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15524 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER, CITY OF CUPERTINO 15524 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION. JOB ADDRESS 21296 Rumf OYC1 .DYlVe UNIT#- LOT# ' PERMIT EXPIRES IF WORK . OWNER Ove HallbeT• CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER .ALL GRADING AND DRAINAGE SHALL BE INSTALLED - PREGUNITE r TO COMPLYMITH THE APPROVED PLANS AND CITY,OF PERMIT VALIDATION - CUPERTINO STANDARDS. - GARAGE SLABS , I POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED (Ir- T UNDERGROUND /SLAB • PLUMBING .. ' ELECTRICAL ' IssunmcE DATE MECHANICAL - doDG ELEcr Pw. MECH ❑ ❑ ❑ . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT - WOOD FLOOR - INFORM•TION PLUMBING VALUAIION F$/FT. - - � - MECHANICAL - ELECTRICAL PERMIT To FRAMING . . ?'-�(.J� - INSULATION - STORIES TYPE CONST. , Q UCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNEDCM CII rtinoL0" 6p.ITP0HAHEA iOiAL ALRf MCP " f ROOF- NOTE:NO FINAL INSP.SHALL BE MADE BEFORE ' DIAPHRAGM THE CONSTRUCTION TAX IS PAID - dUILUINGUSE , +--�•` - ROOF SHEATHING - - Hes IND Cg N Pd Om" APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El L1Y ❑ Cl - A$SESSUHSPAHCELNO. ROUGH SAN.# ' PLUMBING - ELECT.ENERGY TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO ' - MECHANICAL - MECR ENERGv ELECTRICAL BUILDING ENERGY ACC.unrE ACC FILE No FRAMING ELECT.FINAL TEST �7 INSULATION PLUMBING /� ZONING ENG,SITE NO. GAS TEST GAS - MECHANICAL FIRE SPRINK ENERGY T.24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° ❑ N❑ Y Q N❑ FLOOD ZUNf: A.L.U.Q EXTERIOR SHEAR. ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT, Y❑ N❑ ° ❑ 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 OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY-PHONING 252-4505, ELECTRIC " I� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING'. o PLEASE GIVE JOB ADDRESS WHEN PHONING. •t ` s ' Z - SEE PERMIT FOR EXPIRATION DATE — MECHANICAL. { IMPORTANT! ,-, CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL- CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICAJNT T-CQFILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY - BUILDINGPROJECTIDENTIFICATION - PERMITNUMBER _ aGILDI.n - APPLICATION & PERMIT ADDREaSFORD _DR 15524 BUILDING.— —MECHANICAL OWNERS PLAN CHECK VALIDATION OWNERS 'f OTY. ELECTRIC PERMIT FEE OUyE JgU6ER PHONE I_O O ` y rvAMER1.J�A.L 01 Cc E E��// OUTLETS-SWITCHES-RECEP 10.00/1.00 LIC.NO. 4741 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 - ADDRESSSaVYATOaEA SUVIVILJVN�'F�• - _ . 1r PHONE - PANELS 10.00 DATE OF APPLICAT ION ORCH,TECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LAC.NO. SIGNS TRANS. 3.00 ' ADDRESS ENG SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPucANrs ADDRESS MOTORS SEE FEE SCH. t' L SERVICE CHANGE 20.00 c¢ i r 0 9 LIC17NSED CONTRACTORS DECLARATION ' Q.�U I hereby afh m that I am licensed male,provisions of Chapter 9 ISSUANCE GATE H< m (commencing Willi Seclion 7000)of Division,3 of the Business and BLDG. ELECT. PLG. MECH. N z Professions Coda y license is in full fore Bp4Pjf ' ❑ ❑ z e ro License Class Lic.Num hG[' Y•( H F J Dale_ _"_` CnnlruclnrU lNt Q�� ' ¢ m flu 121 Vxt) BUILDING PERMIT ¢ 0a0 OWNER-BUILDER DECL ATO ' - NFORMATION K ; u I hereby aft'irnl that I an,exempLfrom the Contmdor's Liccnxc MISC.— REFER TO OR � LLya Law for the following reason.(Sec.7031.5,Businessaod Professions pERMIT ISSUANCE 100 VVVALUATION g/FT. m0 Code:Any city or county which requires a permit toconstruct,aher, K ¢2 improve,demolish,of repair any structure,prior to its issuance,also ELEC.CONED. LIC.NO. ELEC. aL� ' 0 ¢ requires ilia applicant for such permit to file a signed statement that TOTAL V1�r A. w m" he is licensed pursuant to the provisions of the Contractor,License ERMIT TO HiQ Law(Chapter9(commencing with Section 7000)o(Dlvlsion 3 of lira La� s 4 0 Business and Professions Code)or that he is exempt Iherefrmn and GTV. PLUMBING PERMIT FEE ¢ H m the iasis for the alleged exemption.Any violation of Section 703 L$ STORIES TYPE CONSTR. a3 — by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 Of not more tion five hundred dollars(S500).Y. ❑ I,as owner of the property,or my employees with wages us BACK FLOW PROTECTDEVICE 4.00 their Sole compensation,will do the work,and the structure is not . OCC.GROUP RES.UNITS intended or offered for sale(Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code: fire 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 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his Own employees,provided that such improve- InentsareGetintendedoroffered for sale.IL however,the building. GAS-EA.SYSTEM-1 INC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner-x' GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 ?r' builder will have the burden of proving that he did not build Or im- BUILDING USE'vAaw prove for purpose ol'salc.). INDUSTRIAL WASTE INTER3000 RES IND, CON PB Orae, ❑ 1,as owner of thex e property,am clusively coritm . . eling with El ❑ El ❑ F-1licensed contractors m construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 600 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 SPR IN KLERS-OV ER 5(EA.) 1.00 contracts for Such projects with a conlractorfs)licensed pursuant to SEWER-SANITARY-STORM EA.200it/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I;un exempt lender Sec. ,B.&P.C.for Ibis WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM :G90 _ ACC.DATE ACC FILE N0. WORK 17 RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insum, or a certificate of Workers'Compensation 1B5ucTge x a certiti•g ZONING ENG.SITE NO. copy l hereof(Sec.3800,Lab.C.)OI —8t7 G,11/}OooO(3�7 Policy No. 'Company Cl9.r& F��D O ❑ Ceti It copy is hereby furnished. FIRE SPRINK ENERGY T44 Z. ❑ Curtit"�µB•.,,jJ�.qpy 0leriw lh m ci calm i Ision. MISC.- REFER TO ORD. O ApplicantlLl.A till �Y_1dY11- 1Y _ Y ❑ N❑ - 'Y ❑ N❑ ~ rn ..1&90 CC — CIiRTI PICATIi OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.U.C. Lu > COMPENSATION INSURANCE PLG.CONTR. LIC.No. - PLG. GIV CL 0 (This section need not be completed if the perm [:]it is for one TOTAL Y N[_ Y ❑ NE]ry Iwndred dollars IS 100)or less.) U O 1 certify that in the performance of Ilia work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL 1— mit is issued,1 shall not employ any person in any manner m as to O W become subject to the Workers'Compensation Laws of California. M Date' Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICE TO APPLICANT: 11,after making Ibis Certificate of Ex- ♦— ? emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK ,itvisions'of the Labor Code, you must forthwith comply with FEE U Such provisions or that permit Shall be deemed revoked. AIR HANDLING UNIT(TO 10)000C.F.NL) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0MC.EM.) 6.00 SEISMIC FEE I hereby affirm Olaf there is a construction fending agency for EXHAUST HOOD(WITH DUCT) 5.00 HE performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lenders Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC 1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4,00 information is street. I agree to comply with all city and county PLUMBING / x.• ordinances and state laws relating In building constmclion, and BOILER-CUMP(3 H.P.Or 100,000 B.T.U.) 6.00 r hereby enthoria0 representatives ec ,his city es enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH, MECHANICAL hereby above-mentioned properly for inspection purposes. (We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE - 10.00 - CONST.TAX in in any wa accrue against said City in consequence of the r ti Of lis , nit. MECH.CONT. LIC.NO. MECH. 2S &—P—K TOTAL TOTAL Signature ol'App leant/Contr Or Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER ' CITY. OF .C.UPERTINO 1552.4 INSPECTION DIVISION • JOB INSPECTION RECORO qq ,� // -"••�� 1PERMIT EXPIRATION JOB ADDR ESS OVoZ9W UM ME4/+ `�/Iy UNIT# LOT# - PERMIT EXPIRES IF WORK OWNER. O VLA .9-LL Cr CONTRACTO L J ee g L(j(r IS NOT STARTED WITHIN DATE L} ;INSP.ECT.DR, �";;��;. ,INSPECTION..R ORD 180 DAYS OF PERMIT ISSU FOUNDATION ANCE OR 180 DAYS FROM NOTE: r LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF -PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE UAIF. ' MECHANICAL 11 BLUG. ELECT. PLG. MECN., DOINOT.POUR FLOOR UNT0ABOVE HAS.BEEN,SIGNEDy I[oINC,PERMIT Jv'J WOOD FLOOR �..1 .IN FO RMATIONl.a--} v 11�TT 5/FT. PLUMBING MECHANICALELECTRICAL / FRAMING [E '��J /V/? ✓ Cp�� r ��C, !r T^G� E- ' INSULATION sTovaes TYPE comm+. OCC GROUP RES.UNITS 'PLACE.NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED" sU FI,FLOORAREA TOIAL.ACREACE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM. THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IND CDNPB. Dm., APPLY;NO'ROOFING•UNTIL.ABOVE HAS BEEN SIGNED:` ij b,'I'J;FINALSr;;± c DATE` INSPi ❑ ❑ ❑ ❑ ❑ ': •; s:;: ROUGH ASSESSORS PARCEL NO. �:�.i SAN.q PLUMBING ELECT.ENERGY TUBS& fHACT NO. PARCEL NO MECHANICAL PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ELECTRICAL ACC.DATE ACC.PILE NO. BUILDING ENERGY FRAMING ELECT.FINAL TEST INSULATION ^/ ZONING ENG,SITE NO.. PLUMBING GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY T:'9 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED" HEATING Y ❑ "❑ r ❑ °'❑ EXTERIOR SHEARFLDOUZONE A.LuC, _ I ELECTRICAL RELEASE INTERIOR SHEAR. FIRE DEPT. Y❑ "❑ Y L "❑ 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 OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC a� *ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING d� Z PLEASE GIVE JOB ADDRESS WHEN PHONING. : I - SEE PERMIT FOR EXPIRATION'DATE — MECHANICAL IMPORTANTI coNST TAx . PLEASE READ REVERSE SIDE EiEFORE CALLING FOR FINAL INSPEC.T.ION.; TOTAC ' J��/��/ g