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16624 (2) POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER ,:. CITY OF CUPERTINO 16624 INSPECTION DIVISION JOB INSPECTION RECORD • �T C JOB ADDRESS 101, 7 ( 0-21 — D UNIT# PERMIT EXPIRATION LOT PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU FOUNDATIONANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED � I il:l ILC• cl UNDERGROUND /SLAB '0PLUMBING 171 ELECTRICAL \ ISSDANCE UA T C MECHANICAL / BLur, El-EllPLG. MEC. n` P411: © 0 0 L DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED OCT 1 7 g$$ BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT, PLUMBING, MECHANICAL City0} CUp rtIDD i/r:I.T ELECTRICAL `\ PtyMn TO i I1 T� FRAMING STORIES TYPE CONSTR INSULATION ' OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED $(j IT V1.00R n11EA IOLAL ACHLAGE • - ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID u_u7 GUSE ROOF SHEATHING RES IND CON FB 0"', APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El L L D El ASSLSSORS PAHCE I.NO ROUGH SAN.# PLUMBING ELECT.ENERGY nlnr,T NO PARCELNO TUBS B SHOWER PAN PLUMBING ENERGY ' MECHANICAL MECH.ENERGY ACC LATE. ACC FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT,FINAL TEST ZONING ENG SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE SPRINR ENERGY T 2d MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y N❑ Y L N❑ FLOOU LONE ALUC EXTERIOR SHEAR - ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. L N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH - TEMPORARY APPROVALS BUILDING ! SCRATCH COAT ELECTRIC PLAN CHECK F �.( GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT FOR EXPIRATION DATE MECHANICAL - 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 ,.* BUI LDI NG PROJECT IDENTIFICATION APPLICATION & PERMIT ADDRESS PERMIT NUMBER ADS 16624 s• RESs�� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME / 60wm4pb ^} ^�` (' QTY. ELECTRIC PERMIT FEE J S�� L • PHONE ZS3-JJ E crDRs NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME IV R.1` Elc.NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE 'FG,,NO. OR ENGINEER uc.No. SIGNS TRANS. 3.00 ARCH.On ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS. 20.00 ADDRESSS A,,<, MOTORS SEE FEE SCH. A410NUCG1 0SERVICECHANGE 20.00 Iv� I� Il1Q w o o LICENSED CONTRACTORS DECLARATION ¢ u I 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, PLG. MECH. rH i Professions Code,and my license is in full force and effect. ❑ ❑ ❑ z o w- License Class Lic.Number o z H o Data Contractor OCT 1 7198 a Y q BUILDING PERMIT ¢ ¢ w OWNER-BUILDER DECLARATION INFORMATION w LL P.11.prfil N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER Tti .. o j Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 16.00 VALUATION S/FT. � - Code:Any cityor county which requires a permit to construct,alter, Improve, K Q O demolish,or repair any structure,prior to its MLIance,also ELEC.CONTR. LIC.NO, ELEC. O O u requircy the applicant for such permit Ia file a signed statlmn,nl that TOTAL PEfr�MIT TO E: is m he is licensed pursuant to the provisions of the Contractors License H se a Law(Cllapter.9(commencing with Section 7000)of Division 3 of the 5KI `H 4 D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ H e the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a3 _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).)'. ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 their sale compensutum.will do the work,and the 4mctdre is not OCC.GROUP RES.UNITS intended or offered for sub,(Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Cod,:'Phe Contractor's License Law dues not apply to an 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 or through his own employees,provided that such improve. menus are not intended urad'e.d for sale.IL however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or an- pro.for purposeofsole.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Dube, ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ 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 Contractors 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 l'orsuch ro'• ith a contractods)licensed pursuwlt to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Cont, , Icensc Lew. um exempt It r ' .- ,BAP.C.fur IIR, WATER HEATER W/VENT 6.00 c caner _ Dote WATER SYSTEM 5.00 ACC.GATE ACC FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have A Certificate of consent to self-insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified co thereof(Sec.3800,Lah.C.). Policy Na Company Q ❑ Ceriued copy is hereby famished I FIRE SPRINK ENERGYT-24 Z_ Z ❑ Certified copy is tiled with the city inspection division. MISC.- REFER TO ORD. O Applicant Y❑ NE] Y ❑ N[] �' to PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU CERTIFICATE PF EXEMPTION ION FROh1 WORKERS' W �_ COMPIiNSAT'ION INSURANCE PLG.CONTR. LIC.N0. PLG. 0 1'1'his section need not be completed if the pernit is for one TOTAL Y❑ N Y ❑ N❑ 2 hundred dollars 1$100)or less.) U O 1 Certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall nor employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. Ed Date Applicant ALTER OR ADD TO MECH. 5.00 FSEISMICFEE 17 } m NOTICE TO APPLICANT': If,after muffin,this Certificate of Ex-- I, x- unption,you should beauoc subject to the Workers'Compensation APPLIANCE 5.00 provisions of the Labor Code, you niusl forthwith comply with 7, 5 U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO J0=C.FJVQ 4.00G^ CONSTRUCHON LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 I hereby affirm that there is a construction lending agency Ior EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 R.T.U.) 8.003097.Civ.C.).Lenders Name HEATING UNIT IOVER 100,000 B.T.U.)9.50 Lulder's Address I certify that 1 have read this application and stare 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-CUMP(3 H.P.or 100,000 B.T.U.1 6.00 hereby eulhowe representatives of Illi, city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, imenmify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, casts and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ma ay accrue against said-City in consequence of the ting ofthis rniL MECH.CONT. LIC.NO. a� TOTAL TOTAL 1�1u._�w-� lD-l� $� Sti�ature want/Contractor Date 27 15 OFFICE COPY