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16574 (2) Y, POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16574 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS �`"� � /�Io-wz' ;c-7 UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER Z-07 t/H- CONTRACTOR 4 617fi- IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 186 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE: _ LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INST PREGUNITE TO COMPLY WITH THE APPROVED PLAN TY RM T VALIDATION CUPERTINO STANDARDS. GARAGE SLABS ..--r. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING //'-f ELECTRICALJ SSUANCE DATE MECHANICAL I , vv BLDG,/ELECT I PLG. I MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIG ED BUILDING PERMIT INFORMATION WOOD FLOOR vawnn ON S/FT. PLUMBING Q 'MECHANICAL `� } 0 �`�� ELECTRICAL D PERMIT T FRAMING �t �)� CU 1R M STORIES TYPE CONSTR INSULATION y OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL A80VE HAS BEEN SIGN +'�•' ROOF E:NO FINAL INSP. LL BE MADE BEFORE so.FT FLOOR AREA TOTAL ACREAGE ' DIAPHRAGM TH AX IS PAID rBUILDING USE ROOF SHEATHING RES IND CON PB Um.. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDFINALS DATE INSP. ASSESSORSPAHCELNO ROUGH SANA PLUMBING ELECT,ENERGY TRACT No PARCEL No TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC UnrE ACC FILE No ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST ' ZONING ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS MECHANICAL FIRE SPRMK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A LD.0 INTERIOR SHEAR FIRE DEPT. `'❑ N❑ Y ❑. N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDlJJG SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM i ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING.'. z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL O� J IMPORTANT! CONST.TAX PLEASE READ,REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY •-OAPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY f BUILDING PROJECT IDENTIFICATION ;PERMIT NUMBER Nin BUILDING APPLICATION & PERMIT 1657 4 R'8 ADDRESS �J QO VNT� BUILDING -ELECTRICAL-PLUMBING -MECHANICAL m GBNE1 {� NAME PLAN CHECK VALIDATION QTY. ELECTRIC PERMIT FEE (�(�F PHONE �g AUL UTLETS-SWITCHES-RECEP 10.00/1.00 Z L-/Tb• LIC.NO.' 6+ L LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S �- #6B ADDRESS _APPLIANCES-RESIDENTIAL 4.00 ADDRESS. y PHONE? ,C)7u- PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER, I LIC.No. SIGNS TRANS. 3.00 ADDRESS END' SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT'S MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 wo o LICENSED CONTRACTORS DECLARATION a Ut w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE - ¢ y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. o i Professions Cod and my license is in full force and ff cl. ❑ ❑ ❑ 2 i:o License Class Lin.Number r m m j Dale Contractor W m a ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT Ic a u INFORMATION E 3: vmi 1 hereby affirm that I ann exempt from the Contractor's License MISC.- REFER TO ORD ru04 Law forthe following mason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. S �0Y Code:Any city orcounly which requiresa permit to construct,aIm,, re ta ¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. a- a LL requires the applicant for such permit to file a Signed statement that TOTAL PERM T TO w$ he is licensed pursuant to the provisions of the Contractor's License mei Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢H the basis for the alleged exemption.Any violation Of Section 7031.5 STORIES TYPE CONSTR. T E by any applicant for a permit subjects the applicant to a civil penalty of not alone than five hundred dollars(5500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ 1,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, Easiness and I'rofessions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon:and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve- mentsarenalintendedorofferedforsale.If,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 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose ofsale.). INDUSTRIAL WASTE INTER30.00 RES IND CON PB Omer O I,as Owner of the property,am exeln .sively contracting with 1:1licensed contractors to construct the project(Sec. 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 projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200f1/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ lam exempt under Sac.-,BAP.C.for this WATER HEATER W/VENT 6.0()- reason Owner Date WATER SYSTEM 5,00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereoffSec.3800,Lab.C.) Policy No. Company ��Dl�_✓�DF'� Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified cgry filed with flte city inspection division. MISC.- O pplicant A4 o REF ORD. Y [:] IN Y ❑ No K N CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 1 FLOOD ZONE A.L.U.C. LU COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. p 2 ('Phis section need not be completed if the permit is for Ane T AL Y C] NC] Y 0 N� hundred dollars(5100)or last.) ((�� U O 1 certify that in the perfannance of the work for which this per- QTY. MECHANICAL PIRiMIT u0 FEE FEE SUMMARY LL H mit is issued,1 shall not ennploy any person in any manner all,as to O`C O w become subject to the Workers'Compensation Laws of California. Date Applicant BUILDING a ALTER OR ADD TO MECH. 5.00 } N NOTICE'10 APPLICANT: If,after making This Certificate of IN- Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with AIR HANDLING UNIT FEE U such provisions or this permit shall be deemed revoked. (TO 10MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.RM.) 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.L HEATING UNIT(TO 100,000 B.T.U.) Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lenders 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 PLUMBING ordinances and state laws relating to building construction, and BOILER-C1T(3H.P.or100,000B.T,U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100.000 BTUI SEE FEE SCH. MECHANICAL a 66ove-mentioned properly for inspection purposes. fWe) egrc save, indemnify and keep bunnies, the City of MISC.- REFER TO ORD. \� Cupertino sinOrm ' dgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in a y lsaidCItyinOnsyunfile ranting of MECH.CONT. LIC.NO. MECH. �pTOTALTOTAL Signomror OFFICE COPY -A