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18162 (2) 1 POST THIS CARD NEAR FRONT OF-BUILDING PERMIT NUMBER CITY OF. CUPERTINO g12 INSPECTION DIVISION . JOB INSPECTION RECORD/ p—i- ( � � �/` F PERMIT EXPIRATION JOB ADDRESS_ Q 1/Y l I �Q____ A� UNIT# LOT# PERMIT EXPIRES IF WORK owNER ti e1. CONTRACTOR ` rl be V 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. PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPER71N0 STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED FWD UNDERGROUND /SLAB J, �`�d N.V Ct I PLUMBING - Ij9N , ELECTRICAL . .ISSUANCE DATE MECHANICALBLELECT. PLG. MECH DG. ❑ I x1 1 ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VA Pr PLUMBING MECHANICAL ELECTRICAL - - -PERMIT TO / FRAMING � ( INSULATION ' SrOHIE17 TYPECONSTR UCC GROUP RES,UNIT PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 51, EA TOTAL ACREAGE • / ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAXIS PAID BUILDING USE ROOFSHEATHING HES IND CON PB am., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSL55ORS PAH GEL NO ROUGH SANA PLUMBING ELECT.ENERGY TRA CT NO, PARCEL NO TUBS BSHOWER PAN PLUMBING ENERGY MECHANICAL MECR ENERGY, ELECTRICAL , BUILDING ENERGY ACC.UATE ACC FILE NO FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE SPRINK ENERGY L24 MECHANICAL v E] No Y [j IN COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A L U C ❑ N❑ INTERIOR SHEAR FIRE DEPT. � YL7 T,❑ ' SHEETROCK G ADE9 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 JOCCUPANCY I SEISMIC FEE . OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED13Y BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC r ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o PLEASE GIVE JOB ADDRESS WHEN PHONING. . Z• " — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! coNs7.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 '6UI LDI,;1G PROJECT 1 DENTI FICATION PERMIT NUMBER aolieiNse APPLICATIONIi PERMIT 6 2 I V Z B I DI G-ELECTRICAL-PLUMBING-MECHANICAL g. 6J OWNER'S NAME PLAN CHECK VALIDATION I'A`v.1 �� OTY. ELECTRIC PERMIT FEE CONTRACTORS NAME OUTLETS-SWITCHES-RECEP 10,00/1.00 P,:�X-V LIC.No. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR AAPPLIANCES-RESIDENTIAL 4.00 CONTRAS , O K/ Gt PHONE L3 S/6- Ve PANELS I 10.00 DATE OF APPLICATION OORRCHIrIia PANELSI0VER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.NO. SIGNS TRANS. 3,00 ' ARCH.OR ENG. - PERMIT VALIDATION ADDRESS SPECIALCIRCUIT 5.00 zip TEMP.METER OR POLE INS. 20.00 '", APPLICANTS MOTORS SEE FEE SCH. ADDRESS ¢ z: SERVICE CHANGE - 20.00 S? 0 FoLICENSED CONTRACTORS DECLARATION � .. a I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE ` v~i< vNi (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. r N z Professions Code,and my license is in full force and effect. jU14 ❑ s� ❑ ❑ i 0 w - License Class Lic.Number IVY�I 2 m r ea Dale Contractor rc Y a OWNER-BUILDER DECLARATION City Of Cupertino BUILDING PERMIT - o a u INFORMATION X 3: u r I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD w VALUATION SIFT. Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 ,L-D Ew�f Code:Any City or county which requires a permit to construct,alter, SE ¢ Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH. LIC.NO. ELEC. n a requires the applicant for such permit to file a signed statement that TOTAL /fir�1 PERMIT TO w m he is licensed pursuant to the provisions of the Contractor's License Fzi Law(ChapterProfessions Cde)with Section is 00)exempt the •'` V a easiness and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Ei o ¢ ,-m the basis for the alleged exemption.Any violation of Section 7031.5 STORIE TYPE CONSTR. aa dam _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5,00 of not more(list)five hundred dollars($500)J: ❑ I,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 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 5.00 SD,FT.FLOOR AREA TOTAL ACREAGE himself or through his own mnployees,provided that such improve- - meatsarenotintendedorofferedfarsale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner. GAS EASYSTEM OVER 4 IEA) 200 builder will have the burden of proving that he did not build or int- - . - . . BUILDING USE prove for purpose of sale.). RES IND ' CON PB OthnINDUSTRIAL WASTE INTER. 30.00 ❑ d as owner of the construct am project Se contracting with 11 0 licensed contractors to construct the project La 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions grope The Contractors License Law does not apply to tr owner of properly who builds tr improves rased m:usdwho LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts ct such projects with a ttmtractorlsl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,Is.&P.C.far this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK Ii RS'COMPENSAT10N DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy T hereof(Sec.3800, ). Policy No. Companyymny ❑�rt ified copy is hereby furnished, r FIRE SPRINK ENERGY T.24 Z Z ddlicant tied o�y is d it the city inspection Division. p applicant ✓,F - � MISC.- REFER TO ORD. Y� N� v ❑ N� ~ Oa PERMIT ISSUANCE 10.00 Lu - CERTIFICCOMPE EXEMPTION INS PR NC17 ERS' FLOOD ZONE A.L.U.C. W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. � Z ('Phis section need not he completed if the permit is for one TOTAL YE] N[ v CJ N� hundreddollars(S1001 less.) U O 1 certify that in the perfornanoe of the work for which this par- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued.I shall not employ any person in any munnerso as m become subject to the Workers'Compensalion Laws of Culifnrnia. 0 y Datc ApplicantBUILDING } W NOTICE TO APPLICANT: II,after making this Cerlificzte of rix. ALTER OR ADD TO MECH. 5.00 F 2 eniption,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 permil shall be deemed revoked. AIR HANDLING UNIT(TO 10PMC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 hereby affirm tall there is a construction lending agency 1'ar 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.) 6.00 Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50 OV Lender's Address ELECTRIC I certify that l have real 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 ordinances and slure laws relating to building construction, End 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 lover 100,000 BTU)SEE FEE SCN. MECHANICAL above-mentioned property for inspection purpnsos. (We) agree to Save, indemnify and keep harmless the City DI MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the ranting of th is pe in t. MECHC 0NT. LIC.NO. MECH. -o�G` TOTAL TOTAL Signature of Applicant/U94tractor Date OFFICE COPY