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15242 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMITNUMBER CITY OF, CUPERTINO 15242 INSPECTION DIVISION JOB INSPECTION,RECORD' 7 } , r PERMITTEXPIRATION '� >� _ N, � JOB ADDRESS az o4�'e I rl UNIT# `I bY_LOT# PERMIT EXPIRES IF WORK OWNER E'T/7c SO 1:1`7/CR C - CONTRACTOR q-L� �L�- J•pC/fj- Cf- IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSP TION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - - ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION.- UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED 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 ISSLOCE DATE MECHANICAL BLOG ELECT R PLG, MEC .. O ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - - 9?l INFORMATION PLUMBING \ VALUATION sIPL MECHANICAL - Lo ELECTRICAL PERMIT T ,/ FRAMING �i`'YP�CV / N r INSULATION STORIeS. TYPE CONSTR, ' � 1 OCG.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL:INSP.SHALL BE MADE BEFORE 5°-" FLOOR AREA TOTAL ACREAGE . DIAPHRAGM THE CONSTRUCTION TAXIS PAID RUILOI usE ROOF SHEATHING Res IND CON PB On,.. . APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 0 0 0 0 ROUGH SAN.N ASSESSORSPARCEL PLUMBING - ELECT.ENERGY TUBS&SHOWER PAN PLUMBING ENERGY TRACT No. PARCEL No MECHANICAL MECH.ENERGY• ELECTRICAL BUILDING ENERGY ACC.DATE ACC FILE NO FRAMING ELECT.FINAL TEST ZONING ENG.SIZE NOkr INSULATION PLUMBING _ GAS TEST GAS MECHANICAL EIRE SPRINK ENERGY.T za COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑ EXTERIOR SHEAR - ELECTRICAL RELEASE w FLOOD TONE ALUC INTERIOR SHEAR FIRE DEPT. - Y❑ N❑ Y ❑ N❑ SHEETROCK, GRADE - FEESUMMARY 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 OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. ( .• Z = SEE PERMIT FOR EXPIRATION DATE - MECHANICAL I IMPORTANTI CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY AF,r LICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY r'. BUILDIN11PROJECT IDENTIFICATION PERM IT NUMBER ' r ADDRESS APPLICATION & PERMIT ILI) alO ILDING - ELECTRICAL-PLUMBING-MECHANICAL 15242 J2A ( OWNER'S PLAN CHECK VALIDATION �y NAM OTyELECTRIC PERMIT FEE, 761" �•, v NAME ncTORs OUTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 nool ess As PPL(ANCES-RESIDENTIAL 4.00 - . �� -ONE9 _Q __ PANELS - 10,00 DATE OF APPLICATION! oRRCHITECT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE _P,.C.NO. ENGINEER \ Cy uc.NO. SIGNS TRANS. 3.00 ADDRR'ESS OR i,... SPECIAL CIRCUIT• 5.00 PERMIT VALIDATION ✓✓✓BGG 2 (/ C o !eP, z I P TEMP.METER OR POLE INS. 20.00 �- APPLICANT'S - l'.�R�O✓_N-`�_-__'�-' ADDRESS MOTORS SEE FEE SCH. w Vrqw 19v,osSERVICE CHANGE 20.00 Hoo LICENSED CON'T'RACTORS DECLARATION ri w 1 hereby affirm that I am licensed under provisions of Chapter 9 - - ISSUANCE DATE < (commencingB with Suction 7000)of Division 3 of the usiness unit BLOC ELECT. PLG. MEC.. H w i Professions Code,a my license is in full far' y esl_fjepj.� ❑ ❑ zo i m G License Class Lic.Numbe Z F W H J Date n/!� Contractor / Q,�.e `\ _ a a w < // OWNER-BUILDER DECLAW Q v� QDI NG PERMIT E o a FORMATION w m I hereby affirm that I um exempt from the Conine License MISC.— REFER TO ORD LL o j Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $)FT. Code:Any city or county which requires a permit to construct,alter, 2 rc e[ 0 improve,demolish,or repair any structure,prior to its issuance.also ELEC.CONTR. LIG NO. /� Q.� d m a requires the applicant I'or such permit to file a signed statement that TOTAL w he is licensed pursuant to Ole provisions of the Contractor's License rii Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe E i o Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE /f/9�4' 1G •fGC/Q� X F the basis for the alleged exemption.Any violation of Section 7031.5 STORdES TYPE CONSTR. d3 $ by any applicant fora permit subjects ppl a mthe applicant toacivilpenuhy _ p of not ore than fora hundred dollars the ppl: ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 DCC.GROUP RES.UNITS sole compensation,will do the work,and the structure is not intended or ol'I'cred 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 SO.FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- �� ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-111NC.40UTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not hui lit or im, GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). RES IND CON PB Other ❑ I,as owner of the property,amexclusively contracting with IINDUSTRIAL WASTE INTER. 30.00 11 0 ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 8.00 ASSESSORS PARCEL NO. D 13 and Professions Code:The Contractor's License Law does not apply to an owner or property who builds or improves(hereon,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.200k 00 TRACT NO. PARCEL NO. ❑ Tum exempt under Sec. ,B.&P.C.for this reaWATER HEATER W/VENT -�E 0 son Owner Dutc WATER SYSTEM 0 ,T�. ACC.GATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 100 - I heraffirm that 1 have a certificate of consent to self-insure, - or a certificate of Workers'Compensation Inset a nce,or a cerci .• ZONING ENG.SITE NO. - it ry(I ce.3800,Luh.C.). YYLeAC cim pero1A - POPO��'y��olf� — mpany_ITNR Fy w-O !f e1. O ❑ Certiti•d co y Is hereby furnished Z Z� Cl Certified ohy is led with the city inspection division. FIRESPRINK. ENERGY T-24 F O / Applicard, 1 t 7fps/ MISC.- REFER TO ORD. YEl C]v N� rA CERTIFICATE 017 FXEMPI'ION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > COMPHNSATION INSURANCE PLG.CONTH, LIC.NO. - PLG. � 0 (This section need not be completed if the permit is for one TOTAL Y0 N E3 v E] N❑ hundred dollars($100)or less.I U O I certify that in the performance of the work for which this per- OTY. .MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to O W become subject to the Workers Compensation Laws of California. Date—Applicant BUILDING >. y M NOTICE TO APPLICANT: If,after making this Certificate of lox- ALTER OR ADD TO MECH.. 5.00 f— ? craft ion,you should become subject to the Workers'Conipeusat ion APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or[his permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=41F.M.) 4.00 CONS'(' OM ION LENDINGAG17NCY AIR HANDLING UNIT(OVER IQOWGEM.) 6.00 SEISMIC FEE /4,C" 1 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,Ce C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT IOV ER 100,000 B.T.U.)Lender's Address ELECTRIC 1 certify that 1 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 BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances unit state laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep lorniless file City of 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 this pe nn it, MEC..CONT. LIG NO. MECH. TOTAL TOTAL I S/ &gnature of Applicant/Con Vector Date OFFICE COPY