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17862 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 17862 INSPECTION DIVISION JOB INSPECTION RECORD rl r PERMIT EXPIRATION JOB DDRESS _ + UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER �..,. L �2' CONTRACTOR IS NOT STARTED WITHIN..- INSPECTION DATE INSPECTOR IN PECTION RECORD lHU DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE: LAST CALLEb INSPECTION, LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHnm VALUATION .CUPERTINO STANDARDS. ' GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED }ao)a'��,,3N5 /}N� STAlecw� -fit ,� l�"`T`Y%1• UNDERGROUND /SLAB- -� PLUMBING -`�1-7 ELECTRICAL • - IssUANCE.unrE MECHANICAL - 1 ,7'.. E nLDG .-cr cH R. Q ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BE I E /y� BUILDING PERMIT WOOD FLOOR INFORMATION r0 VALUATION $/FT. PLUMBING MECHANICAL" WI`J®�I)�InWw , ELECTRICAL -'4 t -- r S' � Iv 'SI-.^S. P RMIT TO FRAMINGC INSULATION sroHlEs ry aE.co� "sTa C4C � S � •� . �u WL-11,�'tC� 8 —s� �U S eW�131Ne w OCOR NOD, RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED' 4 e L��+ sn sr.FLoal+ w�me ng ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFOREI ;WPA T TALL ACacE DIAPHRAGM THE CONSTRUCTION TAX IS PAID r / &EG/ UI LOING USE ROOF SHEATHING 2 �'� es Nu CON PB 0"". AP.PLY.NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. H ❑ ❑ ❑ ❑ nssessoas PnHceL Na . - ROUGH SAN.k PLUMBING j '�/� ELECT.-ENERGY iHACr NO, AR NO. SUBS&SHOW PAN PLUMBING ENERGY �9 MECHANICAL • 7 MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DAT FILE No FRAMING -2 �1 C i ELECT.FINAL TEST - G ENG.SITE NO. INSULATION 9-2-15-81 PLUMBING GAS TEST GAS - MECHANICAL `� "RE RINK ENE acv T-14 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` [j FLOOD ZONE A,L U.C. ' EXTERIOR SHEAR _23- E ELECTRICAL RELEASE fj _ INTERIORSHEAR _5 FIRE DEPT. YE] NE] v ❑ ND SHEETROCK _ GRADE - FEE SUMMARY EXTERIOR LATH BUILDING -9'- INTERIOR LATA .� I TEMPORARY APPROVALS BUILDING - �( SCRATCH COAT - - 1 ELECTRIC - LAN CHECK �� GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL.ISSIGNED BY BUILDING INSPEC MICROFILM 111'9 L O ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Cti'9 F- ONE.WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ,( z PLEASE GIVE JOB ADDRESS WHEN PHONING, .. - SEE PERMIT FOR EXPIRATION.DATE - MECHANICAL IMPORTANT! CON ST.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 BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT - -� I� ,. ADOREss I 2 ` s BUILDING-ELECTRICAL-PLUMBING-MECHANICAL x, OWNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE `��L\ Pj pCJ SIS • PHONIG]J Yt1V I fv �f�G LONTRACTO 5 NAME. � L/ OUTLETS-SWITCHES-RECEP 10.00/1.00 ,Od (�AV1=• ME LIC.NO. 167 LIGHTING FIXTURES 10.00/1.00 �--1 p To CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 NEEDS 7•�$ ADDRESS �/ OA�1E HE'�A\lE Ma Q G FSG , PHONE�� _1PANELS '()Do 1 DATE OF APPLICATION ^ ARCHITECT �PLAN CHECK F E P.C.NO. OR PANELS (OVER 200 AMP) 20.00 I'�,1 ENGINEER LIC.NO. SIGNS TRANS. 3.00 �� VWNL7 HRDOREss ENG, SPECIAL CIRCUIT 6.00 .-L/ PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 As ADDDRESSDRESS MOTORS SEE FEE SCH. .OD SERVICE CHANGE 20.00 - w o o LICENSIiD CONTRALTO S DECLARATION a v t 1 hereby aft'inn that I am licensed under provisions of Chapter 9S89 JUL 0 n ISSUANCE GATE '- yz If (commencing with Section 7000)of Division 3 of the Business and < BLDG. ELECT. PLG. MECH. H D i Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑ az o License Class Lia.Number M CU N H w, Lice Contractor W x NIft BUILDING PERMIT n o su U OWNER-BUILDER DECLARATION RATION INFORMATION se ; e, vHi I hereby affirm that I am exempt from Ore Contractors License MISC.- REFER TO ORD Huy J Law for the following reason.(Sea 7031.5,Ilusinessend ProfessionsPERMIT ISSUANCE 1'Q'00 VALUATION $/FT. Code:Any city or county which requires a permit to construct,alter, A-ury.� K ¢ ¢ 0 improve,denmlish,or repair Nay Structure,prior to IN issuance,also ELEC.CONTE. LIC.NO. ELEC. wO u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO he is licensed pursuant to the provisions of the Contractor's License HiQ Law(Chapter 9(commencing with Sect ion 7000)of Division 3 of theA{� -T-I f 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Ah/TDi I '�� a H o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. 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 155001.1: ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Oce.Group RES.urvtTS their solo compensation,will do the work,and the structure Is not intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00IN& so.FT.FLOOR EA TOTAL ACREIGE himself or through his own employees,provided that such improve- .13� I��( ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6,00 or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 a builder will have the burden of proving that he did not build or ire- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ I,as owner of the property,um exclusively automating with 0 ❑ ❑ 0 El licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:'I he Contractor's License Law doe not apply to an owner of property who builds or improvesthereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a conlramons)licensed pursuant to gEWERSANITAR Y=STORM EA.200ft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ I am exempt ander Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner _ Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO, WORKERS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconsent to self-insure. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy Ihercol'(Sec.3800,Lab.C.), Policy No, Compuniy O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 F ZO ❑I Certified copy is filed with the city inspection division. MISC- REFER TO ORD. Y N Y AIcant N W CERT'IFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCEla- FLOOD ZONE A.L.U.C. W > COAIPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. �}n /F-YA ❑ ❑ ❑ ❑ CL M (This section need not be completed if the permit Is I'or one TOTAtO(�(W Y N Y N hundred dollars(S 1001 or Icss) 'U O 1 certify that in the performance of the work forwhich this Per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not employ any person in any manner so ns to OW becom su ec he Workers'Citi n Lnws y)Culil'orniu. a Date/y��yLtd} Applicant_ AM +� BUILDING Q / } W NOTI I�C TO AI�ICANT: If,after making this Certificate of nix- ALTER OR ADD TO MECH. 5.00 46A Z 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 p 2Qs ;r U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 FEE 7 U1v CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm that them is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the pedv,C.). e of the work for which this permit is issued(Sec. MICROFILM 3097, .C.l. HEATING UNIT ITO 100,000 B.T.U.) 6.00 Lender's Name HEATING UNIT(OVER 100,000 B. . 9.50 � - Lender's Address ELECTRIC I'cerlify that I have read this application and state that the above VENTILATION FAN (SINGLE) .00 ,x..1./ information n correct I agree to comply with al oast and county PLUMBING ordinances and state laws relating to Daintily with construction, and BOILER-COMP(3 H.P.or 100,0008. 0 hereby authorize representatives of this city to enter upon the BOILER-COMP (over 100,000 BTU) S above-mentioned property for inspection purposes. 'MECHANICAL (We) agree to save, Inde reify and keep harmless the City of MISC.- REFER upGrxhnr' st liabi'tie judgmenh, c sand expenses which CONST.TAX ay in any w ac tie against saiA in consequence of the PERMIT ISSUANCE 10.00 rantin6 of[Ills Cr L MECH.CONT. LIC.NO. MECH. _ TOTAL TOTAL I ore o pplicant/Contractor OFFICE COPY