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18167 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 18167 INSPECTION DIVISION • JOB INSPECTION RECORD Q�� PERMIT EXPIRATION JOB ADDRESS_I�(�—(---(—>`v!, I�'�^�� U�MIT# _LOT# tt ` / /� PERMIT EXPIRES IF WORK OWNER \�l�` CONTRACTOR 1.V Ole , Cy IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECT10 RECORD 180 DAYS OF PERMIT ISSU. FOUNDATIONANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER' ALL GRADING AND DRAINAGE SHALL BE INSTALLED d' TO COMPLY WITH THE APPROAND CITY OF PERMIT VALIDATION PREGUNITE CUPERTINO STANDARDS. �a-��++aall % ,G,• � GARAGE SLABS - .POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB �. y:Vl a, i PLUMBING �Pertino ELECTRICAL ISSUANCE DATE MECHANICAL BLDG [L�yee{r •PLc. MCCH El ,�1 ❑, ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION, WOOD FLOOR VALUATION SIFT) PLUMBING MECHANICAL PeHMn TO ELECTRICAL FRAMING STOHILS TYPECONSTR INSULATION OCC GHDUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED " SO FT FLOOR aiEA TOTALACREAGE ROOF NOTE.NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IND CON Pd omr. ED c APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING - ELECT.ENERGY rRAcr No. PARCEL No TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC DATE. ACC FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT,FINAL TEST TONING ENG.SITE NO. INSULATION - PLUMBING GAS TEST GAS FIRESPRINK ENERGY T-7a MECHANICAL Y L rvL Y ❑ NL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE AL VC EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. v NL v L N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INT15RIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ,g(� F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING . O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL — 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 BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER DILDING pAPPLICATION & PERMIT 4. 18167 ADDRESS Iv ING - ELECTRICAL-PLUMBING-MECHANICAL 4•. r ' OWNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE fitN/t e �J° ANTRALTDRs NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 N laov�- LIGHTING FIXTURES 10.00/1.00 ADCONTRACTORs PPLIANCES-RESIDENTIAL '4.00 OESS �GQQ _ PHONE,T gn- PANELS 10.00 DATE OF APPLICATION ARLHrtECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE D.C.NO. OR ENGINEER LIC.No, SIGNS TRANS, 3.00 ARCH.Oil ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. / ADDRESS + SERVICE CHANGE PAMP 20.00 aat o LICENSIi1)CONTRACTORS DECLARATION Q v 1 herchy affirm chat I am licensed under provisions of Chapter 9 h;will l- k1 ISSUANCE GATE y a N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH- N z Professions Code,and my license is in full force and effect. Q i H o License Class Lic.Number {s, 'J � oI El ❑ ❑ x r w Dmc Contractor CItY < f BUILDING PERMIT w OWNER-BUILDER DECLARATION INFORMATION wD I hereby atfirn tat I mm exempt frons the CmHmclo[s License MISC.- REFER TO ORD LL VAWATION $/FT. H _ o¢ ou Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 10.00 ,'t.0p Code:Any city or cnty which requires a permit to construct,alter, Qw improve,demolish,or repair any structure,prior toils issuance,al so ELECCONTR. LIC.NO. ELEC. n O as requires the applicant for such permit Io file a signed Statement that TOTAL PERMIT TO w c, h e is licensed Pursuantuto the provisions of the Contractor's License Hzi Law(Chapter 9(commencing with Seclion 7000)ofDivision 3 of the re - a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ _ $ the basis for the alleged a semption.Any violation of Seclion 7031.5 STORIES TYPE CONSTR. T by any applicant for a permit subjects the applicant Ica civil penalty gLTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars 1$5001.1: ❑ L as owner o1'the property,or my employees will, wages as BACK F LOW PROTECT. DEV ICE 4.00 OCC.GROUP RES.UNITS Ihcir sole compensaion,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'rhe Contractor's Livenxe Law does not apply to an owner of property who builds o,improves thereon,and who does such work FIXTURES-PER TRAP 5.00 sa PT.FLOOR AREA TOTAL ACREAGE hi n,self or through his own employees,provided that such improve- mems are not intended or offered for sale.IL however,the building GAS-EA.SYSTEM-111NC.40UTLETS 6.00 or imro pvement is sold wilhir,one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE huildcr will have tire burden of proving Dal he did not build or ire- RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project ISee. 7044,Business LAWN SPRINKLERS-1 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 prrjecls with it contraclorls)licensed pursuant to the Contractor's License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec .B.&P.C.tin this WATER HEATER W/VENT 6.00 reason Owner Dune WATER SYSTEM 5.00 ACC.GATE ACC.FILE NO. WORKERS'COMPENSAT'ION DECLARATION WATER TREATING EQUIP. 5.00 I hereby infirm that I have a certilicale of consent m eel-in,or,. ZONING ENG.SITE NO. or a certificate of Workeri Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C.). Policy No. Company . O ❑ �i r itied copy is hereby furnished. FIRE SPRINK ENERGY T-24 z 2 /Certified Copy Js fyHl lb the city inspection division. O Applicanty i"-.��' ^1 MISC.- REFER TO ORD, Y ❑ N❑ Y ❑ N❑ N PERMIT ISSUANCE 10.00 El FLOODZONE A.L.U.C. CC CIi R'I'I PICA'I'Ii OF I AX ION ION FROM WORKERS' UJ _ need not be coin'INBU RA NCI: PLG.CONTR. LIC.No. PLO. Y❑ N❑ Y ❑ N d O ('chis section need not be complcled it' the permit is for one TOTAL Z:) 2 hundred dollars IS 100)or less.) U O I certify that in lire performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY U_ F not is issued,1 1111111 net employ any person in any manner so as to V become subject to Lite Workers'Compensation Laws of California. BUILDING w Dole ApplicantALTER OR ADD TO MECH. 5.00 } N NOTICE TO APPLICANT: if, He,making this Certificme of Ex- ? caption,you should become subject to lire Workers'Compensation APPLIANCE_ 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith com,Ply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.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 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 HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Qd Lender's Address . I certify that 1 have read this application and ,are Hit,the above VENTILATION FAN (SINGLE) 4,00 informatnn 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 stat, laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over IDg000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes (We) agree m save, indemnity and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 mnUngoft 'spermiL MECH.CONT. LIC NO. MECH. 17 TOTAL TOTAL �,0 Signature of Applicant 'ontractor Date OFFICE COPY