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16736 (2) POST THIS CARD NEAR FRONT OF,BUILDING PERMIT NUMBER CITY OF CUPERTINO 16736 INSPECTION DIVISION JOB INSPECTION RECORD / ��• PERMIT EXPIRATION JOB ADDRESS _ L UNIT# - _LOT# ? PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 780 DAYS OF PERMIT;ISSU FOUNDATIONANCE OR 180 DAYS FROM NOTE: LASTCALLED 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 i UNDERGROUND /SLAB + PLUMBING - - _ 2 t , •! ELECTRICAL �� b5 ISSUANCE DATE '. BLDG ELECT, PLG. MECH MECHANICAL Cliy OF CU 11 El V❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUAT�ON SIFT, PLUMBING MECHANICAL ` PERMIT r . ELECTRICAL FRAMING - '' {+ I^ —rt STORIES TYPE CONSTR. INSULATION ; OCC CROUP 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 S _ DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING - BUILDING USE I H[S INO" CON PB GO, APPLY NO ROOFING UNTIL.ABOVE HAS BEEN SIGNED FINALS DATE INSP. SE 1:1 ASSESSORSPARCEL NO . ROUGH - SAN.# PLUMBING ELECT,ENERGY TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL No MECHANICAL MECH,ENERGY - - ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO. FRAMING - ELECT.FINAL TEST zomwc ENG.SITE No. INSULATION • PLUMBING GAS TEST GAS MECHANICAL FIRE SPRwK ENERGY T 24 E] N[]COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v L � N FLOOD ZONE A. u.c. EXTERIOR SHEAR ELECTRICAL RELEASE ' INTERIOR SHEAR FIRE DEPT. Y NY • SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING' - INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK + GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE " OCCUPANCY OF BUILDING ISNOT PERMITTED UNTILBUILDMG FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING'252.4505, ELECTRIC \. ujONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o PLEASE GIVE JOB ADDRESS WHEN PHONING. ZMECHANICAL . - SEE PERMIT FOR•EXPIRATION DATE - IMPORTANT! CONST.TAX' PLEASE READ REVERSE SIDE BEFORE TOTAL ', CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY PERMIT NUMBER �96ILDING PROJECT IDENTIFICATION APPLICATION & PERMIT C - BUILDING ESS U ADDR e BUILDING-ELECTRICAL-PLUMBING-MECHANICAL .. 736 OWNER'S PLAN CHECK VALIDATION NAME OTV. ELECTRIC PERMIT FEE ' PHONE �I ONr ACrORs OUTLETS-SWITCHES-RECEP 10.00/1.00 p NAME r lya uc.No LIGHTING FIXTURES 10.00/1.00 ronrRAcroaa APPLIANCES 4.00 40DRESS 7 44tPHONE f, PANELS 10.00 DATE OF APPLICATION OARCHITECT PANELS (OVER 200 AMP) .20.00 PLAN CHECK FEE P.c ANO. ENGINEER ' LIC.NO. SIGNS TRANS. 3.00 ARCH,OR ENG. PERMIT VALIDATION ADDRESS SPECIALCIRCUIT 5.00 tEMP:METER OR POLE INS. 20.00 iIv S..At�C1DNl'�Gl AvvucANrs ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 V 3�ad� 3 wC o O LICENSED CONTRACTORS DECLARATION 198 J7 a u u 1 hereby affirm that I um licensed under provisions of Claque"' ISSUANCE DATE ' a< w (commencing with Section 70007 of Division 3 of the Business and - BLggG. ELECT. PLG: MECH. "D Z Professions Co a license is in full.1', d f t T ❑ �( z o License Class_ Lic.Number PIT Lpl o Z f w Date Contractor(� k a r T BUILDING PERMIT R w OWNER-BUILDER DECLARATION INFORMATION woe- MISC.- REFER TO ORD 3 w r I hereby affirm that I am exempt front the linstinesContractor's P License VALUATION S/FT. . o"� ' Law fornycit the following r ount whichee7ireart permit to construct, Professions PERMIT ISSUANCE 10.00 HNHa Code:Any demyshcountywhicyolocti permi[toconstrud,alter, C Improve,demolish,or repair any structure,prior to its issuance,also ELEC.DONTR. LIC.NO. TE LEC. va G¢, requires the applicant or such permit to file a signed statement that - TOTAL PERMIT TO u w $a- he is licensed pursuant to the provisions of the Contractor's License \A q 1 Fz > La.(Chapter 9(commencing with Section 70001 of Division 3 of the '``IY'.�.'JLrJ'••1 a Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE r the basis for[he alleged exemption,Any violation of5ection 7031.5 STORIES, TYPE CONSTR. i by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN&VENT-WATER (EA',) 5.00 of not more than five hundred dollars(8500).): ❑ I,as owner of tire property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do 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 rices such work FIXTURES-PER TRAP 5.00 so.FT.FLOOR AREA TOTALACREAGE menta am through his own employees,provided that such offered for that suhemprovg GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that he dill not build or im- . RES IND CON PB . Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ],as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑' licensed contractors to construct the project(Sce. 7044,Business LAWN SPRINKLERS-I 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 conlractods)licensed pursuant to the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL No. - ❑ I am exempt under Sec. ,B.&P.C.bar Olis WATER HEATER W/VENT 6.00 reason Owner Data WATER SYSTEM 5.00 ACC.DATE. ACC.FILE NO. WORK ERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00 , I hereby affirm that 1 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.0.). - Policy No.-Company - 0 ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-24 Z Z ertifed o(�jy (s fit with the city inspection division. MISC.- REFER TO ORD. � D PP¢ant 2 L _ Y❑ N❑ Y ❑ N❑ � W CERTIFICATE OF 1, EMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LD >_ COMPENSATION INSURANCE PLG.CONTR. - LIC.NO. PLG. YE] N� Y NC] d O (This section need not be completed if the permit is for one TOTAL Z hundred dollars(S 100)or less.) ,U O 1 certify that in the performance of the work for Which this per- QTV MECHANICAL PERMIT FEELL . FEE SUMMARY h mit is issued,I shall not employ any person in any manner was to O W become subject to the Workers'Compensation Laws of California. - BUILDING ' Date Applicant ALTER OR ADD TO MECH. 5.00 } N NOTICE TO APPLICANT': If,alter making this Certificate of Ex- 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 (� such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,00DGF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 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,Civ C.). HEATING UNIT.ITO 100,000 B. .- .1 8.00 Lender's Name HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lendels Address i I certify that I have read this application and slate 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-COMPI3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL a, above-mentioned property for inspection purposes. (We) Big to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. _up4rt ag s[,imbilit7a�h,it is, costs and expenses which CONST.TAX ay i any va//ace u//agai t said City in consequence of the PERMIT ISSUANCE 'tQ:00 anting Iia 6m /777 MECH.CONT. LIC.NO, MECH. 31n .m, TOTAL `00 TOTAL Signet f ApplicantfConirador Date - OFFICE COPY