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15788 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER. _ CITY OF CUPERTINO 5788" INSPECTION DIVISION 1 JOB INSPECTION RECORD t� ,, ./ ',ff P,ERMI,T EXPIRATION Q. JOB ADDRESS ' I= 3 �V( -WoL R6 UNIT#JLOT# - - •PERMIT EXPIRES-IF WORK' OWNER L O CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMiTIssu- FOUNDATION _ - ANCE OR 180 DAYS FROM - NOTE: LAST CALLED INSPECTION: UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED - PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - �,.I •C,:,M UNDERGROUND /SLAB PLUMBING . ELECTRICAL ISSUANCE DATE MECHANICAL B�LDG. ELECT. PLG ECR. M : DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING P RMIT INFORMATION WOOD FLOOR vALUATION SFT. PLUMBING � _ MECHANICAL P �� ELECTRICAL p PERMIT"TO FRAMING ,U� a EK/O�//'�' /COVIN..• STORIES YP CONSTR. 1 INSULATION .�•�'ot It - 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 BUILDING USE ROOF SHEATHING RES IND CON PB omr, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ El ' aSSEB50R5 PARCEL NO. ROUGH SAN,# " PLUMBING. ELECT.ENERGY TRACT NO, PARCEL NO . ' TUBS&SHOWER PAN PLUMBING ENERGY - MECHANICAL MECH.ENERGY - -I ELECTRICAL BUILDING ENERGY ACC.DATE ACC FILE NO, FRAMING ELECT.FINAL TEST mNING F ENG.SITE NO. INSULATION PLUMBING GAS TEST - - GAS MECHANICAL Tv^ FIRE SPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING JJ Y N❑ Y NE] EXTERIOR SHEAR ELECTRICAL RELEASE `„ Fi000 ZONE AtOG. INTERIOR SHEAR FIRE DEPT. ' YEI N0 . rl] ,,N❑ SHEETROCK - GRADE - FEE SUMMARY EXTERIOR LATH BUILDINGPFEE INTERIOR LATH TEMPO RAR APPROVALSd�a 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. " ELECTRIC ARRANGE FOR INSPECTION BY PHONING 252-4505,LU ° ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING IS PLEASE GIVE JOB ADDRESS WHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE' MECHANICAL ,;T: . IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE zNµ° CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING p � In o 'APPLICATION & PERMIT n ADORE ,U�1 1 rh 7/}�( f0 �A. W o -I BUILDING - ELECTRICAL-PLUMBING-'MECHANICAL 1 V I VS NAME AI- A f•0DA 6UR0PE5A PLAN CHECK VALIDATION : n) OTV. ELECTRIC PERMIT FEE ^ I 'FASNIoPHDN .� 16 . CONTRACTORS NAME �/p" UTLETS-SWITCHES-RECEP 10.00/1.00l SS(>p0/. �f�ZL�-(+�� - LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ( p] . A-L'-C PPLIANCES-RESIDENTIAL 4.00 ADDRESS /I O 1/� J 'VQ/S fix '\ s&u; 'e I gis C'6F� G pHON VdB SS�^� PANELS 10.00 DATE OF APPLICATION F ARCHITECT TI{S FOf✓M IµTg N 1lON L• P_LA_NC H ECKFEE P,Ce NO "TL oR PANELS (OVER 200 AMP) 20.00 ENGINEER uc.No.(,'O/ SIGNS TRANS., 3.00 ' ARCH.OR END. I p PERMIT VALIDATION aoDRESS I�( 5• aQS�01•N f}- SPECIAL CIRCUIT 5.00 CA �EMP.METER OR.POLE INS. 20.00 APPLI CAESS MOTORS SEE FEE SCH, AOR SERVICE CHANGE 20.00 •11/1�� a o LICENSED CONTRACTORS DECLARATION , Q U U 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE 3 y (commencing with Section 7000)of Division 3 Of the Businessand BLDG. ELECT. PLG. MECH. H 7 z Professions Cade,and my license is in full force and O//effect. ❑ ❑ ❑ z O uvS+ License Class Lie.NumM1cr �y-IT . 4 v, w Date Contiactof I s.f BUILDING PERMIT ¢ ¢w a OWNER-BUILDER UECLA nTION INFORMATION e'' MISC.- REFER TO ORD w;A m I hereby affirm that I am<%cert from Lite Contractor's License UATION $/FT. HLLOa Law for the following reason(Sec.703 L5,Businessand Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, Impo,,e,dem011sh,or repair any structure,prior to Its issuance,also ELEQ CONTR. LIC.NO. ELEC. so E:o u requires the applicant for such permit to file a signed statement that ' TOTAL JV �,n PERMIT TO w m he is licensed pursuant m the provisions of the Contractor's License 1 FZi Law(Chapter 9(commencing with Section 7000)ofDivision 3ofthe - Q e6e4 �.L��,2i✓Sa g 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT . ¢ I- m the basis for the alleged exemption.Any violation of$eclion 7031.5 STORIES TYPE CONSTR. i ;_ by any applicant for a permit subjects the applicant to acivil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($5001): ❑ 1,as owner of(he 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 no( intended or offered for sale(Sec, 7044, Business:utd 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. GAS-EA.SVSTEM-11NC.40UTLETS 6.00 mems are not intended or offered for sale.If,however,the huddmg or improvement is sold within one year of completion,the owner- --EA.SYSTEM-OVER 4 IEA.1 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Omer prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ .❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. , 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply 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 contractor(s)licensed pursuant to - ItsContractor'sLicenseLaw. SEWER-SAN ITARV-STORM EA.2001t/1 0.00 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. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to sell-insure, ZONING ENG,SITE NO. or a certificate of Workers'Compensation Insurance,of a certified copy thereof(Sec,3800,Lab.C), I^� Policy No. Company-- - �__f1 O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T.24 ❑ Certif. c y is with the city inspection division. Z Z x Applicam /rLI(' U{ /�(tA� MISC.- REFER TO ORD. Y❑ N❑ Y ❑, N❑ _ b� N CERTIFICATE OF EXEMPTION FROM WORKERS• PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU COMPENSATION INSURANC17 PLG.CONTR. - LIC.No. PLG. d D (This xmion need rat be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑ Z hundred do1lars($I00)orless.) L) O 1 certify that in the performance of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY IL - mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Com ensation Laws of California. w Date Applicant p ALTER OR ADD TO MECH. 5.00 BUILDING add,MIS. ' } m NOTICE:TO APPLICANT: If,after making this Certificate of Ex-eruption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE fJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.ENL) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.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(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.001MICROFILM 3097,Civ.C). Lender's Name Lenders Address HEAT(NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC _ ' 1 certify that I 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 PLUMBING ordinances and state laws relating to building construction, and BOILER-COW 0 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP IOvar 100,000BTUI SEE FEE SCH. MECHANICAL above-mentioned property for inspection purpous. _ (We) agree to save, indemnify and keep hmmless the 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 _71 MECH.CONT. CIG .NOMECH. TOTAL TOTAL � Signalure.of Applicant/Contractor Date ate OFFICE COPY