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18916 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 18916 INSPECTION DIVISION JOB INSPECTI N RECORD. S ,� PERMIT EXPIRATION JO B'ADDR ESS 1_LJ T#, LOT# PERMIT EXPIRES IF WORK OWNER coNTR AcioR IS NOT STARTED WITHIN INSPECTION 1 DA—T—E -1 INSPECTOR INS ION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE-SHALL BE INSTALLED PREGUNITE TO COMP.LV WITH I HE:APPROVED PLANS AND CITY OF PEHNrn VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED . UNDERGROUND /SLAB - PLUMBING Lir' V ^^••f11 IV ELECTRICAL, - ISSUANCE UPiE MECHANICAL BLuc ELEcr PLG. MSCI. ❑ ❑ - ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATLON SIFT. �- MECHANICAL "1 ELECTRICAL PERMIT TO �.- _ FRAMING A I H I INSULATION STOI ES IYPE CONSTR. OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE X °O;�"EA TOTALACREAGE 4 DIAPHRAGM - THE CONSTRUCTION TAX IS PAID 1 f'� - . BUILDING USE RES IND ROOF SHEATHING _ El El 1-1 N ❑ 1:1APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE NSP. AssessaePARCEL No - . ROUGH SAN.q PLUMBING ELECT.ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO MECHANICAL MECR ENERGY ELECTRICALBUILDING ENERGY ACC,DATE ACC.FILE NO FRAMING ELECT.FINAL TEST INSULATION PLUMBING - ZONING ENG_si rE NO. GAS TEST GAS FIRE SPRINT: ENERGY i.7a MECHANICA COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ` ❑ N❑ �i FLOOD ZONE ALU C. EXTERIOR SHEAR ELECTRICALR S INTERIOR SHEAR FIRE DEPT. Y ElN❑ r L-1 SHEETROCK I GRADE FEE SUMMARY EXTERIOR LATH BUILDING 'INTERIOR -LATH TEMPORARY APPROVALS euILOwG � , Oo SCRATCH COAT ELECTRIC PLAN CHECK L�J GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I SEISMIC FEE I , OCCUPANCY,OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBYB UILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ED ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 Z PLEASE GIVE JOB ADDRESS WHEN PHONING. SEE PERMIT FOR EXPIRATION DATE — MECHANICAL <r� IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. . OFFICE COPY J APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY . BUILDING PROJECT IDENTI FICA710N PERMIT NUMBER BUILDING APPLICATION & PERMIT �� r b AO RES@ D ^ BUILDING-ELECTRICALPLUMBING MECHANICAL I - - "' O'NNER'S PLAN CHECK VALIDATION NAME DTV. ELECTRIC PERMIT FEE. Emmerlc;` PRONE 9`t6-`I NAM>ERACTDR ((�7 Q UTLETS-SWITCHES-RECEP 10.00/1.00 (,k L, LIc.No. I`� r�� ✓ LIGHTING FIXTURES 10.00/1.00 f-ONTRA TORS l� ADDRESS (ys(aaCtS /T,[)' PPLIANCES-RESIDENTIAL 4.00 IPHONE 56-Vv PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER LIc,No, ISIGNS TRANS. 3.00 ADDRESS euG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION zIP EMP.METER OR POLE INS. 20.00 AMOTORS SEE FEE SCH. DAFSS E55 ADOR SERVICE CHANGE&a-•�,C) 20.00 0 i Foo LICENSIiD CONTRACTORS UIiCLA RATION P r.. rt v I hereby uffum that I am licensed under provisions of Chapter 9 U 'J i ��y. ISSUANCE DATE w li (commencing with Section 7000)of Division 3 of the Business and n ¢ u BLDG. ELECT. PLG. MECH. r w i Prolusions Cnde,and my license in lull lone and effect. - ❑ ❑ ❑ ❑ ¢ o - License ClassLic.Numberc rv. Ir Q F Umc Contractor ^,rtirrp Q y f J ¢ ¢ w OWNER -R DECLARATION MATION BUILDING PERMIT a u INFOR wa r 1 hereby at rim that I am exempt frons the Contractor's License MISC.- REFER TO ORD u O`� law for the following reason.(Sec.7031.5,11usinessand Professions VALUATION 5/FT. _ crntit PERMIT ISSUANCE 10.00 Code:Any city or county which a-qui¢su mconstnmt,alter, Qrt ¢ improve,demolish,or repair any'structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. - o¢ requires the applicant for such permit to IIIc a signed statement that TOTAL w m he is Imenud pursuant to the provisions of the Con otclor s License PERMIT TO ^ ia Law(Chapter 9(commencing with Section 7000)ofDiOmon 3 o fte i E o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE ¢ I- the basis for the alleged exemption.Any violation of Section 7031.5 STOR 5 IITYPE CONSTR. ra by any applicant far a permit subjects the applicant to acivil penalty ALTER-DRAIN (EA.)of not more than five hundred dollars(55001): ❑ 1,as owner of the property,or my employees with wages us BACK F LOW PROTECT. DEVICE 4.00 OCC,GROUP RES.UNITS their sole compensation,will do the work,and the structure is not 'mended 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 Hereon,and who does such work FIXTURES-PER TRAP 5.00 sa FT.FLOORA EA TOTAL-ACREAGE himself or through his own employee,provided that such improve- mittsamnot intended ororTcrcdfor sale.IL however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- ! builder will have the burden of proving that lie did not build or int- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB On., ❑ I,as owner of the property 3111 exclusively contracting with ElC1 1:1 ❑ licensed contractors to Imminrct the project(Sec. 7044.Business LAWN SPRINKLERS-1 INC 6 V.B. 6.00 ASSESSORSPAEC EL NO. 1-1 and Professions Codc l'he CI)ctraela[s License Law 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 contmcturtV licensed Posumll m the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sea ,B.&RC.for His WATER HEATER W/VENT 6.00 reason Owner Ont, WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPIiNSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a e,rtilicme of consent to self-insure. uruc untilcute of Workers'Compensation Irrimcnec,ora certified ZONING ENG.SITE Nl copy thereof(Sec,30,Lab. Policy No.-Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z ❑ Cenificd copy is filed wilh the city impaction division. MISC.- REFER TO ORD. F O Applicant Y❑ N❑ Y N❑ fL m CER'TIFICA'TE OP EXEMPTION FROAI WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. IL > COMPEN'SA'TION INSURANCE PLG.CONTE. LIC.NO. PLG. ❑ ❑ ❑ ❑ CL O (This Yclum need not be completed if the permit is for one TOTAL V N V N :-) Z hundred dollars t$100)ar less.) U O 1 ceNily that in the Performance of He work for which this Per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,I shall not employ any person in any manner so us to become subject to the W'orkeri Com Pensation laws of California. Q U-1 D3tc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING Q } m NOTICE,TO APPLICANT: It,eller making the Certificate of Ex- Z_ emption,you should become subject to the Workeri Comlrensation APPLIANCE 5.00 PLAN CHECK Provkmm, of the Labor Code, you most forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 FEE F CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of rte work for which this permit is issurd(Sea MICROFILM 3097.Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Land,r's dr AdHEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC I ert ify that l have read this applicot ion and state that the above VENTILATION FAN (SINGLE) 4.00 x information a correct.I I agree to comply with all city and county PLUMBING .ojhinformation B orate . Ia (elating m building constall ands, and BOILER-OOAR I3 H.P.or 100,000 B.T.U.) 6.00 hereby authorise representatives no,ec the city m enter upon Heshose- BOILER-COMP (Over 100,000 BTU(SEE FEE SCH. MECHANICAL herebyn authorize property for ves of ion purposes. (We) agrtt 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 may in any way accrue against said City in consequence of the m 4of t¢pe it. MECH.CONT. LIC.NO. MECR. 7� �n TOTAL TOTAL ignature of ADPlie,^UConIorcN.traemr Date OFFICE COPY N CAL I ' = T � � II / NN x � z N LAM = of FA z _ Z W G . W Ltl {�'V :J rtl V c m ¢ m