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17156 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER -� C1WOF CUPERTINO INSPECTION DIVISION �� JOB INSPECTION RECORD J Q' ("`(� Y PERMIT EXPIRATION JOB ADDR ^ESS�(�" '�' '" ��- 'F ��_U/NIIT#, -LOOT.# PERMIT EXPIRES IF WORK. awrvLR' lY� U' v OONTR ACTON Lj-�{�e, QV` (}�VV IS NOT STARTED WITHIN INSPEC ION - DATE INSPECTOR INS ECT ON.RECOR ) 180 DAYS OF PERMIT ISSU- FOUNDATIONANCE.OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. UFER, _ ALL GRADING AND DRAINAGE SHALL BE INSTALLED PR EGUNITE - 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 PLUMBING7 FED 2 19P ) ELECTRICAL - ISSUANCE DATE MECHANICAL . city ut Cupertino RLUO. EI.ECT,I PLG. - ME CH ED ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. 'PLUMBING MECHANICAL - - PERMIT TU ELECTRICAL FRAMING - •' fie INSULATION - _ STORIES TYPE CONSTR. DOC'GHDUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ' so.FT PLaoI+AREA, rzI rAL ACR[Aee �'•N ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID - BUILDING USE ROOF SHEATHING '' Rl;s IND CON Pe 0"', APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. F-1 ❑ 0 ❑ ASSESSORS PARCEL NO ROUGH SAN.M PLUMBING ELECT.ENERGY TRACT N0. PARCEL NO TUBSBSHOWERPAN - PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC DATE ACC FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT,FINAL TEST ZONING ervc.SITE No. INSULATION PLUMBING GAS TEST - GAS MECHANICAL FIRE SPRINK ''ENERGY 1 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING r ❑ N❑ Y ❑ N❑ EXTERIOR SHEARELECTRICAL RELEASE _- FLoon zorve ALuc. INTERIOR SHEAR FIRE DEPT. Y ❑ N❑ Y ❑. 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 OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL-BUILDING FINALISSIGNEDBY BUILDING INSPECTOR, MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING OPLEASE GIVE•JOB ADDRESS WHEN PHONING. Z - 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 ,PERMIT NUMBER 'DING ING PROJECT IDENTIFICATION APPLICATION BE PERMIT r` /'� BUILDING 'V1 Vh aooyCs� eC p, L.,AlG Q QD BUILDING-ELECTRICAL-PLUMBING-MECHANICAL , OWNER'STT_ G ✓ .J �� / 2�1� PLAN CHECK VALIDATION N°�M J P(({/_r) ^ . OTY. ELECTRIC PERMIT FEE Ai? CONTRACTORS ame acrogs V/) w �y voEr UTLETS.SWITCHES-RECEP 10.00/1.00 4N LIC.NO, LIGHTING FIXTURES 10.00/1.00 roNTRacroRs �L1I APPLIANCES 4.00 _ Pte^ ,r PANELS 10.00 it GATE APPLICATION ARCH E T10 PLAN CHECK FEE P.C. O. " DR ,Fb`�f� ARPANELS (OVER 200 AMP) 20.00 C�E LIC.NO, - SIGNSTRANS. 3.00 ARCH,OR ENG. PERMIT VALIDATION adooREss -1, j 01' SPECIAL CIRCUIT 5.00 -5[l/0 f0 )A4911 rrPA✓nN ,Gp J EMP.METER OR POLE INS. 20,00 T APPLICANS MOTORS SEE FEE SCH. •C ;"e7 REaS SERVICE CHANGE 20.00 �O O LICENSED CONTRACTORS DECLARATION - a u u I hereby affirm that 1 am licensed under provisions of Chapter 9 - ISSUANCE DATE w a w (commencing with Section 7000)of Division 3 of the Business and - BLDG_ ELECT. PLG. MECH. F h z Professions Cmle d nhy license is in full frau•' effect14 AA A z O m - License Class_ Lic.Number _ FEB ° w H 11 60 11�vj Dale-j'.J� ContmcturIlya'A ¢ ¢ w a OWN iR-BUD.DF.R DCCLA RATION BUILDING PERMIT A °w ° MISC.- RD INFORMATION X g;¢ H I hereby affirm that I am exempt from the Contractor's License u O a Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION H _ PERMIT ISSUANCE 10.00 �() Code:Any city or county which structure permit tororisuance,also ¢Q 0 improve,demolish,or repair any structure,prior to its issuance,ulM ELEC.DDNTR, LIC.NO. ELECPERMIT TO . °LL requires the applicant Ibr such permit to file a signed statementment[hal TOTAL w$ he is licensed pursuant to the provisions of the Contractor's License y,z Law(Chapier9(Emnmencing with Section 7000)ofDreision 3 ofthe Q s i° Business and Professions Code)or that he is exempt therefrom a»d QTY. PLUMBING PERMIT FEE - ¢ H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a3 _ by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATEfl (EA.) 5.00 of not more than five hundred dollars($500).): ❑ I,as owner(it the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their Mae compensation,will do the work,and the structure is not intended or offered for sale(Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA, D. 5.00 T Code:The Cmriractor's License Law does not apply to an owner of properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE 7� mm.,himself re through his own employees,provided that such improve ' hia throuot gh or employeeffered for sale.lf,ed that g(he building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner builder will have the burden Ed Proving that he did not build or inh, IGAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES , IND CON PB Other ❑ 1,as owner of the property,am exclusively contracting with . . ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044, Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractors License Law does not apply to un owner of properly who builds or.improves Ihereon,and who LAWN SPRINKLERS-OVER 5-(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ tum exempt under Sec. ,B.&P.(:.for jhls WATER HEATER W/VENT 6.00 re'as'on Owner QQ �JJ Date - WATER SYSTEM 5.00 ACG DATE ACC.FILE NO. WWORKERS'COMI9iiCSX'I�ON DbOCA RATION WATER TREATING EQUIP, 5.00 ' rarefy affirm that I have a certificate of consent to self-insure, or a tifi<ate of Workers Compensation Insurance,or v cctlifal ZONING r ENG.SITE NO. copy the f Sec.3800,Lab.C.I. - Policy No. COmpally__L.1J/ FL - 0 ❑ Certified copy is hereby famished' FIRE$PgINK ENERGY T 24 Z Z ❑ Certifie copy is-filed with th- city`insp.ec�tion division. MISC.• REFER TO ORD. Q Applicant VlY�• Y ❑ N❑ Y ❑ . N❑ M W CERTIPICA'I'Ii OP F:%li IPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.II.C. LLI > COMPENSATION INSURANCE PLC.CONTE. LIC.NO. PLG. CL 0 (This station need not he completed if the permit in for one TOTAL V❑ N❑ Y❑ N❑ O hundred dollars($100)or less.) I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY U. H mit is issued,1 shall riot employ any person in tiny manner so as to 0 w become subject to the Workeri Compensation Laws of California. Date Applicant BUILDING >_ W NOTICE: TO APPLICANT: If,after making this Certificate of fix- ALTER OR ADD TO MECH. 5.00 F ? mnption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forlhwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency lot EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Cie C.). Al, P.fr F',G HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name �I HEATING UN IT 100,000 B.T.U.)9.50 Lender's Address ELECTRIC - I certify that l hav Bids a h tit rid state that the above VENTILATION FAN (SINGLE) .4.00 ...dicvation n correct. agree to comply with all city whit county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING oNinances and state laws relating to building construct ion, and I hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCM. MECHANICAL above-mentioned property for inspection purposes. _ - (We) agree to save, indemnity unit keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments,costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX i any way accrue against said City in comequen a of the rant of t his permit MECH.CONT. LIC.NO. MECH. .l TOTAL TOTAL na reof Applicant/Contractor D. e OFFICE COPY