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15786 (2) f POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER i CITY . OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD ,/ 15.6 PERMIT EXPIRATION JOB ADDRESS /o/.12 /V , �OL�' �}Q UNIT# 'F 'LOT# � ` PERMIT EXPIRES IF WORK cFu T DINNER CONTRACTOR ,C Si�"�/ IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180..DAYS OF PERMIT ISSU- FOUNDATI N - 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 7• ELECTRICAL IssuANCE DATE MECHANICAL BLuc, ELecT PLG. MECR DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR A•� INFORMATION PLUMBING DvawnnO" .S/Fr. MECHANICAL of ELECTRICAL PERMIT TO FRAMING S/&/qj ' INSULATION STORIES TYPE CONSTR OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - a ROOF _ NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so IT FLOOR ARCA rorAL ncReAcc DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IN CON PB 0"r APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. O ❑ ❑ 0 ❑ ROUGH SAN.H A SSESSORS PARCEL NO, , PLUMBING ELECT.ENERGY TRACT NO PARCEL NO TUBS&SHOWER PAN PLUMDING ENERGY MECHANICAL MECH.ENERGY ELECTRICAL - BUILDING ENERGY ACC DATE ACC.FILE NO FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION - PLUMBING GAS TEST GAS MECHANICAL FIRE SPRWK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y "� Y NO EXTERIOR SHEARELECTRICAL RELEASE FLOOD ZONE ALUc. INTERIOR SHEAR FIRE DEPT. 7 Y,O - NO YO N❑, SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING .INTERIOR LATH TEMPORARY APPROVALS EFEE 33 �- SCRATCH COAT ELECTRIC - - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC c, ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING a oPLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL <:,• , = SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! coNST. rax PLEASE READ REVERSE SIDE BEFORE ac?.; a'9 TOTAL — a3 S. CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY - • :BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT AOORE55 �� _ N, �' dL �• BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 15786 OWNSR's PLAN CHECK VALIDATION NAM y� DTV. ELECTRIC PERMIT FEE l^7 - � To PHONE • CONTRA TOH'S—�•-'� ��--� OUTLETS-SWITCHES-hECEP 10.00/1.00 LIC,NO. ZZ, LIGHTING FIXTURES 10.00/1.00 ADDRESS R'S' -��5�/ G` APPLIANCES-RESIDENTIAL 4.00 CONTRAS yJ/o�j [/ PRO % O°'O- PANELS 10.00 PATE OF APPL KATION OR RRPANELS (OVER 200 AMP) 20.00 ... PLAN CHECK FEE. P.C:NO. ENGINEER uc.NO. I ISIGNS TRANS. 3.00 0"_ ARCH.OR Y ADORERS ENG. SPECIAL CIRCUIT 5.00 • PERMIT VALIDATION ZIP TEMP. METER OR POLE INS. 20.00 APPLICANT'S AODRESs MOTORS SEE FEE SCH: SERVICE CHANGE 20.00 - -7 "4"_ _ w02 LICENSED CONTRACTORS DECLARATION �d wI hereby affirm that I am licensed under provisions of y Chapter 9 a y (comment rig with Section 7000)of Division 3 of the Business and gIII��ppp CTNCE PUG. MECH. w Professions Code and m license is in full force a d f ect. g, ❑ ❑ oz m o License Class Contract u Z f Date Contractor f� ¢ w u . OWNER-BUILDER DECLARATION MISC. r.0 INFORMATWDING RMIT wION 1 hereby affirm that I am exempt from the Contractor's License - REFER TO ORD VALUATION $/FL, LL 0 ¢ Law for the following reason.(Sec.7031.5,Business and Professions L - PERMIT ISSUANCE / w Y Code:Any city or county which requires permit to construct,utter, S ¢ ¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. wO u requires the applicant for such permit to file a signed statement that TOTAL PERMJ T TO he is licensed pursuant to the provisions of the Contractor's Licensef D �G �zQLaw(Chapter 9(Commencing with Section 7000)oivision 3 ofthe Lrj7 z c Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE re H m the basis for the alleged exemption.Any violation of Section 7031.5 •STORIES TYPE CONSTR. a3 � by anyapplicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5,00 of not more than five hundred dollars($500y): ❑ 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 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 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such Improve. rents 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- EA.) 2.00 OVER 4(SYSTEM EA.- - builder will have the burden of proving that he did not build or int- GAS- BUILDING USE prove for purpose of sale.). RES IND CON PB Other ❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 'Ellicensed contractors to construct the project(Sea in 7044,Busess LAWN SPRINKLERS-1 INC 5 00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law docs 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 contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. 'TRACT NO. PARCEL NO. ❑ l am exempt under Sec,—,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.-3800,Lab.C.). ' Policy No. - Company 0 ❑ Certified copy is PSeby furnisher FIRE SPRINK ENERGY T-34 , Z 2,/+ Certifi �I i)h city inspection division. ❑ ❑ ❑ ❑ � O Ap licant MISC: REFER TO ORD. Y ry v ry CC CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00 FLOOD ZONE AL.U.C. W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. ❑ ❑ '❑ ❑ CL Z (This vection need not be complete) if the permit is for one _ TOTAL Y N Y N hundred dollars IS 100)or les'.) ) O I certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mil is issued,I shall not employ any person in any manner so as to 0 U become subject to the Workers'Compensation Laws of California. 32 ED Date Applicant BUILDING } N NOTICE TO APPLICANT: If,after making this Certificate of Ex- emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK• - p provisions of the Labor Code, you must forthwith comply with 6 Q U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 FEE ` CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 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(See. MICROFILM 3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name H EATI NG U N IT(OV ER 100,000 B.T.U.)9.50 Lender's Address - ELECTRIC ✓ I certify that I have read this application and state that the above - VENTILATION FAN ISINGLE) 4.00 . information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or100,000B.T.U.) 6.00 hereby authorize representativesofthis city to enter upon the BOILER-COMP(Over 100,0008TU1 SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. ' (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. - upertino a nst liabilities,judgments, costs and expenses which PERMIT ISSUANCE - 10.00 CONST.TAX Sly in an s�y ac�c(rue roar said City in consequence of the - m go t is eI J. - MECH.CONT. LIC.N0. - MECH. �/1 TOTAL TOTAL �Q 3� 7 i Signature of pplorm Contractor Da e OFFICE COPY