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18257 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMITNUMB A CITY OF. CUPERTINO 18257 INSPECTION DIVISION JOB INSPECTION RECORD '. `/• //` /'` -• PERMIT EXPIRATION JOB ADDRESS '� 3 �b C-4--�d-et4 ✓qtr UNIT# _LOT# �pERM1T EXPIRES IF WORK OWNER d Z '�_ + CONTRA- Q.e IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPEC ION RE RD 180 DAYS OF PERMIT ISSU- FOUNDATION - - ANCE OR.180 DAYS FROM NOTE: UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS, PAID GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED r � y UNDERGROUND /SLAB - JV� PLUMBING ^ d W��C�W�/y�we�Nww , L)a ✓L'G f ELECTRICAL - - - KIR , _ ISSUANCE DATE MECHANICAL BLDG. ELECT, PLG. MECH. ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING -+ ' MECHANICAL ELECTRICAL - _ PES, MI TO FRAMING ~' INSULATION ORIE.S TYPE CONSTR. � - /v9G C^�� .-�- 5/ O/C _ • - OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT FLOOR 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 Om„, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE . INSP. E 0 ❑ D El ASSESSORS PARCEL NO. ROUGH ' SAN.# PLUMBING ELECT.ENERGY CEL NO.. R TUBS&•SHOWER PAN PLUMBING ENERGY TRACT NOPA• ` MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC,DATE ACC.FILE No. FRAMING - ELECT.FINAL TEST INSULATION PLUMBING ZONING ENG.SITE NO. J GAS TEST GAS MECHANICAL Z FIRE SPRINK ENERGY 124• COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y [3 NYo NL EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L.0 C. INTERIOR SHEAR FIRE DEPT. - YL .NL YL N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH IBUILDING INTERIOR LATH . TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GASFEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTORI MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, .ELECTRIC � H ONE WORKING DAY BEFORE REQUIRED INSPECTION.- PLUMBING' Z PLEASE GIVE JOB_ ADDRESS WHEN PHONING: - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL ' „Q / IMPORTANT! CONST.TAX' PLEASE READ REVERSE SIDE BEFORE TOTAL - D� CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES,- USE BALL POINT PEN ONLY J, PERMIT NUMBER BUILDBUILDING PROJECT IDENTIFICATION ING APPLICATION BI PERMIT 7 ADDRESS BUILDING-ELECTRICAL-PLUMBING-MECHANICAL o G 825J OWNER'S I PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE 07 RAN NIA-21 PHONE CONTRACTORS NAMEI J UTLETS-SWITCHES-RECEP 10.00/1.00 Ll CTNc1 pit el J.(uL.NO. 0111'7Y? ILIGHTING FIXTURES10.00/1.00 ADDRESS ICaOR's [APPLIANCES-RESIDENTIAL 4.00 10 19 4 -ddidlA'✓' ONE '37V'7 PANELS 10.00 DATE OF APPLICATION ARCHITECT - PLAN CHECK FEE OR PANELS (OVER 200 AMP) 20.00 ENGINEER LIC.NO, SIGNS TRANS. 3.00 ADDRESS ENc' SPECIALCIRCUIT 5.00 PERMIT VALIDATION AZIP EMP.METER OR POLE INS. 20.00 -7 ADDRESS O DDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 , • //�� 0 0 2 LIC17NSED CONTRACTORS DECLARATION x,is u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE Z n (commencing with Section 7000)of Division 3 ol'the Businessand BLDG. ELECT. PLG. MECH. H N i Professions Code,and my license is in full force and effect. - - - u--r Z, i g C License Clans Lie.Number - El 0 0. Date Conlrunor w�//��wft�� L f citW y �' BUILDING PERMIT M ,Cw OWNER-BUILDER DECLARA'T'ION INFORMATION w ;u F. I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD IL0 < Law for the following reason.(See.7031.5.Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. Code:Any city or cousty which requiresa permit to construct,alter, a ¢re improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG NO. ELEC. wO M requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO m he is licensed pursuant to the provisions of the Coutnwtor's License r � HZQ Law(Chapter 9(commencing will,Section 7000)of Division 3 ofthe .eV 4 D Business and Professions Code)or that he isceempt therefrom and OTY. PLUMBING PERMIT FEE It F. m the basis for the alleged exemption.Any violation of Section 7031.5 SrORIES TYPE CONSTR. a;� by any applicant for a permit subjects the applicant ton civil penalty of not more than Ove hundred dollars(S500)J: gLTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ Las owner of the property,or my employees with wagesas BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will d0 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,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE . himself or not or fared fors,provided that howevr,the improve- GAS-EA.SYSTEM-1 6.00 himsel are oat ugh his ow 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 on. RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ E3 E] + ❑ ❑ 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 a contractotls)licensed Pennant to SEWER-SANITARY-STORM EA.200ft/10:00 TRACT NO. PARCEL NO. the Contractor's License Law. ❑ I am exempt under Sec. ,B.&P,C.for Ibis WATER HEATER W/VENT 6.00 reason Owner Dam WATER SYSTEM 5.00 ACL.DATE ACC.FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of Consent to self-insure'. ZONING ENG.SITE N0. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(See.3800,Lab.C•). Policy No. Company 0 ❑ 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. 0 Applicant - Y❑ N❑ Y C] No y PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU 1 CERTIFICATE E SATION'INS FROM WORKERS' _ COMPENSATION INSURANCE PLG.CONTR. LIC.Na. PLG. 1 0 (This section need not be completed if the permit is for one TOTAL V❑ N❑ Y ❑ N❑ D Z hundred dollars IS 100)or less.) U 0 ' 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mil is issued,I shall not employ any person in any manner so as to O w becomt�/ghjgtj the Workers'(rp a au Laws of California. ED am_ Applicata Lx �t ALTER OR ADD TO MECH. 5.00 BUILDING } rn NOTICE TO A PLICANT! If,after making this Certificate of lix ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions Or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MOC.F.M.) 4.00 'CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10fMC.FM.) 6.00 SEISMIC FEE 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,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 - Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 Lenders Address ELECTRIC 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 suit,all city and county PLUMBING ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000B.T.U.),6.00 hereby awhorim representatives of On% city to enter upon the 1301LER-COMP love,100,000 BTU)SEE FEESCH. MECHANICAL 0 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 by in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 NVQ rant�in§of this permit MECH.CONT. - LIC.NO. MECH. L� f . l rorq��'D� . TOTAL '.00 Signalu of Applicant/Contractor Date OFFICE COPY