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17925 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY 01 C.UPERTINO 17825 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS J O Ic`�✓ r� - 1 \� 1�� UN IT 4—_ ��I _LOT# . p,.,, �� PERMIT EXPIRES IF WORK OWNER N- O , O1 1 CONTRACTOR aptk. IS NOT STARTED WITHIN INSPECTION I DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE, OR 180 DAYS FROM NOTE: '.LAST CALLED INSPECTION. LIFERALC 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 pAl PLUMBING 1 {{,,• ELECTRICAL MAY U 98 Is ANCE DATE MECHANICAL - BIOc. eLEc PLG. MECH. City of cuperU6 ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT WOOD FLOOR - INFORMATION r PLUMBING VALUATION SEF , MECHANICAL - ELECTRICAL FERN+IT ro FRAMING, INSULATION. STORIES TYPE CONSTR. OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED , (� ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE 5(IFT FI.()OR AREA TOTAL ACREAGE DIAPHRAGMTHE CONSTRUCTION TAX IS PAID ROOF SHEATHING RES • IND W Lo CON USE 011'., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH - SAN.N - ASSESSORS PARCEL Na PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO ' TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY . ELECTRICAL BUILDING ENERGY " ACC DATE ACC FILE NO FRAMING ELECT.FINALTEST ZONING - - ENG.SITE NO. INSULATION � - PLUMBING GAS TEST - GAS MECHANICAL FIRE SPRINK ENERGY T�2E COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ _N E] Y ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALuc. INTERIOR SHEAR FIRE DEPT. - Y❑ N❑ Y ❑ N,❑ SHEETROCK GRADE, FEE SUMMARY EXTERIOR LATHBUILDING - -' INTERIOR LATH TEMPORARY APPROVALS BUILDING •. SCRATCH COAT JELECTRIC - PLAN CHECK - GAS ' FEE NO'rAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE _ OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING.INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC . H ONE WORKING DAY BEFORE REQUIRED INSPECTION.' PLUMBING 00� PLEASE GIVE JOB ADDRESS.WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX' PLEASE READ REVERSE SIDE BEFORE ' TOTAL ':'V CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN REDLINES- USE BALL POINT PEN ONLY jiI BUI LD1 NG PROJECT I DENTI FICATION '- PERMIT NUMBER ` BUILDING APPLICATION & PERMIT J(� ADDRESS ` (�F (/ BUILDING - ELECTRICAL-PLUMBING-MECHANICAL S: 5 NAMERS J -1 PLAN CHECK VALIDATION ✓ CITY. ELECTRIC PERMIT FEE ONE cDMERAc*DR's OUTLETS-SWITCHES-RECEP 10.00/1.00 '1,5' 'u LIC.N0. 36 c/ LIGHTI NG FIXTURES10.00/1.00 CONTR TOR'S ADORES( T/I'��.r� q l _/'�/ PPLIANCES-RESIDENTIAL `4.00 .. S_) N /� /�/ PHONE < p CJ 3 6 PANELS 10.00 , DATE OF APPLICATION ARCHITECT PLANCHECKFEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 - ENGINEER LIC.NO. SIGNS TRANS. 3.00 ARC OR ADDRESS ENG. SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION •• '' ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT'S MOTORS SEE FEE SCH. " �� ADDRESS �1 y^ SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION IVY r - - c i w I hereby at that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE < n (commencing with Section 7000)or Division 3 of the Business and .BLDG. ELECT PLG. MECH. H i Professions Code,and my license Is In full force and e(fce).� ❑ ❑ ❑ z o o - License Class Lic.Number N 7(o"Y 9 H a Dale��Contractor 1r:. _ k a Y s 7 BUILDING PERMIT a a - OWNER-BUILDER DECLARATION ` °a " MISC.- RD INFORMATION w ;LL r I hereby affirm that 1 am exempt from ore Contractor's License T VALUATION $/FT.' . H .. oj Law for the following reason.ch(Sec. requires a permit to Professions PERMIT ISSUANCE 0i6,pD. Code.Any ,cityor county whiny requirese permit to construct,alter, QQ Q Q require¢,the applicant repair h p rmit structure,prior a si lO it,issuance,talsohat ELEC.CONTR. � /.(d.I C.NO. ELEC (�-/� G u requires the applicant for such permit to file a signed statement that 9 TOTAL ADV PERMIT TO - a. , .u- he is licensed pursuant to the provisions of the Contractor's License HZQ Law(Chapter9(commencing with Section 7000)ofDivision 3 ofthe �Iv CCA l 4 C Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE + I 1 A M 1- 0 I, lire basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES TYPE CONSTR. u ; m by any applicant for a permit subjects'the applicant toacivil penalty ALTER-DRAIN -WATER IEA) 5.00 ` of not more than five hundred dollars($500).): ❑ 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,AR EA,COND. 5.00 Code:The Contractor's License Law does not apply m an owner of _ property who builds or improves thereon,and who does such work FIXTURES-PER TRAP - 5.00 SQ.FT,FLOOR AREA TOTAL ACREAGE himself or through his Own employees,provided that such improve- parts ate not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-11 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.00 r BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB °cher ' prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ F-1 ❑ D I,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 properly 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 SEWER-SAN V-STORM EA.200ft110.00 the Contractor's License Law. TRACT NO. PARCEL NO. D In...exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner - Date WATER SYSTEM - 5.00 _ ACC.DATEACC.F ILE NO: . WORKERS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00 f 1 hereby affirm that I have a certificate of consent to self-insure, ZONING - ENG.SITE NO., or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C:). - Policy No. - Company O Certified copy is here by f mishecL FIRESPRINK ENERGY T 24 Z 2 Certified copy is fd rlh the ty inspection division. O A plmant - 9 ;- -� MISC.- REFER TO ORD. "Y.[ -N� Yf[] NQ ~ rn _� �-�� -nom- PERMIT ISSUANCE 10.00 CERTIFICATE OF EXEMPTION FROM WORKERS'- FLOOD ZONE .A.L.U.C. LU 7 COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N - Y C] NE CL 0 (This section"need not be completed if the permit is for one -- TOTAL hundred dollars($100)or less.) U O ,I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT 'FEE FEE SUMMARY LL 1- mit is issued,I shall not employ any person in any manner so as to - O W becomesubject tothe Workers'Compensation Laws of California. BUILDING - Date Applicant - ALTER OR ADD TO MECH. 5.00 } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- . F'2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK , provisions Of the Labor Code, you must forthwith comply with FEE L..1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 _ CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10P00C.EM.) '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. MICROFILM 3097,Civ.C.). - HEATING UNIT(TO,100,000 B.T.U.) 8.00 Lender's No Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 1cattily that l 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-COMP(3 H.P.or 100,000 B.T.U.) 6.00 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 harmless the City of MISC.. REFER TO ORD. - upertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequeryryVe of)he - PERMIT'ISSUANCLI HL . ranting of this permi 4 '/ a -J / T MECH.CONT. LIC.NO. 'MECH. /1/)/, / / /oQ T°TAL TOTAL /1.� Q SrgnaNre o plrcan[/ ontracmr Dale , OFFICE COPY