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15409 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 15409 INSPECTION DIVISION - f JOB INSPECTION RECORD L , ,2/'s - PERMIT EXPIRATION JOB ADDRESS_Cy�a`3 'V ' Wd�' L� ' UNIT# LOT# ��y. - PERMIT EXPIRES IF WORK OWNER �t/t_T O�qC/[� CONTRACTOR !l�W�cj �QN(7- IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPE TION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: . LIFER - ALL GRADING AND DRAINAGE SHAH LASTCALLED INSP ECTIONBE INSTALLED . PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLRMIT VAIJI)ATION CUPERTINO STANDARDS. GARAGE.SLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -7 J Iff UNDERGROUND /SLAB j aull . G PLUMBING ELECTRICAL I$$UANC[U/+iE p BLDG, ELECT. PLG. MFCH . - MECHANICAL - -� 08 IPe. Q(72.'U- ❑ ❑ ❑ low �"6 eoC�ioWrCP D JL , 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Ju,. �. BUILDING PERMIT v INFORMATION WOOD FLOOR PLUMBING VALUATION SIFT. � � �E�EE MECHANICAL elN �� ELECTRICAL - - PERMIT O FRAMING �-''vd e&me-• - INSULATION ) STORIES TYPE CONSTR. OCC.GROUP 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 I ROOF SHEATHING RES IND ILDLONG USEPBOmr� � APPLY NO ROOFING UNTILABOVEHAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH SAN.» " PLUMBINGELECT.ENERGY TRACT NO PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY - MECHANICAL MECH.ENERGY - - - ELECTRICAL - BUILDING ENERGY ACC DATE ACC.FILE NO FRAMING ELECT.FINAL TEST INSULATION PLUMBING ZONING 'ENcrsITE No. GAS TEST - GAS ., MECHANICAL FIRE SPRINK ENERGY T-2A COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ v ❑ "❑ FLOOD LONE A.L LLC. EXTERIOR SHEAR - ELECTRICAL RELEASE INTERIOR'SHEAR , FIRE DEPT. I Y ❑ N❑ Y ❑ N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING p INTERIOR LATH TEMPORARY APPROVALS BUILDING, SCRATCH COATELECTRIC' .�y, PLAN CHECK GAS FEE M NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE M OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BU ILDINGINSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC �� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. z MECHANICAL. — SEE.PERMIT FOR EXPIRATION DATE — IMPORTANT! coNsr.Tax ' PLEASE READ REVERSE SIDE BEFORE !' is ! . CALLING F.OR FINAL.INSPECTION. TOTAL. OFFICE COPY " APPLICANT TO FILL IN,INFORMATION WITHIN RED LINES - USE BALL,POINT PEN ONLY _ 1' 4 BUILDING PROJECT IDENTIFICATION - :PERMIT NUMBER 'III /1�P/EE�L�,•1F.[-OZ.I p5+I0I LS tlL.�b APPLICATION & PERMIT ALDOG• FA,.AjopIBUILDING - ELECTRICAL-PLUMBING-MECHANICAL 15409 11 TONER's " NAME ( PLAN CHECK VALIDATION r w�L ��yp� ��p OTV. ELECTRIC PERMIT FEE I ' LJFFT JTFIW�'"GT" PHONE - CONTRACTOR'S NAME 14 A�YAc, 2 JL3-7 OUTLETS-SWITCHES-RECEP 10.00/1.00 , �+.Os 'IZIAG t©/ CIC.No. 'T. LIGHTING FIXTURES 10.00/1.00 ADOR's ADDRESS 5C;1S CJ/.11V,1zrzS 1'T`f A(/ APPLIANCES-RESIDENTIAL 4.00 (9 -, PANELS 10.00 PHONE DATE OF APPLICATION ' aflCHITECT -j, OR �kl PANELS (OVER 200 AMP) 2O.00ry PLAN CHECK FEE P.C.NO. - W SIGNS TRANS. 3.00 ARCH.aooREss ENG. PERMIT VALIDATION SPECIALCIRCUIT 5.00 EMP.METER OR POLE INS. 20.00 APPLICANT'S' ADDRESS � MOTORS ' SEE FEE SCH. lS r SERVICE CHANGE 20.00w;App w 00 LICENSED CONTRACTORS DECLARATION ¢w a u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE u (commencing witli Section 7000)of Division 3 of[he Business and BLDG. ELECT. PLG. MECH. 0 y i Professions Code,' d my license is in lull fort a fo .1 ❑ ❑ ❑ pz w - License ChasS_ ,�qp�Lic.Number �'S` Fwc Date_._. IA�•� Contractor - ¢_ w a I-, OWNER-BUILDER DECLARATION BUILDING PERMIT w0 o u INFORMATION ;u w I hereby affirm that I am exempt from rhe Contractor's License MISC.- REFER TO'ORD F a_ O¢ Law for Ote following reason.(Sec.7031.5,Business and Professions ATION $/FT. > PERMIT ISSUANCE 10.00 Coda:Any city or county which requires a permit to construct,alteq 2 ¢ ¢0 improve,demolish.or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. T. c ¢ requires the'applicant for such permit to file a signed statement that _ TOTAELEC.L A W 0 he Is licensed pursuant t0 the provisions of the Contractor's License Q PERMIT T r r Law(Chapter9(commencingwith Section 7000)of Division3 ofthe C`;v% Ex.-O c Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT ( ¢I- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($5001.): ❑ 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 or apply to an owner of property who builds'or improves thereon,and who does such work FIXTURES-PER TRAP - _ 5.00 so.Pr.FLOOR AREA roraL ACREAGE himself or through his own employees,provided that such improve. mems are not intended or Offered 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- builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER30.00 RES IND- CON .PB other . ❑ I,as owner of the property,am exclusively contracting with El El El -1 Ellicensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 VB600 ASSESSORS PARCEL NO. and Professions Code:The Contractors License Law does not apply V.B. . 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 conlractor(s)licensed pursuant to - the Contractor'sLicense Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. ,B.&P.C.for this reason WATER HEATER W/VENT 6.00 - Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 " 1 hereby affirm that 1 have a certificate of consent m self-insure. - or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG:SITE NO. copy thereof(Sec.3800,Lab.CJ. �� � - -Policy No.. cmpany 0 ❑ Certified cop ' hereby nished- - Z Z ❑ Certified c y is Irl• Illi th t its tion dlvoi FIRE SPRINK EN ERGV T$4 F p -, Applicant MISC.- REFER TO ORD. v ❑ N❑ v ❑ N❑ N .CERTI C EOI' AEMPTIf N FROM WORKER ' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.O. W 1 COMPENSATION VNSURANCE PLG.CONTR. LIC.NO. PLG. CL (This section need not be com leted if the permit is for one TOTAL Y❑ IN V❑ No Z hundred dollars($100)or less.) L) O I certify that in the performance of the work for which this per- DTV. MECHANICAL'PERMIT FEE FEE SUMMARY LL H' mil is issued,I shall not employ any person in any manner so as to 0w become subject to the Workers'Compensation Laws of California. p�LJ �CA) BUILDING y Date Applicant ALTER OR ADD TO MECH. 5.00 r } N NOTICE TO APPLICANT: If,after making this Certificate of Ex- Z emprion,you Should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U FEE such provisions or this shall be deemed revoked. AIR HANDLING UNIT(TO 10MOC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1O=C.EM.16.00 SEISMIC FEE 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,Civ.C.). �I � - HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) '4.00 - information is correct.1 agree to comply with all city and county BOILER H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and j abovheree- authorize representatives of this city to enter upon rhe BOILER-COMP (Over 100,000 BTU)SEE FEE SCR. MECHANICAL above-mentioned properly representatives this purposes,to. (We) agree to.save indemnify and keep harmless the City of MISC.-; REFER TO ORD. _ upe 1.0 gains[ li dies,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in way ire against aid ity in con uence of the ranting this p IL' \ / MECH.CONT. LIC.N0. MECH. TOTAL TOTAL. Sig lure of App ant Con tactor Date OFFICE COPY.