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18441 (3) POSTTHISCARD'NEAR FRONT OF.BUILDING " • PERMIT NUMBER _ CITY OF CUPERTIN:O INSPECTION DIVISION 8441 ..'N425 � JOB INSPECTION RECORD ' .S '�L I, PERMIT EXPIRATION JOB ADDRESS 0 W �I UNIT _LOT# �'�r •/ / �1 „-] �� p P M •EXPIRES IF WORK OWNER J ('`e, ACTOR (,'� IS NOT STARTED WITHIN INSP TION DATE INSPECTOR INSPECTION RECORD ,180 DAYS OF.PERMIT ISSU- FOUNDATIONNOTE, •, ANCE OR 180 DAYS FROM UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED L'O'ST CALLED INSPECTION. PREGUNITE _ 'TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. . GARAGE SLABS •. ” - - t _ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED PLUMBINUNDERGROUND /SLAB G ELECTRICAL - _ . . .� ISSUANCE DATE MECHANICAL - - - - - BLDG ELECT. PLG. MECH .. El DO E ' 11 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN"SIGNED - - BUILDIN P RMIT WOOD FLOOR � . - INFORMATION VA©T�v $IFTi PLUMBING . - y� " MECHICAL - (J� AN �x ELECTRICAL•. 0.,... p _ PERMIT TO FRAMING INSULATION • STORIES TYPE CONSTR ' OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED , . R ROOF. NOTE:NO FINAL INSP.SHALL BE MADE BEFORE $UFTFLOOEiATOTALACREAGE DIAPHRAGM' THE'CONSTRUCTION'TAX IS.PAID ROOF SHEATHING USE - - saes IBUILDINND• COON PB" 00", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS ' DATE' INSP. ❑ ❑ ❑ ❑ ❑ ROUGH SAN.p ASSESSORS P ARCEL NO ' - ' � � - ' PLUMBING ELECT.ENERGY - TRACUNO. PARCEL NO TUBS B SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ELECTRICAL - BUILDING ENERGYACC.DATE ACC.FILE N0.; ' , FRAMING p, ELECT.FINAL TEST. INSULATIONPLUMBING - ZONING ENG.SITE NO. GAS TEST MECHANICAL EIRE SPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ `❑ ❑ EXTERIOR SHEAR - ELECTRICALRELEASE FLOOD ZONE AL.U.C; INTERIOR SHEAR FIRE DEPT. Y ❑ IN " Y ❑ No SHEETROCK - GRADE - FEE SUMMARY EXTERIOR LATH BUILDINGUg INTERIOR LATH TEMPORARY APPROVALS BUILDING .� j; SCRATCH COAT ELECTRIC PLAN CHECK n� GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - - SEISMIC FEE I,Q,.'y�p OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINALISSIGNED BYBUILDING INSPECTOR. MICROFILM LUFOR INSPECTION BY PHONING 252-4505, ELECTRIC 'ARRANGE�' ONE WORKING DAY BEFORE REQUIRED INSPECTION. ' PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR. EXPIRATION DATE — MECHANICAL. ' IMPORTANT! consT TAX "PLEASE READ'REVERSE SIDE BEFORE AL TOTr^ CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -'USE BALL POINT PEN ONLY -BUI LDI NU PROJECT IPENT1 FICATION PERMIT NUMBER APPLICATION & PERMIT yLDING 18441, A DRESS - T.,t BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER' AY 1-.-• /•_� /)� PLAN CHECK VALIDATION NAME 1 ✓J p���r� G CITY. ELECTRIC PERMIT FEE if y0� ►k..tbuE.rj CONTRACTORS rvA E OUTLETS-SWITCHES-RECEP 10:00/1.00 r LIC.NO, LIGHTING,FIXTURES 10.00/1.00 cf 7,'-v3 CON CTOR's ADD as {/h"N ��F APPLIANCES-RESIDENTIAL 4:00 P / uj-ax .ONE PANELS 10.00 GATE OF APPLICATION , ARCHITECTp PLAN CHECK FEE- P.C.NO. DR Rv�S CDtg-&-3(5 PANELS (OVER 200 AMP) 20.00 ' ENGINEER LIC.NO. SIGNS TRANS. 3.00'ARCH OR /1�a • I� l r w SPECIAL CIRCUIT 5.00 ' PERMIT VALIDATION ARORE55 (.fV 1/ �V IIP -EMP. METER OR POLE INS. 20.00 PLICAN 's ' ADDREss r MOTORS ,- SEE FEE�SCH. ' 1- SER NGE '20.00 ���ft✓C-C�� ) F o 2 ' 'LICENSED CONTRACTORS DECLARATION < is I hereby affirm that I am licensed under provisions of Chapter 9 r• ISSUANCE GATE " oz w (commencing with Section 7000)of Division 3 of the Business and -MIS 211-1989 , .y i Professions Code,and my license is in full farce and effect. i t BLDG. ELECT. PLG. MECH. oz m o License Class Lic.Number - ®I{Y d� )4 Dale Contractor R[�d�y1' 4y`eJ -18 Ic p.w OWNER-BUILDER DECLARATION Ca BUILDING PERMIT w3. LL N I hereby hf6rm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION u o 4 Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION �. $/FT. r - PERMIT-ISSUANCE -. 10.00 Code:Any city or county which requires - 7o Q IC It Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. yO LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w m he is licensed pursuant to the provisions of the Contractor's License H z ar Lnw(Chapter 9(commencing with Section 7000)of Division 3 of the '4 Business and Professions Code)or that he isexempt therefrom and \"Y' �e 'e¢= � the basis for the alleged exemption.Any violation of Section 7031.5 QTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. e. 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(8500).): '❑ 1,as owner of the property,or my employees with wagesas BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their Sole.c°mpensafion,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 5.00sD.ET FLOOR pp TOTALACREACE 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-11NC.4OUTLETS 6.00 6 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 200 BUILDING USE builder will have the burden of proving that h . . . e did not build or im- .RES IND CON PB Omar prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 111,as owner of the property,am exclusively contracting with El ❑ ❑ ❑ ❑ licensed contrgelors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B., 6.00 ASSESSORS PARCEL NO. and Professions Coda:The Contractor's License Lew 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 conttamoos)licensed pursuant to the Contractor's License Law. " SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. O Iamcxemptunder Sec. ,B.&P.C.forthis reasn WATER HEATER W/VENT 6.00 Ownoer Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKFRS'COMPENSATION DECLARATION WATER TREATING EQUIP.• 5.00 " I,hereby affirm.that I have S certificate ofconsent 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 _ Q 4, Celtic d copy is he Eby funisFted FIRE SPRINK ENERGY T-24 z Z �y Cerlifie pY filed with 1t1 cit nspectiivision. - O Appp canl MISC. REFER TO ORD. Y❑• N❑ Y ❑ N❑ . � N CERTIFICATE OF EXEMPTION FROM WO ERS' PERMIT ISSUANCE 10.00 ' FLOOD ZONE A.L.u.C. 'UJ > COMPENSAT ION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ :N C: v ❑ N❑ ?-Z( This sccliwreiid oat be completed if the permit is for one - TOTAL hundred dollars IS 100)-or1ese) U0 I certify that in the performance of lire work for which this per- FEE SUMMARY IL H mit is issued,1 shall not employ any person in any mannerso as to CITY. MECHANICAL PERMIT FEE O W become subject to the Workers'Compensation Laws of California. BUILDING Y y Date Applicant ALTER OR ADD TO MECH.' 5.00 ' } N NOTICE TO APPLICANT: If,after making this Certificate of Ex- emption, x- " 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 I U, such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000QF.M.) 6.00 SEISMIC FEE dam. 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(Seca MICROFILM- ' 3097,Ce.C.). I. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC ' I certify that 1 have read•this application and state that the above VENTILATION FAN (SINGLE) 4.00 r information is correct. 1 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 enteruponthe BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL' above-mentlnned property for inspection purposes. - (We) agree to save,'indemnify and keep harmless the City of MISC.- -REFER TO ORD. Cupertino against liabilities,judgments,costs and expenses which CONST.TAX may in any way accrue again said i[y in asequence of this; PERMIT ISSUANCE, 10.00 • ranting (this mR: MECH.CONT.' - LIC.NO. - MECH. - I r C y . TOTAL TOTAL SIS.ep Signature at, Drificz OFFICE COPY - -