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15040 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINOX040 INSPECTION DIVISION JOB INSPECTION RECORD - PERMIT EXPIRATION JOB ADDRESS � -Z/%y�/Tc2d'TOn/ 7� UNIT# _LOT# /^ PERMIT EXPIRES IF WORK C OWNER R d lC CONTRACTOR IS NOT STARTED WITHIN INSPEC ION 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 -. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION _ CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB - . . PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG ELECT I PLG. MECH. '❑ ❑ '' ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION S/FT. MECHANICAL - ELECTRICAL PERMIT TO FRAMING. INSULATION STORIES TYPE CONSTR. OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED P ROOF NOTE:NO FINAL INSP.SHOALL RE so.Fr Fwov AVEA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TA) IL� ROOF SHEATHING p�wg `n0 BUILDING USE V Y' RES IND CON PB Olnr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.a PLUMBING , ELECT.ENERGY TUBS&SHOWER PAN - PLUMBING.ENERGY TRACT NO. PARCELNa- MECHANICAL MECH.ENERGY E LECTRIQAL BUILDING ENERGY ACC DATE ACC FILE NO FRAMING ELECT.FINAL TEST INSULATION PLUMBING ZONING "'ti• ENO.SITE NO, GAS TEST GAS MECHANICAL A FIRE StFUNK ENERGY_T-]J , COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' ❑ N❑ Y ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALUC. INTERIOR SHEAR FIRE DEPT. Y❑ IN v ❑ N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVAL BUILDING SCRATCH COAT ELECTRIC PLAN CHECK . GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM - w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLurnewG z PLEASE GIVE JOB ADDRESS WHEN PHONING. r" - - SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING'FOR FINAL INSPECTION. 'TOTAL OFFICE COPY APPLICANT TO FILL IN.INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY /� ^ BUILDING PROJECT IDENTIFICATION PERMIT NU MEER BUILDING APPLICATION & PERMIT 15OYO ADDRESS / O.y r� '1 G BUILDING—ELECTRICAL—PLUMBING—MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE ONE�/"J7 ENAM (Ac R OUTLETS-SWITCHES-RECEP 10.00/1.00 LIC,No. LIGHTING FIXTURES 10.00/1.00 - CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE PANELS 10.00 DATE OF APPLICATION 0R ARCHITECT PANELS (OVER 200 All 20.00 PLAN CHECK FEE P.C.'NO. ENGINEER ' LIC'.0, ISIGNS TRANS. 3.00 ' ooeess ENG. PERMIT CIRCUIT 5.0D PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 APP u0ANrs ADDRESS SEE FEE SCH. MOTORS SERVICECHANGE 20.00 o ¢i Foo LICENSED CONTRACTORS DECLARATION Z S/ a u U 1 hereby affirm that I am licensed under provisions oCChapter 9 aim3oftheBusinessadw (comencing with Scaion 7000) ISSUANCE DATE F N z Professions Code,and my license is in full lures and effect, BLDG. ELECT. PLG. MECH. ❑ ❑ ❑ o 0 w o License Class a LiNumber Date Cmilmolor Q y E. ¢ ¢ w a OWNER-BUILDER DECLARATION BUILDING PERMIT wo a o INFORMATION 3 I- 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD u o j Law for the following reason. Sec.7031,5, VALUATION F _ b l Brain cssendtrct,alter, PERMIT ISSUANCE S/FT. Code.Anymolish coumyir any rrgviresa Permi(tot,SUmove.aeq 10.00 - ar R¢p improve,demolish,or repair any structure,prior ID its issuance,also ELEC.CONTE. LIC.NO. ELEC. D¢ requires the applicant for such Dcrmi(to file a signed statement that A w m m he is licensed pursuant to the provisions of the Contractor's License TOTAL PERMIT TO Fa, Law(Chapter 9(commencing wish Section 7000)nCDivision 3 ofthc 4 o Business and Professions Code)or that he is exempt therefrom and QTY, PLUMBING PERMIT FEE L re F$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a _ by any more Cora permit dollars tile applicant Ira LIV11 penalty of not more than five hundred dollars(S500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ I,as owner of the property,or my employees with wagos as BACK FLOW PROTECT. DEVICE 4.00 their sole a nlpenmtion,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale(Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00 Code:'file Contractor's License Law does not apply to in 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 re through his own eared forsale. provided that such improvc- OrUrPrOsimenotntiswidorol'in one year .lf,however,completion the bowner. GAS-EA.SV$TEM-11NC.40UTLET$ 6.00 or ider will av is sob within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the nnmem of proving that he did not build or in" BUILDING USE prove for purpose of salCT. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ 0 0 0 licensed contractors to construct the proje cl(See,7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 and Professions Code:The Contractors License Law does not apply ASSESSORS PARCEL NO. - 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 to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/,WAOTgaeT NO. PARCEL NO. ❑ tum exempt under Sec. ,B.& C.for thisWATER HEATER W/VENT a Ownu )a WATER SYSTEM ACC.GATE ACG FILE NO. woRKERS'Co, :NsnnoN DECLARATION WATER TREATING EQUIP. .0 at I hereby affirm th1 have a certificate of consent to self-insure. or a certificate of Workers'Compensation Insurance,or a cerlified ZONING ENG.SITE NO. cup,thereof(Sce.3800,LabL). Policy No. Company , O ❑ Certified copy is herehy,furnished.- Z Z ❑ Certified copy is tiled with the city inspection division. FIRESPRINK ENERGY R24 H 0 Applicant MISC.- REFER TO ORD. Y [:] N0 - Y ❑ NE] CC y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.u,c. LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. CIL 0 (This section need not be complete)-if (he Pamir is for one TOTAL / Y❑ N� Y ry� U O hundred dollars(Sloth or les.) I Lend, that I. the performance of the work fur which this per- QTY MECHANICAL PERMIT FEE SUMMARY LL t- mit is issued,I shall not employ any person in any manner so as to FEE O W become subject to the Workers'Compensation Laws of California. Q. Dat` Applicant ALTER OR ADD TOMECH. BUILDING } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- 5.00 2 emption,you should hecome subject to the Workers'Comlpensution APPLIANCE 500 PLAN CHECK provisions of tire . e Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MOGF.M:) 4.00 FEE CONSTRUCTION LENDING-AGENCY AIRHANDLINGUNIT(OVERIO=C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 tire n e pP,foma nee of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC I certify that I have read(his application and state that the above VENTILATION FAN (SINGLE) 4.00 information n correct. I agree to comply with all city and m.County and PLUMBING / hereby ncos and steno laws relating to building construction. and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby enti orirepresentatives of this city erose upon the above mentioned properly for mspecNon purposes . BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL I(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, costs and expenses which may in any way accrue galost said City in consequence of Orn PERMIT ISSUANCE 10.00 CONST.TAX •m goft mit MECH.CO NL LIC.NO. TOTAL Igo ofApplie. t bn Ga o e TOTAL OFFICE COPY