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16564 (2) 1.� POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16564 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS_(/ �'�/ / '�-�77 �� UNIT# _LOT# � � PERMIT EXPIRES IF WORK OWNER CONTRACTOR A_tsIT IS NOT STARTED WITHIN INSPEC I N DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATIONANCE OR 180 DAYS FROM NOTE: UFER ' ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEIm11T VALIDATION CUPERTINO STANDARDS. GARAGE SLABS I POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATL MECHANICAL BLDG ELECT I PLG. tNIEC. ❑ ❑ ID ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL ELECTRICAL - PEHmn TO L_ B Cr FRAMING oci ST RIES IYPECONSTR. INSULATION L4 Goo; c CROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO FT FLUOR AHI.A� TOTAL ACHIAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING Rcs IND CON PB 01,11-1 0 El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ED ASSESSORS PARCEL NO ROUGH SANA PLUMBING ELECT,ENERGY IRACI NO PARCELING TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY- dCC DATE ACC FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT,FINAL TEST ZONING ENG.srtE No. INSULATION PLUMBING GAS TEST GAS FIRE SPR INK ENERGY L]< MECHANICAL — — /3 Y ❑ NE] Y ❑ N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLoou roNL A EXTERIOR SHEAR ELECTRICAL RELEASE I INTERIOR SHEAR FIRE DEPT. Y0 N� T N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC .PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING p0 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z rCHAN' CAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! NST.TA% 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 I LDING PROJECTIDENTIFICATION ,PERMIT NUMBER BUILDING APPLICATION & PERMIT 16564 C [� A ADDRESS ' V I U 5 6 `F / BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S C PLAN CHECK VALIDATION ""ME JS OTY. ELECTRIC PERMIT FEE NS o �J CON ions NAME UTLETS-SWITCHES-RECEP 10.00/1.00 ` �q/ �j GvwI,SY✓ sec No (�I LIGHTING FIXTURES 10.00/1.00 NTR croR's APPLIANCES-RESIDENTIAL 4.00 A oREss [� 7 �J ' S (7- PRONE //�O PANELS 10.00 DATE OF APPLICATION ARCHITECTPLAN CHECK FEE :P.0 NO. DR PANELS (OVER.200 AMP( 20.00 i ENGINEER LIC.No. SIGNS TRANS. 3.00 ' AEG ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 �- APPLICANT MOTORS SEE FEE SCH. ADDRESS SERVICECHANGE 20.00 Al 02 LICENSED CONTRACTORS DECLARATION v u I hereby affirm that I on licensed under provisions of Chapter 9 ISSUANCE DATE , Vi a u (commencing with Section 7000)of Division 3 of the Business and F w BLDG. ELECT. PLG. MECH. z Prof cssion,Cody gaggIcenxc is in Hill fo ❑ ❑ ❑ z o w - License Class L .7b Lie,Rmnber� 9 z 0 O Date Contractor_ F y 2� BUILDING PERMIT ¢ ¢ w OWNER-BUILDER Df:CLARA'FION INFORMATION w3 1 loc.by affirm that I mn exempt Dom the Contractors License MISC.- REFER TO ORD Huta Lawlor the followingmasontSuc.7031.5.Buorces:md Pmlcssions PERMIT ISSUANCE 10.00 VALUATION 5/FT. Code Any city or county which requiresa permit to construct,alter, a, 12 Improve,dem06]h,or repair any Structure,print t0 its issuance,also ELEC.CONTR. LIC NO. ELEC. _ O u retluires the upplicant for such permit to f ile a signed statumenl Ilial TOTAL _ PERMIT TO x m he is licensed pursuant to the provisions of the Contractor's License I\ '�( LawI(Chapter 9(commencing with Section 7000)of Division 3 of the 4;_ < Buiness and Professions Code)or that he is exempt Ihcrcfrom and QTY. PLUMBING PERMIT FEE fi0 ¢ H$ the basis for the alleged cxem Poon.Any violation of Section malty STORIES TYPE CONSTR. n , by any applicant lorapennit subjects the applicam toacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5. of not more than five hundred dollars($500).): ❑ I,as owner of the Properly,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 (Scc. 7044. Business and Professions DRAINS-FLOOR,ROOF,AR EA,CONIC. Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,a Old who does such work F IXTUR ES-PER TRAP O ,FT.FLOOR AREA TOTAL ACREAGE himself or et ince his own eared fors, le If,cd ev such improve. Of.ki menus are net hsorofferedfor sule.lf,howeve such cbuilding GAS-EA.SVSTEM-11NC.40UTLETS 6. of improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or int RES IND CON Pe Omer prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 El El ❑ ❑ 1:1❑ I,a owner of the property,ani exclusively contracting with fee nsed amitocons to construct the project(Sec.7044,11 LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and I'mfessbmn Code:T'he 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 projeeu with u conNuctort.v)licensed pursuant to the Comracber's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. E) lam exempt under Sec. .BAP.C.for this WATER HEATER W/VENT B.00 00 Reon, Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORK FRS'COMPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO. or a ecnifica to of Workers'Cogitum Iluvrune or a certified cup too,L f Pon Comp' y I'J e if 'opy is perch ed. FIRE SPRINK ENERGY T$4 z Zertilit ipy i file the city inspwuion division. MISC- REFER TO ORD. O pPlicant �_ Y ❑ N❑ Y ❑ N❑ y CI:RTI ' 'ATE OE EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10[00 dD FLOODZONE A.L.U.C. UJ > COhIPENSATIONINSURANCE PLO.CONTR. LIC.NO. G G.AL ❑ ❑ ❑ ❑ CL 0 obis suction need not be completed if the Permit iN I'or one >7 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- QTY. - MECHANICAL PERMIT FEE FEE SUMMARY U_ H mit is issued,I shill not employ any person in any Inammr so as to . U become subject to the Workers'Compensation Laws of California. BUILDING O ED Dam Applicant ALTER OR ADD TO MECH. 5.00 } 0 NOTICE 10 AVI'LICAN L: 11,after making this Certificate of fix F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you cast forthwith comply with FEE U such provisions or this permit sloll be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE I hereby al'firin that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 ' the peNbrmance of the work for which this permit is issued IS". HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.). - Lender'sName HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I 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 PLUMBING N� ordinances and slate laws relating to building construction, and BOILER-COMPI3 H.P.or 100,0008.T.U.) 6.00 hereby auuhoriec representatives of this city to enter upon fit, BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against iubilitie-.judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way ecrue against said City in consequence of the gra h of this pen it. MECH.CONT. LIC.N0. MECH. TOTAL TOTAL !�/f`,` Signa c of Applican[Contructor Uate lo� OFFICE COPY