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15399 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT"umeER CITY OF CUPERTINO, 15399 . INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS •�^��S—czl .k/Odl) G7 UNIT# _LOT# _ PERMIT EXPIRES IF WORK. OWNER -�^/ Cdd Lz 8 (rc-- CONTRACTOR Ck!}7E�-71 / J-g;J'7c3.e-.P'. IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD - - 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS'FROM NOTE: LAST CALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT.VALIDATION PREGUNITE CUPERTINO STANDARDS... ' GARAGE SLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -�- rock IL e-wCe 4-v cwr�� UNDERGROUND /SLAB .. PLUMBING - lY N �; • •�i ELECTRICAL - M' n::nTiA�cE UA TE MECHANICAL' �M5 ,,11BypOi-•ELEC �T. PLG.V, MECH. El : 0 ' -0:' 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT . WINFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING • - - MECHANICAL PERMIT TO' ELECTRICAL. FRAMING . STORIES TYPE CONSTR. INSULATION I OCC,GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO,FT,FI.DOR AREA TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID - BUILDING USE ROOF SHEATHING RES IND CON PB Go— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. - SE SP ASSESSORS PARCEL NO ROUGH SANA PLUMBING ELECT.ENERGY TRACT N0. ,PARCEL NO . TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL . MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC,DATE ACC.FILE No FRAMING' ELECT,FINAL TEST PLUMBING S - zONlrvc ENG SITE No. INSULATION � - GAS TEST GAS MECHANICAL .FIRE$PRINK ENERGY nN COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING p "� ❑ ❑' EXTERIOR SHEAR ELECTRICAL RELEASE 'FLOOD ZONE A u.c. , INTERIOR SHEAR FIRE DEPT. - Y] "I] Y ] "]I SHEETROCK. — GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING' F SCRATCH COAT • ELECTRICFEEN CHECK- r ✓; GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE'FOR INSPECTION BY PHONING 252-4595, ELECTRIC I. ONE WORKING DAY, BEFORE REQUIRED INSPECTION. PLUMBING S 00 PLEASE GIVE JOB ADDRESS,WHEN PHONING.. SEE PERMIT FOR EXPIRATION DATE - „ MECHANICAL IMPORTANT! CONST.rnx PLEASE READ REVERSE SIDE BEFORE TOTAL l I :l CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - LISE.BALL'POINT P.EN ONLY i _ -PERMITNUMBER " BUILDING;PROJECT IDENTIFICATION APPLICATION & PERMIT' ` /�IHNG• .15399 • REas ro �' Z��✓I' fA .�J/-s BUILDING-ELECTRICAL-PLUMBING-MECHANICAL a OWNER'S NAME - PLAN CHECK VALIDATION PHONE CITY. ELECTRIC PERMIT ' FEE IlRobLIRACTORS N �.•�- OUTLETS-SWITCHES-RECEP10.00/1,00 .fir J ' UN.,60'75-f/ LIGHTING,FIXTURES ,; ,10.00/1.00 - , CONTRACTOR'S - - - ADDRESS Q S Ts�7r 91r.37�? APPLIANCES-RESIDENTIAL 4.00 ' /- �•I<'RtvND PNONE gG P.'J PANELS :.10.00 DATE OF APPLICATION ARCHITECT. - - PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER. .+/ .' - - /Y Lln.uo, SIGNS TRANS: 3.00 ! AENG. PERMIT VALIDgTI ON ADDRESS DDREss SPECIAL CIRCUIT .5.00 ZIP TEMP.METER OR POLE INS. 20.00 - APPLICANT'& AODRESS - MOTORS SEE FEE H. e/C`• I[.pl.t/-W/�/ SERVICE CHANGE '20.00 - w o o LICENSED CONTRACTORS DECLARATION if) O a u I hereby affirm that 1 am licensed under provisions of Chapter 9 111" � '.' ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and f•B LDO. (�ELECT. PLO. MECH. Zn V Professions Code, d my license is m full force'n eff t „_ wF ( ••... ' Zo i u,o License Class LIc NumbeEy ;KLiL �+'�+P�7 VI Y. ❑ 0 Date �.,�.�� Contractor x �' ® ❑ < m - BUILDING PERMIT -• OWNER-BUILDER DECLARATION - INFORMATION W ;'m 1 hereby affirm that I am exempt from the Contractor's License MISC.- . REFER TO ORD VALUATION -$/FT. -F a_ J Law forthe following reason.(Sec.7031'.5,Business and Professions PERMIT ISSUANCE r ' '10.00 - aa Code:Any city or county which requires a permit to construct,alter, _ _ Q improve,demolish,Or repair any structure,prior to its issuance,also ELEC.CONTE. LIC•NO. ELEC. 4,t, 0 eL w m u requires the applicant for such permit to fire a signed statement that TOTAL ✓V PERMIT Tri a he is licensed pursuant to the provisions of the Contractor's License t` )_ FZQ Law(Chapter 9(conimencingwilh Section 7000)ofDivision 3 ofthe /N�� Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ H$ the 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 IEA.) 5.00 of not more than five hundred dollars($500).). ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 Oce.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of '! !!Iproperty who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.0 D.SFT.FLOOR AREA TOTAL ACREAGE 1 himself or through his own employees,provided that such improve. - meats are not intended or offered for sale.If,howevegthe building •GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 IEA.)' 2.00 BUILDING USE - builder will have the burden of proving that he did not build or im- - RES IND CON PB Other prove fors owner of the INDUSTRIAL WASTE INTER. 30.00 ❑ ❑- ' ❑ ❑'• ❑ - ❑ d as owner of the property,he exclusively contracting with licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B.c 6.00 ASSESSORS PARCEL N0. I' and Professions Code:The Contractor's License Law does not apply co' tr owner of h projectsproperty,whowi builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 line Contractor's actor'shcenecLwithnconiractor(s)licensed pursumst to SEWER-SANITARY-STORM EA.200ft/10'.00 : [he Col am exempt License Law. TRACT No. PARCEL NO. ❑ lam exempt under Sec. ,B.&PC.for this ` WATER,HEATER W/VENT 6.00 . reason Owner Date WATER SYSTEM 5.00 ACG GATE ACC.FILE N0. � WORKERS'COMPENSATION DECLARATION ' r' WATER TR EATING'EQUIP, '5.00 1 hereby affirm that I have a certificate of consent to self-insure, ZONING ENG:SITE N0. or a certificate of Workers'Compensation Insurance;or a certified copy thereof(Sec..-3800,LcoC. Policy No. 4 - Companv � Oertified copy is hereby furnif'hed. FIRE SPRINK ENERGY T@4 Z Z. AlA( Certified copy is filed with the city inspection division. Applicant - MISC.- REFER TO ORD. Y.❑ ,N❑ Y ❑ No P:-0054 . LU CERTIFICATE EXEMPTION FROM WORKERS' FLDOD ZONE A.L.U.C. 1 W -� - . PERMIT ISSUANCE 1000 COMPENSATION INSURANCE. ?i. PLG.CONTE. .LIC.N0. PLG. ' CL a (This Section need not be completed if the permit is for one TOTAL Y E] � NEI Y❑ NC ]c dollars($100)or less.) 010 1 certify that in the performance of the work for which this per- QTY. 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 California. Date Applicant - BUILDING ' a ALTER OR ADD MECH. 5.00 } N NOTICE TO APPLICANT: If;after making this Certificate oDEx- F ? eruption,you should bor Code, to the Workers'Compensation APPLIANCE ' , .. 5:00 ^'- PLAN CHECK l such provisions. ns he Labor Cit shall lib must forthwith comply with 'FEE U - such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,0000 F.NL) 4.00 -� CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER JOPWC.F.M.) 6.00 SEISMIC FEE S 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.). - i 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 Le ' ELECTRIC Q ndei-VAddr, S ( certify that l heveneed 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(3H.P.or100,0008.T.U.I 6.00 hereby authorize representatives of this city to enter upon.the - BOILER-COMP(Over t00,0008TU)SEE FEE SCH. MECHANICAL shove-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 ' PERMIT ISSUANCE . 10.00 CONST.TAX may in any way accrue against said City in consequence of the s Ian Xthis per MECH.CONT. LIC.NO. � MECH. 6�c 0 - :29 3 21-8� TOTAL TOTAL 'gnature of Applicant t/Contractor Date - OFFICE COPY