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14569 (2) POST THIS CARD NEAR FRONT.OF.BUILDING PERMIT NUMBER .CITY OF CUPERTINO 14569 INSPECTION DIVISION • JOB INSPECTION'RECORD _ PERMIT EXPIRATION JOB ADDRESS 1217 WEymOth DYNE ` UNIT# _LOT# LO - A. & H HEdt1II PERMIT EXPIRES IF WORK OWNER CONTRACTOR EI IS NOT STARTED WITHIN .INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE 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 PER rnnr vn LlDntloN CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ' PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL - BLDG ELECT, PLG. MECH ❑�. El El 'Ip DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION .PLUMBING VALUATION $/FT. MECHANICAL ELECTRICAL PERMIT TO -1 - � FRAMING - „ uiF-L .:i. STORIES INSULATION TYPE CONSTH, I OCG GROUP RES UNITS. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED FLOOII AREA TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.'SHALL BE MACIGBBOI�E" - DIAPHRAGM THE CONSTRUCTION TAX IS PAID rr 44 . BUILDING USE ROOF SHEATHING filtv VM' IND CON PB om.- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE _11,11SP. ❑ ❑ ❑ ❑ ❑ ROUGH SAN.a ASSESSORS PARCEL NO ' PLUMBING ELECT.ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO _/ - MECHANICAL MECH.ENERGY ACC.DATE ACC FILE N0, ELECTRICAL BUILDING ENERGY ; ' - FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY r29 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING r Y ❑ No ❑ NF] , EXTERIOR SHEAR ELECTRICAL'RELEASE FLOOD ZONE A.L a c INTERIOR SHEAR FIRE DEPT. Y❑ NO Y*L-1 IN C] SHEETROCK GRADE EE SUMMARY EXTERIOR LATH BUILL IN -// INTERIOR LATH T MPORARY APPROVALS 10T G SCRATCH COAT ELECTRI - ECK . GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY FEEOCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNEDBYBUILDING INSPECTOR. LMARRANGEFOR INSPECTION BY PHONING 252-4505CLONE WORKING DAY BEFORE REQUIRED INSPECTION.~� G0 PLEASE GIVE J06 ADDRESS Wp�EN PWONING. ' ''" 'ZSEE PERMIT FOR EXPIRATION DATE - ICALAXIMPORTANT!PLEASE READ REVERSE SIDE BEFORE AL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY _ PERMIT NUMBER BUILDING PROJECT IIDENTIFICATION APPLICATION 4569 BUILDING J o J ADDRESS BUILDING- ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION "AME. //�� QTY. ELECTRIC PERMIT FEE ' UPHON � / NAMERAcroRs OUTLETS-SWITCHES-RECEP 10.00/1.00 G _C.NO,5D LIGHTING FIXTURES 10.00/1.00 CONRRCONTRACTOR. ADDRESSAPPLIANCES-RESIDENTIAL 4.00 ADRAC �PHONE ,o 0 PANELS 10.00 DATE OF APPLICATION OR PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEEP.C.NO. RR ENGINEER LIC.NO. SIGNS TRANS. 3.00 ARCH Ess ENG. SPECIALCIRCUIT 5.00 PERMIT VALI DATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 ,-02 LICENSED CONTRACTORS DECLARATION/ / Fi w 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE' a n (commencing with Section 7000)of Division 3 of the Business and, BLDG. ELECT. PLG. MECH. r y z Professions Codd t ease is in rnbe ur - ❑ ❑ ❑ Z' z w 0 License C s Lic.Number P In r j Date Contractor aIS ¢ OWN1:R BUILDING PERMIT o a D Bul u)ER DECLARATION INFORMATION `x ;LL t- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD w 'A VALUATION $/FT. Rw0 J Lew for the lollowing reason.(Sec.7031.5,Businessund Professions PERMIT ISSUANCE 10.00 f yj0 Code:Any city orcointy which requires a permit to construct,alter, rz ca St, improve,demolish,or repair any structure,poor to ELEC.CONTR. LIC.NO.its issuance,also ELEC. - wZ u requires the applicant for such permit to file a signed statementisLithat TOTAL PERMIT $ re is licensed pursuant to the Provisions of the Contractors License i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe a Ilusiness and Professions Code)or that he is exempt therefrom and GTY. PLUMBING PERMIT FEE /11 EE 0 the basis for the alleged exemption.An violation of Section 7031.5 p 8 p il STORIES TYPE CONSTR. y ; m by any applicant fire permit dolhistile(S500phC9mt lna Clvl penalty ALTER-DRAIN 5,00 of not more than five hundred dollars(5500).): - , ❑ I,as owner of Ilse property,of my employees with wagesas _ BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do.the work,and the structure is not OCC.GROUP RES.UNITS 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 doesueh work FIXTURES,PER TRAP 6.00 SO.FT.FLOOfl AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsam"otintended or ffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 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 he did not build or im- BUILDING USE prove for purpose of sale.). RES IND CON PB Omar ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 licensed'contractors to construct tile project(Sec. 7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARGE:NO. and Professions Cade:'I'he Contractor's License Law does riot apply to an owner al'properly.who builds Or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractor s)li caned pursuant to the Contractors License law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. ❑ lam exempt under Sec.-,B.&P.C.for this reason WATER HEATER WIVENT 6.00 Owner _ Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE 140. WORKERS'COMPENSATION DECLARATION - WATER TREATING EQUIP. 5.00 I Hereby affirm that I have a certificate of consent toself-insure, or a certificate of Workers Compensation Insurance,or a ratified I ZONING ENG.SITE NO. /y,,�,`e 00,Lab.C... I IT F O CCC��1 Certified copy i5 hereby lurni5h¢d/�/1Y)C19N1 FIRE SPR I NK EN ERGV T-24 Z Z Certhd is f)lcA with tete ty inspumion Ivlslon. Allplicant!y.!Lh!_�I'.In/--1� MISC.- REFER TO ORD, Y E] N❑ Y E] N[3 ~ Oy PERMIT ISSUANCE 10.00 � - CERTIFICATE OP Ii%IiA11'TION FROM WORKERS' FLOOD ZONE A.L.U.C. LU I I COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG. CL Q (This section need not be completed if the permit is for one TOTAL Y[] N Y[D N Z hundred dollars IS 100)or less.) IkV (_) O I certify that in the performance of the work for which this per- QTY. MECHANICAL ERMIT FEE FEE SUMMARY LL I- mit is issued, I shall not employ any person in any manner so as to n O W became subject to the Workers'Compensation Laws of California. 0. Dale ApplicantBUILDING } N NOTICE. TO'APPLICANf: If,alter making this Certificate of lix ALTER OR ADD TO 5.00 Z emption,you should become subject lO the Workers'Compensatio l APPLIANCE 0 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 IT 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C,FNL) 6.00 SEISMIC FEE bhemby affirm that there is a construction lending agency for I EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 5 Lender's Address ELECTRIC I certify that I haJ¢road this application and state that the ubovc VENTILATION FAN (SINGLE) 4.00 ordinarce, n correcState la agree to comply b with all city and county BOILER-OOMP l3 H.P.or 100,000 B.T.U.) &001PLUMBING ordinunc¢s and slate lows relating to building construction, and hereby authorize representatives of this city to enter Inion the BOILER-COMP (Over 100,000 BTU)SEE FEESCH.1 MECHANICAL S a above-mentioned property 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 m y n any waK Acer a gainst said City in consequence of the r n ng aof n lhls p¢face MECH.CONT. LIC.NO. MECH. _ 7� TOT A S� TOTAL signature of Apphcanl/Cont or Date „/ l� / 7 / OFFICE COPY