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18165 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER i^ CITY -OF 'CUPERTINO 18165 INSPECTION DIVISION JOB INSPECTION RECOR I E� 0� PERMIT EXPIRATION JOB ADDRESS /oo��..jj( � Fa �t, a y,--LOT# PERMIT EXPIRES IF WORK OWNER Q coNTR ACTOR IS NOT STARTED WITHIN NSPECTION DATE I INSPECTOR INSPECTION RE ORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED' TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. PJUD �• iy' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,!LIN 2 G 1989 UNDERGROUND /SLAB PLUMBING 14 ' 4 �� IA V C<`' City, Of CUpprtino ELECTRICAL - IssunrvcE DATE MECHANICAL ❑ BLDG ELECT PLG. ME CH El � ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL PERMIT TO ELECTRICAL ' �E( FRAMING e� SIUNIES 11 TYPE CONSLR INSULATION UCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 50 IT FLOOR flREA lOIAL FCREMGL . ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING use HEs IND CON PB ROOF SHEATHING om• APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑_ ❑ ASSESSORS PARCEL NO ROUGH SANJI PLUMBING ELECT.ENERGY TRACT NO PARCEL No TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC DATE ACC,FILE NO ELECTRICAL BUILDING ENERGY FRAMING - ELECT.FINAL TEST zoNlNc ENa.SITE No. INSULATION PLUMBING GAS TEST GAS FIRE SPRINK� ENERGY i-24 MECHANICAL Y E] NE 0 N[—] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING F1.00112VNE A.I.UG, EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. Y[] IN Y ❑ N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC I 1,L, PLAN CHECK FEE GAS 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 LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o� PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TA)( PLEASE READ REVERSE SIDE BEFORE TOTAL .0?) CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY. ti BUILDING PROJECT IDENTIFICATION PERMIT NUMBER RUILD,NG APPLICATION &PERMIT ADDRESS 1 ^b U L N -E ECTRICAL-PLUMBING-MECHANICAL L: 1816 / O ' 02EH's E AM I PLAN CHECK VALIDATION NAME a OTY. ELECTRIC PERMIT FEE v CONTRACTOR OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME I.C.No. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR', APPLIANCES-RESIDENTIAL 4.00 ADD/RESS _ W�Qpyl - PHONE 1� PANELS ' 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C.NO, OR ENGINEER LIC.No. SIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL CIRCUIT S.OD PERMIT VALIDATION ADDRESS E� ZIP EMP.METER OR POLE INS. ' 20.00 Q..() ! ��6 -. •/ APPLICANT'a MOTORS SEE FEE SCH. O 1 ADDRESS SERVICE CHANGE 20.00 ,,ll o at i -4v,: �lV LLP H D o LICENSED CONTRACTORS DIiCLARATION - i U o I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE - w G H (Commencing with Section 7000)of Division 3 of the Business and F BLDG, ELECT. PLG. MECH. H y z Professions Code.and my license is in full force and effect. (�ISI 1 ❑ ❑ ❑ Z OL - Licensc Class Lia Number g Z r Da[cContractor x City of Capertino BUILDING PERMIT re w a OWNER-BUILDER DECLARATION INFORMATION MISC.- REFER TO ORD R LL N I hereby affirm that I am exempt from the Contractors License VALUATION $JFT. F LL m j Law for the following reason.(Sec.7031.5.Businessund Professions PERMIT ISSUANCE 10.00 a V,0 Code:Any city or county which requires a permit to construct,alter. SE to Q 20 Improve,demolish,or repair any structure,prior to Its issuarc ,also ELEC.CONTR. LIC.NO. ELEC. requires the applicant for such permit to Ole a signed statement that TOTAL DLO,I O PERMIT TO u w$ he is licensed pursuant to the provisions of Ore Contractor's Licensc cLaw(Chapter 9(commencing with Section 7000)of Division 3 ofthe Business and Professions Code)or that he is exnnpt therefrom and QTY. PLUMBING PERMIT FEE s Oo the basis for Ole alleged exemption.Any violation of Section 7031.5 TORIES TYPE CONSTR. nam by any applicant fora permit subjects the applicant toaeivilpenalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred fidiars(S5001.)'. ❑ I,as owner of the 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,AR EA,COND. 5.00 Code.The Contractor's License Law if.,,not apply to an owner of property who builds or improves thereon,and win does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE • himself or through his own employees,provided that such int Prove. menus arc not intended or offered l'or sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 200 BUILDING USE builder will have the harden of proving that h . . . e did not build or int' RES IND CON PB Other prove ter purpose of sakJ. INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct Ole project(Sec 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contract,,,',License Low 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 contractions)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Contractor's License Law. ❑ 1 am exempt under Svc.-,B.&P.C.for this WATER HEATER W/VENT 6.00 canon Owner Date WATER SYSTEM 5.00 ACC.DATE ACC,FILE No. WORK ERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00 I hcrcby affirm that I have a certil'Icale of consent to self-insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or u certilied copy thereof(Sce.3800.Lab.CJ. Policy No. Company ❑ );,,rti fled copy shereby furnished. FIRE SPRINK ENERGY T 24 Z 2 A/Certificd . Yis Ie with lie city inspection divisnn. MISC.- REFER TO ORD. v N v N p Applicant ❑ ❑ ❑ ❑ 0: w CER'1'IITICA'1'UOF IiX1iMP ION FROM WORKERS, PERMIT ISSUANCE 10.00 FLOOD ZONE . A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 0- a ('Phis section need not be completed f the Permit I, for one TOTAL Y❑ N❑ Y ❑ N❑ D Z hundred dollars IS 100)or less U O_ 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not enmloy any person in any manner so as to w become subject to the Workeri Conhpensetion Laws of Califoma. O Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } y NO]'ICl,TO APPLICANT: 11,after making this Cerlificatc of Ex. F ? coalition,You should become subject to the Workers'Conhnensotiun APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code. you must forthwith conhply with FEE U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONS'I'RUCI'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000OF.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(TO 100,000 B.T.U.) 8.00 Lenders Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC , QV Lender's Address I Certify that l have read l his application and state that t lie above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree Rn comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 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 abuse-mentioned property for inspection purposes. (We) agree to save, indeamify and keep I..rnhless 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 morin,of This enol. MECH.CONT. LIC.NO. MECH. /_ "_ TOTAL TOTAL aa, pd Sig a are A p wont/ Tactor (O Is)-arl/e OFFICE COPY