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18025 (2) POSTTHIS'CARD NEAR FRONT OF BUILDING !• - PERMIT NUMBER CITY OF CUPERTINO 1 $025 INSPECTION DIVISION JOB INSPECTION RECO/OR/DD PERMIT EXPIRATI ON JOB ADDRESS / UNIT# _LOT# ' PERMIT EXPIRES IF WORK OWNER /"�- '/_ / v�✓ CONTRACTORS' G YC /�f/ IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR - INSPECTION RECORD , 180 DAYS OF PERMIT ISSU. FOUNDATION - ANCE OR 180 DAYS FROM NOTE: UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREG UNITE 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 V49 PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL 7.�i Li2, ?,� BLDG ELE T PLG. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION SIFT. PLUMBING' '. - - MECHANICAL ' T ELECTRICAL PERMIr rte.:.'/ ' FRAMING � p�'�•�'�J a INSULATION PAI STORIES TYPE CONSTW PAIEW . M�' OCC:GHOUP RES,UNIIS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I IUiV ;I, n .19 9 91 ROOF NOTE:NO FINAL INSP.SHALL BE NO PG�g SO,FT.FLOOR AREA TOTAL ACREAGE THE CONSTRUCTION TAXIS PAIDEiO„V_ I 0 . DIAPHRAGM - BUILDING USE ROOF SHEATHING. RES IND CON PB om«, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑' ❑ ❑ ROUGH SAN.N ASSESSORS PARCEL NO PLUMBINGELECT.ENERGY TUBS&SHOWER PAN PLUMBING ENERGY ' TRACT NO PARCEL NO, MECHANICAL , MECR ENERGY - ELECTRICAL BUILDING ENERGY ACC.DATE ACG FILE NO, FRAMING ELECT.FINAL TEST INSULATION PLUMBING ZONING ENG,SITE NO, - - GAS TEST GAS FIRE SPR[NK ENERGY L24 MECHANICAL E] 'N E] r E] N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - FLOOD ZONE AL.0 C. EXTERIOR SHEAR ELECTRICAL RELEASE . .. INTERIOR SHEAR FIRE DEPT. Y❑ "❑ 1 '' ❑ N❑ ' SH,EETROCK ' 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 IOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT,PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDIN G INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICID , LEI ONE WORKING DAY BEFORE REQUIRED, INSPECTION. PLUMBING o PLEASE GIVE.JOB ADDRESS WHEN PHONING. Z 1 - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST,TAX PLEASE READ REVERSE SIDE BEFORE . TOTAL CALLING FOR FINAL INSPECTION.' ' 0O� OFFICE-COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER BUILDING CUP 1N APPLICATION & PERMIT - O O ADORE ^ $u BUILDING - ELECTRICAL-PLUMBING -MECHANICAL ' v J OwrvER'S S PLAN CHECK VALIDATION N/ME .r - vISDNE OTY. , N TONu/, ELECTRIC PERMIT FEE CONTRACTOR'E NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 C' yV✓46, 11(crM 'I b LIGHTING FIXTURES 10.00/1.00 r.Go. as �b Dia PI_-I2(")r APPLIANCES - 4.00 ADOREss ,r - _ Sic3 PHONE b-/6 7 PANELS 10.00 I p. - DATE OF APPLICATION on ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER -LIC.No. ISIGNS TRANS. 3.00 ' ARCH.OR ENG. PERMIT VALI DATION AODRBSS SPECIAL CIRCUIT 5.00 7.SO nP TEMP.METER OR POLE INS. 20.00 J pVN/ ON APPLICANTS MOTORS SEE FEE SCH. «) ADDRESS SERVICE CHANGE 20,00 w 02 LICENSED CONTRACTORS DECLARATION D a v I hereby affirm that I am licensed under provisions of Ch.pon 9 Z 119Q ��( O ISSUANCE GATE I" (commencing with Section 7000)of Division 3 of the Business and rn ¢ y -dam BLDG. ELEC PLG. MECH. r y z Professions Code,and my license is in full force and effect. _ t'j+ z o y License lus5y�-p[�-Lic.Number��., ��f O m r w Uate��L_T-._p_-/-Contmctor}NONLj'__ 'O1/ � ❑,- 0_J ❑ a x g ¢ ¢ OWNIi RB UILDIiR DBUILDING PERMIT ECLARATION - o 0 0 INFORMATION X ; LL N 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD Fu0 J Law for life following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE. 10.00 VALUATION b/FT. i Code:Anycilyorcounly which reyuiresa permit to construct,alter, 0�QQ• ¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.N0. ELEC. �I O an O ¢ requires the applicant for such permit In file a signed statement that TOTAL d P u ERMITTO an$ he is licensed pursuant to ing provisions of the Contractor's License 5i4 Law(ChapterProfessions Codewith Section is 00)exempt the E i D Business and Professions Code)or that he is exempl therefrom and QTY. PLUMBING PERMIT FEE s ¢ H m the basis for the alleged exemption.Any applicant of.aclibn malty STORIES TYPE CONSTR. by any more fora permit dollars the($5000.) tuacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of Get more than five hundred Dollars(my em): ❑ o as owner al the properly,or my employees with wages as BACK F LOW PROTECT,DEVICE 4.00 OCC.GROUP RES,UNITS intheir sole r ofensalion,will(S the work,and the structure is not - \\J intended or Contractor's for ice(Sec. 7044, Business and n owner of DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The h o build of s License Law docs not apply to an owner of properly Who builds or improves eand who docs such work FIXTURES-PER TRAP T.FLOOR AREA TOTALACREAGE himself through his own employeyees,s,provided that such improve- mennato ate not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11 ,6.00 or improvement is sold within one year of Complelion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) _ builder will have the burden of proving that he did not build or int- _ - - - BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ 1,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 qss EssORS PARCEL NO. and Professions Code:*1 he Contractor i License Law dues not amply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts Gorsuch projectswith a Contmctons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ l am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT - 6.00 reason Owner - Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPBNSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of Consent In self-insure., or a certificate of Workers'Compensation InsnrAC,or a certified ZONING ENG.SITE NO., copy thereof(Sec.3800,LnhCA Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGYTY4 Z Z ❑ CerliRed copy Is fled with the city inspection division. O Applicant MISC.- REFER TO ORD. Y•[:] As Y [3 IN ~ w C WIT 1[CAT E OP liXIiMP'I'ION FROM WORK F.RS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C. LU COMPENSATION INSURANCE PLG CONTR. LIC.NO, PLG. ❑ ❑ ❑ ❑ CL O (Phis section need not he completed i1' tire permit is for rasa TOTAL Y N Y N Z hon Bred do11ms(8100)or loss.) U O 1 certify that in life performance of the work for which this per- GTV. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any Person in any murmur so as to O w become subject to the Workers'Compensation Laws of California. Date Applicant BUILDING } cS NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 F emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the labor Code, you must forthwith comply with FEE U such provisions or this permit shall be decoyed revoked. AIR HANDLING UNIT(TO 10=171F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER iQ 1C.F.M.) 6.00 SEISMICFEE I hereby affirm that them 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,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATI NG UN IT ER 100,000 B.T.U.)9.50 00 Lender's Names ELECTRIC 1 certify that I have.Baa this application and state teal the above VENTILATION FAN (SINGLE) 4.00 information correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and � BOILER-COMP(3 H.P.Or 100,0008.T.U.) .6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over l00p00 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. - uperlino against liabilities,judgments, costs and expenses which CONST.TAX may in any way ace ue ng St said City in consequence of the PERMIT ISSUANCE 10.00 rz i of Lisp For . MECH,CONT. LIC.NO, MECH. UOM 4,�- TOTAL TOTAL {�Q Signature of Applicant/Contractor Date ' " OFFICE COPY