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15491 (2) POST THIS CARD NEAR FRONT OF BUILDING . PERMIT NUMBER CITY OF CUPERTINO 15491 INSPECTION DIVISION JOB INSPECTION RECORD AW1 PERMIT EXPIRATION JOB ADDRESS 868. South . StE;llinQ UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER, Blair CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYSTROM_ NOTE: ' UFER � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. 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 - a ISSUANCE GATE MECHANICAL - - BLDG ELECT. IPL; MECH. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMITA WOOD FLOOR - - -• - INFORMATION PLUMBING - VALUATION SIFT. ' MECHANICAL - ' ELECTRICAL - - PERMIr TO FRAMING INSULATION STORIES TYPE CONSTR. " � - � , i OCC.IjRuull RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' SO.FT FLOOR AREA TOTAL ACREAGE • ROOF. NOTE:NO FINAL INSP.SHALL BE MADE BEFORE ' DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING ' - ; HCS IND CON ' PB Um,., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ E] ASSESSORS PARCEL NO ' ROUGH SAN.k ' • • PLUMBING - - - ELECT.ENERGY TRACT NO. PARCEL NO TUBS&SHOWER'PAN PLUMBING ENERGY p MECHANICAL - MECH.ENERGY ' ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO FRAMING - ELECT.FINAL TEST . ?d•(f ZONING ENG.SITE NO, INSULATION PLUMBING 6)0 Alf GAS TEST - GAS . MECHANICAL FIRE SPRINK ENERGY T;14_ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED, HEATINGFLOOD ZONE A.L UC. Y E] N[] Y E] No ' EXTERIOR SHEAR ELECTRICAL RELEASE '' .❑ Y ❑ - N❑ INTERIOR SHEAR FIRE DEPT.-,• ' YN❑ SHEETROCK GRADE - FEE SUMMARY EXTERIOR LATH - BUILDING 23A719 INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC - PLAN CHECK _ GASNO 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 , 0 II-- ONE WORKING.DAY BEFORE REQUIRED INSPECTION. PLUMBING / o PLEASE GIVEJOB ADDRESS WHEN PHONING. MECHANICAL -.'SEE-'SEE PERMIT, FOR EXPIRATION,DATE - IMPORTANT! CONST.TA%, PLEASE READ REVERSE SIDE BEFORE .o CALLING FOR FINAL INSPECTION: TOTAL OFFICE COPY.- APPlJCANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILBUILDING UI LD1 NG PROJECT IDENTIFICATION - n'PERMI ^T NUMBER A-� APPLICATION & PERMIT ' `l�J `�JJ ADo�� C./�� S ✓/�'-(.�11l� BUILDING -ELECTRICAL-PLUMBING -MECHANICAL OWNER'S - PLAN CHECK VALIDATION -� NAsee t QTY. ELECTRIC PERMIT FEE • f PHONE L�ObS Np'rvy`TRAcroRs p / r OUTLETS-SWITCHES-RECEP 10.00/1.00 UC.No ` . TT62,z;� / LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S s1,2 PPLIANCES-RESIDENTIAL '4.00 ADORE52 JCC/IV/1JP -p" PHONE 71/ -Y'724 PANELS 10,00 DATE OF APPLICATIOOR N ll ARCHITECT PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P,a No. ENGINEER i Lot No. ' SIGNS TRANS. 3.00 " ADDRESS ENG' - SPECIALCIRCUIT 5,00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 APPLIOO.CAFSS MOTORS SEE FEE SCH. AOR SERVICE CHANGE 20.00 Ho o LICENSED CONI'RACTORS DECLARATION /�led rt i w I hereby affirm that I am licensed under provisions of Chapter') ISSUANCE DATE y G (commencing with Section 7000)of Uivisian 3 of the Business and BLDG. ELECT. PLG. MECH. F m i Professions Code,and my license Is in full farce and effect. o 0 m D License Class Lic.Number T F w r J Datc Contractor sz�� CR Ix a, w u OWNER-BUILDER DECLARATION t, BUILDING PERMIT o. MISC.- REFER TO ORD .i INFORMATION is ; I 1 hereby affirm that I on exempt from the Contractor's License [`I, r u o J Law for the following reason.(Sec.7031.5,Business and Professions VALUATION + $/FT. v+ Code:Any city or county which requiresa permit to construct,alter, PERMIT ISSUANCE 10.0014 - e : Qp ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. O LL requires the applicant for such permit to file a signed statement that TOTAL C a PERMIT TO E At he is licensed 9(eumtt to the provisions of 00 Contractor's License 7� � C H10Law(Chapter 9(commencingwith Section 7000)of Division3oflhe AfE'V a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE M r $ the basis for the aIle•ed exeni tion.An 6 p he appliono f Sac civil malty STORIES TYPE CONSTR. by any applicant for apermitsubjects SSOO).licam toacivil penshy ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(5500).): ❑ 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 d0 the work,and the struc4ue is not intended or offered for sale (Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:I lie Contractor's License Low does not apply to on owner of property who builds or improves thereon,and who does sach work FIXTURES-PER TRAP 5.00 FT.FLOOR ARFA TOTAL ACREAGE m eats Cor through his own eared for S Provided that such improves mems are not intended or offered for s'alc.If,however,the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 or improvement is sold within one year Of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that lie did tint build or int- 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 ❑ ❑ El ❑ licensed contractors t0 construct the project'(Set.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 an Owner of property who builds Or improves thereon•and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractons)licensed pursuant to SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO. the Co ntractor's License Law. ❑ lam exempt under Sea ,B.&P.C.for thisless on WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARA7ION WATER TREATING EQUIP. 5.00 I herchy infirm that l ha a certificate ofconsent msell'-insure, or a certificate of WO ker'COmpentralion Insurance,or a certified ZONING ENG.SITE NO. copy IhereoffSec. 0 .C.. Polley No. ( y O ❑ Certified c rc y furnished. FIRE SPRINK ENERGY T 24 Z ❑ Certified copy is fled with the city inspection division. MISC.- REFER TO ORD. O APPlicont Y NO , VEl No ~ w+ PERMIT ISSUANCE - 10.00 O Cr CIiRTI PIC I'Ii HN)AX ION ION FROM WORKERS' FLOOD ZONE A.L.u.C. W OMPot be completed INSURANCE tine PLc.CONTR. LIC.No. PLG. /3-d,U O ❑ ❑ ❑ CL O (This section need not be completed if the permit is for one TOTAL V N V N ::) Z hundred dollars($100)or Ic sJ ' U O I certify that in the performance of the work for ieh this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued, I sh II not employ ce of the in any n tier so as r- U UU become ly LLte Workers'Q e1nC IdL W Lu A y Patc Applicum BUILDING -r�Gwl sr } N NOTICE 'TO APPLICANT: If,alter making this Certificate of fix- ALTER OR ADD TO MECH. 5.00 rZ 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 deemed revoked.. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE SD 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.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC ok.Q I 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 /U ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6,00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Ova,100,000 BTU)SEE FEESCH. MECHANICAL above-mentioned properly for inspection purposes. (We) agree to save, indemnify and ke p harmless the City of MISC.- REFER TO ORD. Caperfiao against liabilities•lodgments, c is and expenses which CONST.TAX ay in any way :I ru ig inst said Cit in consequence of[hu PERMIT ISSUANCE - 10.00 ranting of[his per IL MECH.CONT. LIC NO, MECH. TOTAL TOTAL �Q Signature of Applicant/Contractor Date OFFICE COPY