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17183 (2) POST THIS CARD NEAR FRONT.OF BUILDING PERMIT NUMBER CITY OF CUPERTINO71 83 INSPECTION DIVISION ' I� JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESSpp'L�}/�J+' 4„�1`��` T G�) -UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER /^L vJ^/\• CONTRACTOR IS NOT STARTED WITHIN INSPECTION DAIIE INSPECTOR INSPECTION RECORD 100 DAYS OF PERMIT ISSU. FOUNDATION , ANCE OR 180 DAYS FROM NOTE:. LAST CALLED INSPECTION. LIFER - ALL.GRADING AND DRAINAGE SHALL BE INSTALLED PR EG UNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. \�j� GARAGE SLABS 'TTJJ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLABS PLUMBING ELECTRICAL ISSUANCE DATE • BLDG ELECT PLC. MECI MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL PERMIT TO ELECTRICAL FRAMING STORIES TYPE CONSiR INSULATION 'OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED sO.IT nLOoe Almn TOTAL ACRcauo ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BuumNc USE ROOF SHEATHING +e IND coN PB Dui.. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ASSESSORS PARCEL NO ROUGH SAN.4 .+•: PLUMBING ELECT.ENERGY ° TRACT NO PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY T. •L' MECHANICAL MECH.ENERGY' ACC DATE ACC FILE NO ELECTRICAL BUILDING ENERGY 3. FRAMING ELECT.FINAL TEST XJJU ZONING ENG.SITE NO. INSULATION PLUMBING c GAS TEST GAS FIRE SPOINK ENERGY L?< MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING y N� Y ❑ NE] FLOODZONE A.l U L. EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. °❑ ❑ N❑ SHEETROCK GRADE - - FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC - PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC LU WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 00� PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. I I Ifoot3o OFFICE COPY 1� APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY �BUI CDING PROJECT IDENTIFICATION PERMIT NUMBER 9UILOINGSS APPLICATION & PERMIT 17183 MDRE -N ` -, BUILDING-ELECTFjICAL-PLUMBING-MECHANICAL _ OWNER'5 PLAN CHECK VALIDATION NAMF A/S �11 fSi_PHON OTY. ELECTRIC PERMIT FEE 7 cDNTRACTORsUTLETS-SWITCHES-RECEP 10.00/1.00 3 � NAM C '!'{ na ,c.N y7 IGHTING FIXTURES 10.00/1.00 no Tess TORS _ APPLIANCES-RESIDENTIAL 4.00 Op ' _ vHON PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,00PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No. SIGNS TRANS. 3.00 AR H.OR ENG. SDD PERMIT VALIDATION ADOCSPECIAL CIRCUIT 5.00 ^L �j iIp TEMP.METE OR POLE INS. 20.00 APPLICANTS MOTORS - SEE FEE SCH. L-t%CO ADORE Ss SERVICE CHANGE 20.00 oO o LICENSED CONTRACTORS DECLARATION " <v U I hereby of firm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE i7 Q y (commencing with Section 7000)of Division 3 Of cite Business and BLDG. ELECT. PLG. MECH. H H z Professions Co#�Nl`,��LDER ''sone is in Hill force' '}/i/Q ❑ ❑ ❑ z o w - Licerae Clu�ss� Lic.Nmnher N7[L Q m r w Dale /�, Contractor LG ¢ y s �' BUILDING PERMIT ¢ ,c w ¢ R-BUIDECLARATION INFORMATION U REFER TO ORD A. LL y I hereby aflinn that I am exempt Iron the Contractor's License MISC.- LL O< Law for the following reason.(Sec 7031.5,Business and Professions pERM1T ISSUANCE 10.00 VALUATION 3/FT. � - I Code:Anycity orcounly which requiresa permit to construct,alter, �vCO 2 2 s- 20 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. //��,, -O u requires the oppicant for such permit to file a signet statement that TOTAL I,yvL`,i0 PERMIT TO wm he is licensed pursuant to the provisions of the Contractor's License HiQ Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. v';m by any applicantfor a permitsubjects the applicant toacivil penally ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(5500).): ❑ [,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCG 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 Cody, The Con tmclur's Li ceusa Law does not apply In an owner of prVperty Who build,Or Improves floncn.and Wh011OCfi such work FIXTURES,PER TRAP' 5.00SQ FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenotintendedoroffered Nitride.If.however,the building GAS-EA.SYSTEM-I INC-40UTLETS 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 h .e did not build or im" IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑, 1,as owner of the property,am exclusively contracting with RES ❑ ❑ ❑ ❑ 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 Contract(ir's License Law dues 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 it contractoNs)license(]pursuant to SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO. the Contractor's License Law. ❑ I am exempt under Sec. ,BAP.C.for dus WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.GATE ACG FILE NO. WORKERS'COMPENSA'1ION DECLARATION WATER TREATING EQUIP. 5.0_0 I lmrehy ofirm tlmt 1 has,a ccrtilicate of consent to sdf-insure. ♦(d'�-L� ZONING ENG.SITE NO, or a certificate of Work crs Com uatem Insurance,or iierli 'ed copy thereof Ise".cl Co,Lab.C.f/'� Policy No. Cotngb Q ❑ Cc copy is hereb lu nisbcJ. FIRE SPRINK ENERGY T24 Z Z eni0cd copy'Y 5F. II• 't' 'ns •ctluZlt Division. O Applicant-G-1/ MISC.- REFER TO ORD. v❑ N❑ v ❑ N(G� ir CERT IFICATB 01'EXEM11'[ON FROM WORKERS' PERMIT ISSUANCE 1 FLOOD ZONE A.L.U.C. w LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. d 0 (Phis section need not be completed if the permil is for one TOTAL Y[:JN❑ Y N❑ Z hundred dollars IS 100)or lws.) U O 1 certify than in me permrman«of the work fur which this per QTV MECHANICAL PERMIT FEE FEE SUMMARY 1L F it is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of C.IiImma. BUILDING n Date Applicant ALTER OR ADD TO MECH. 5.00 } y NOTICE"f0 APPLICANT: If,after nuking this Certificate of Ex- F" Z umpton,you should hecomu suhjact is,the Workers Compensation APPLIANCE 5.00 PLAN CHECK provisions ul' the Labor Code, you must forthwith comply with FEE - U such provisions or this permil shall be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.00 CONSTRUCTION LENDING AGBNCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a cunstructwo lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which(his permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 e.T.U.) 8.00 Lender's Name HEATING UNIT I0 VER 100,000 B.T.U.)9.50 ELECTRIC /Q(+j�"3o Lender's Address 1 certify that I 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 BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and slate laws relating to building construction, and hereby awls senlmivesa( This city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-me med proper for inspection purposes. ree to s keep harmless the City of MISC.- REFER TO ORD. upers bilitie. gments, costs and expenses which - CONST.TAX in any aceru •amst said City in consel uen a of the PERMIT ISSUANCE 10.00 / MECH.CONT. LIC.NO. TOTAL TOTAL CO,10 ma Si nn/Coalracto, U c OFFICE COPY