANICAL MECR.ENERGY ELECTRICALBUILDING ENERGY ACC,DATE ACC FILE NO FRAMING ELECT.FINAL TEST zoNlNc ENc.SITE No, INSULATION PLUMBING GAS TEST GAS FIRE SPRINK ENERGY Tq< MECHANICAL Y ❑ NE] v N[:] COVER NO WORK UNTIL-ABOVE HAS BEEN SIGNED HEATING . I EXTERIOR SHEAR ELECTRICAL RELEASE � FLOOD ZONE ALLLC,w-0 INTERIOR SHEAR FIRE DEPT. Y 11 NE Y ❑ N❑; SHEETROCK ' GRADE FEE SUMMARY EXTERIOR LATH BUILDINGOTE u-$Qz INTERIOR,LATH TEMPORARY APPROVALS BUILDING A;D SCRATCH COAT ELECTRIC PLAN CHECK - GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE p-0 OCCUPANCY OF BUI LDI NG IS NOT PE RMITTED UNTI L BUI LDING F INAL IS SIGN ED BY BUI LDING I NSPECTOR. MICROFILM. ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC • I_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING.. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! coNsr.Tnx PLEASE READ REVERSE SIDE BEFORE TOTAL � CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN REDLINES — USE BALL POINT PEN ONLY - BUILDING PROJECT I DENTI FICATION PERMIT NUMBER ' Rp INC APPLICATION & PERMIT 16569[1 ADDRESS © I ��� J J G BUILDING—ELECTRICAL-PLUMBING—MECHANICAL i( NAMcleasE TY.G//L�/ PLAN CHECK VALIDATION NAM/ PHONE" � . QTY. ELECTRIC PERMIT FEE Nome ACToes UTLETS-SWITCHES-RECEP 10.00/1.00 . Auc Noo LIGHTING FIXTURES 10.00/1.00 Hoo/Ess TORS /�rlov y� Q�� APPLIANCES-RESIDENTIAL 4.00 - /� (-PHONE 3x/-S�6 PANELS 10.00 DATE OF APPLICATION -1n ARCHITECT- - PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. O ENGINES. jTp�H � !!(� )'Lu:.N. SIGNS TRANS. 3.00 ARCH.OR vG ADDRESS ENG. /fI �A SPECIAL CIRCUIT 5.00 PERMIT VALIDATION- a fV T Z EMP.METER OR POLE INS. 20.00 ADDRESSSTsJQJ' MOTORS SEE FEE SCH. �G a ` '`,Vl;y e /Q � SERVICE CHANGE 20,00 �. o o ,LICENSED CONTRACTORS DECLARATION a v rH-r _I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE w w (commencin with Section 7000)of Division 3 of the Business and <y g BLDG. ELECT. PLG. MECH. F o z Professions Code,and my license is in full fort•: clsf 1 1y oe ❑ z o y ce Licenm C Its Lin.NumberN� ( Ov o r•O Die Contractor< x OCT BUILDING PERMIT ¢ ¢¢ OWNER-BUILDER DECLARATION o ao INFORMATION X3 u m I hereby effinn that 1 am exempt from the Comractor's License MISC.— R R T RD _ u0< Law for the following reason.,(Sec.703 1.5,Business and Professions •VALUATION $/FT. H H w PERMIT ISSUANCE ^` 41'. ea a y Code:Any county structure, permit �1/ 2 ¢Q p improve,demolish,or repair any sUGClure,prior 10 its issuance,also ELEC.CONTR. LIC.NO. ELEC. io LL requires the applicant for such permit to file a signed statemerV that TOTAL PERMIT TO w m w he is licensed pursuant to the provisions of the Contractor's License < HZLaw(Chapter 9(Commencingwlth Section 7000)of Division 3 of the 1`r 14 O Business and Professions Code)or(bat he is exempt therefrom and OTY. PLUMBING PERMIT I FEE ¢ 1_ $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE C NSTR. by any applicant for a permit subjects the applicant loa civil penalty of not more than five hundred dollars($500l): ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 ocCGROUP RES.UNITS their sole compensation,will do the work,and the structure is not . intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-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,and who does such work F IXTUR ES-PER TRAP -4b 61 \ sa FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ' Hunts are not intended or offered for sale.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-EASYSTEM-OVER 4 (EA) 200 BUILDING USE builder will have the burden of proving that he did not build Or im . . . - RES IND CON PB Dinar prove for purpose of sale.). INDUSTRIAL WASTE 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 thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with it contractors)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ Iemexumptunder Sea. ,B.&PC.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. XWORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 ' I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified Copy thereof(Sec.3800,Lab.C.). %�Z/T(/ Policy No. Company /1-:LLY _ 0 ❑ Certified copy is hereby furnished. - FIRE SPRINK ENERGY T 24 Z_ 'Z P`Certiii�yi y is filed with file city inspection division. MISC.- REFER TO ORD. O Applicant—.FI�IL,¢Os*J rA Y ❑. N V ❑ N❑ ~ �+ - PERMIT ISSUANCE 10.00 Zr0 CCCF-RTI FICATE OE EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C. LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. %f CL O (This section need Hol be completed if the pennil Is 1'or one TOTAL / T• D Y❑ N❑ Y❑ N❑ 0 Z hundred dollars(S100)or less.) 0 O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL•U mit is issued,.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of Calil'omiu. O w BUILDING q L CL NOTplatc—Appliclut ALTER OR ADD TO MECH. 5.00 J 1 U } W NOTICE you should become : If,after to king this Certificate of Ex- , F Z emptiions or sthe Labor bCo e, yo HI USI Wrth With Comply Withcut App LIANCE 5.00 PLAN CHECK provisions io lorthispe mit shall you dee drevoke comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITU 10,000QF.M.1. 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER l0A00C.F.M.) 6.00 SEISMIC FEE t � 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(Sec. MICROFILM ' 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100;000 B.T.U.)9.50 Lender's Address ELECTRIC I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 - • information is Correct.I agree to comply with all city and co only - - PLUMBING U� BOILER H.P.or 100,000 B.T'.U.) 6.00 Ordinances and state laws relating to building construction, and - hereby authorize representatives Of this city to enter,upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH, MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, hiderrnify and keep harmless the City of MISC.- 'REFER TO ORD., Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,00 - CONST.TAX may in g�any way accrue against said City in consequence of the rantinri6t th f thie rt MECH.CONT. LIC.NO. MECH.is TOTAL /�.)(J TOTAL Sq u of Applicant/Contractor �. OFFICE COPY