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17558 (2) I I. POST THIS CARD NEAR FRONT OF BUILDING : P[RMiT HOMIER CITY OF CUPERTINO INSPECTION, DIVISION 17558 JOB INSPECTION RECORD • " ,,�}6 - PERMIT EXPIRATION ,F JOB ADDRESS��L( N : Pei A-LL " UNIT#- _LOT,# ,'PERMIT EXPIRES IF WORK • owrvER ( I corvra AcroR 0 M, 1A IS NOT STARTED WITHIN INSPECTION DATE - INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION NOTE: . LASTCALLED INSPECTION. ! UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED °. PREGUNITE _ TO COMPLY WITH THE APPROVED PLANS AND CITY OF -;PERMIT VATICAnoN CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 11 - -� UNDERGROUND /SLAB f� PLUMBING city Of � .,L41 ELECTRICAL - ISSUANCE GATE MECHANICAL - BLDG. ELECT PLG. MECR ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR vawnnoN SIFT. PLUMBING N, - MECHANICAL ELECTRICAL PERMIT /STD FRAMING 11 ^�•u e�" INSULATION STCHIES TYPE CONSTR. . OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' SO.IT FLOOR AREA TOTAL ACREAGE ' ROOF NOTE:NO FINAL INSP..SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID eulLmrvc,USE ROOF SHEATHING RES )ND CON Pe om.! APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El ❑• L ROUGH SAN,H ASSESSORS PARCE L NO PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO. TUBS&SHOWER PAN - PLUMBING ENERGY MECHANICAL' MECH,ENERGY ACC DATE .ACC,FILE NO ELECTRICAL - BUILDING ENERGY. FRAMING ELECT,FINAL TEST INSULATION PLUMBING ZONING ENG.SITE NO. GAS TEST • - GAS MECHANICAL FIRE SPRINK ENERGY T24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING •Y11NEI Y C] NE]EXTERIOR SHEAR ELECTRICAL RELEASE FLoOo ZONE- A.L.0 c. INTERIOR SHEAR FIRE DEPT. ° ❑> N❑ Y L' NL SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING • INTERIOR LATH TEMPORARY APPROVALS BUILDwc SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE o NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - -SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ' ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC O Fw ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 1 O PLEASE GIVE JOB ADDRESS WHEN PHONING. I • z - SEE PERMIT FOR EXPIRATION MECHANICAL DATE — I IMPORTANT! ' CONST.TAX PLEASE READ REVERSE SIDE,BEFORE TOTAL d x, 10 CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN.ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER APPLICATION & PERMIT nn'L�ji° 17558 • ADDITESS T1��L� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER' •L/ y'� PLAN CHECK VALIDATION NAME • C/,e-C 3 /,L DTV' ELECTRIC PERMIT FEE PNONE d/' 2Syb NAMERAciDRs UTLETS-SWITCHES-RECEP 10.00/1.00 A) LI.,N.,46_4ARR0Z ILIGHTING FIXTURES 10.00/1.00 CONTRACT R'S�� /� �� 1 6 PPLIANCES-RESIDENTIAL 4.00 i ADDRESSQ�/a 1 d ✓(r II C/A... OwKs fY BONE s PANELS O.00 DATE APPLICATION ARCHITECT PLAN CHECKK FEE P.C.NO. oR PANELS (OVER 200 AMP) 20.00 - - ENGINEE '- SIGNS TRANS. 3.00 AARCH.09 DDRESS ErvG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 _UO APPLICAe3„e Zd�N �Q 11--t 1/4 MOTORS SEE FEE SCH. �Y QA•GS art %A8 SERVICE CHANGE 20.00Zt �02 LICENSED CONTRACTORS DECLARATION _ Jye. �"u /I/X�';Ir a mo u I hereby affirm that I am licensed under provisions of Clrnpter 9 ILA ISSUANCE DATE - N a (commencing will,Section 7000)of Division 3 of the Business and - APR 4 BLDG. ELECT. PLG. MECH. H N i Professions Code,aapp�sLLjfny license is in full force 4n�Lofy-,cj�� ❑ ❑ Z,o m - License Cla .LZ_-Lic.Numher .#,j.Cli�+may ❑ o -O Datc -4-/ Cnnlmctor _�'-M�t-/JIJ city wL Wf10 W ¢ r w V V W 1^ BUILDING PERMIT ¢ ¢w OWNER-BUO.UF.R DECLARATION INFORMATION w ;LL I hereby affirm that I am exempt from the Contractor's License MISC. REFER TO ORD - uo¢ Law for line following reason. 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. .j -N � Codc'.Anycity or county which requires a permit construct,alter, 'LE IS u, ¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. I` y m¢ requires the applicant for shell perout t0 file a Signed statement that TOTAL DZ 0 D PERMIT TO w he is licensed Pursuant to the provisions of the Contractor's License F z i Law(Chapter 9lcommencingwith Section 7000)of Division 3 of the a: Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢F$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. ai by any applicant for a permit subjects the applicant to A civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(S500c): ❑ I,as..net of the property,or an,employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP REB.UNITS their sole compensation,will Jo the work,and the structure is not intended of offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of - property who builds or improves thereon,and who docs such work F I XTUR ES-PER TRAP '5.00 sn.Pr.PLooR AREA TOTAL ACREAGE himself re of ingh his own employees,Provided that such imf?ovc menlsarenocar le sold within one year lf,however,etion the howner- GAS-EA.SVSTEM-11NC.40UTLETS 6.00 or improvement is said within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove will hove the burden of proving that he did no[build or ire RES IND CON PB Omar prove 1,as owner of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ Cl ❑ ❑ ❑ ❑ L as owner of the property,ren exclusively. 70meting with licensed contractors m construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 . ASSESSORS PARCEL NO. toProfessions Code:Tho Contractor'sbuildCicero Luw docs 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 contractors)licensed pursuant In the Contractor's License Law. SEWER-SANITARY-STORM EA..200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO. WORKE RS'COMPIINSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self-insure, ZONING ENG.SITE NO. ora certificate of Workers'Compensation Insurance.or a certified _ copy thenuf(See.3800,Lob.C.I 0 I'nNo. Company-S �- Q pCc�2illed copy ishereby f vilishcJ. FIRE SPRINK ENERGY T-24 Z Z IIi�Cenifad is filed with t ne t ins tion division. O Applicant��+-�tY�� MISC.- REFER TO ORD. v ❑ N❑ Y ❑ N❑ Q' N CERTIPICATEOFEXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTR. ❑c.No. PLG. CL Cl (This section need not be completed if the permit is for one iTOTAL Y[:] N❑ Y [3 At[3 ::) Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- DTY. MECHANICAL PERMIT FEE FEE SUMMARY a LL I- it is issued,I shall not employ any person in any manner so s to OW become subject to the Workeri Compensation Laws of California. - BUILDING Dare-Applicant ALTER OR ADD TO MECH. 5.00 �- N NOTICE TO APPLICANT: If,after making this Certificate of lix- H ? eruption,you should become subject to(lie Worker'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 10,ODOC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,OODO.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of tine Is Is for which Ihis permit is issued(Sec. MICROFILM 3097,Civ.C.). � _ HEATING UNIT(TO 100,000 B.T.U.) 8.00 ' ELECTRIC Q Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address I certify ilial 1 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-COUP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city W enter upon the BOILER-COMP (0.,100,0008TU)SEE FEESCH. MECHANICAL above-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and.expenses which PERMIT ISSUANCE 10.00 CONST.TAX nay in any way accrue against said City in consequence of the ranting ofthis permit MECH.CONT. LIC.NO. MECH. `yJ rj_ P? TOTAL TOTAL x.00 ignature of Applicant/Contractor Uutc ' OFFICE COPY