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18442 (3) POST THIS CARD NEAR FRONT•OF BUILDING !' " - CITY OF CUPERTINO R MIT MB INSPECTION DIVISION �� JOB INSPECTION RECORD 1 PERMIT EXPIRATION JOB ADDRESS_�._(.��7— ' , PLO UNIT# '_LOT# _ � '7 PERMIT EEEXPIREStIF-WORK OWNERbs coN ACTOR •��" IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION J NOTE: - AN 180 DAYS FROM UFERINSPECTION. ALL GRADING AND DRAINAGE SHALL BE INSTALLED _ PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS; ,,rrppgg , GARAGE SLABS - END POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB CSP PLUMBING ELECTRICAL - W.WM�""�' ISSUANCE DATE •l"/ MECHANICAL BLOG ELECT I PLG. MECH 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT WOOD FLOOR INFORMATION ' � � PLUMBING' vawan Na �s/Fr. •• / (�yE ' MECHANICAL �� 4O!G ELECTRICAL PTo PERMIT FRAMING A T pcc.Vu D INSULATION STORIES TYPE CONSTR. -OCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED J50,1'T-FLOOR-AHED TOTAL ACR EAf.E ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID . BUILDING USE ROOF SHEATHING RES IND CON PB ow" APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ 1:1 1 ! ROUGH SAN.N .. ASSESSORS PARCEL NO. PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO TUBS&SHOWER PAN. PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC,DATE ACC.FILE NO. ELECTRICAL BUILDING ENERGY " FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS ' MECHANICAL FIRE SPRINK ENERGY TQ< COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N❑ Y "❑ FLOO000?,ONEL cwE A. uc, EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT.. Y❑ N Y ❑ N SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH - TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK ».► , GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE (0; rvI OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BOILDINGTINAL ISSIGNED BY BUILDING INSPECTOR' MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505,- ELECTRIC s; I,_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. Z' — SEE PERMIT FOR EXPIRATION DATE — ' MECHANICAL IMPORTANT! covsT.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL .CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY PERMIT NUMBER y I LDING PROJECT'I DENTI FICATION ' ADDRESS APPLICATION U PERMIT . 184 ^ Z O ' 1 � BUILDING - ELECTRICAL-PLUMBING-MECHANICAL la,,, F} OWNER'S PLAN CHECK VALIDATION IIA E • � QTV. ELECTRIC PERMIT FEE vHONE CONTRACTO 'S NA E OUTLETS-SWITCHES-RECEP 10.00/1.00 .e P LIC.No. LIGHTING FIXTURES 10.00/1.00 C G 3 qo TR aTOR's hk��/�,(I(�/�Jr1{', �J6•� 7� �// � ppLIANCES-RESIDENTIAL 4.00 WL�'a PHONE ( PANELS - 10.00 DATE OF APPLICATION" ARCHITECT ^�� PLAN CHECK FEE P,C.NO. OR l/!/ PANELS (OVER 200 AMP) 20.00 ENGINEER uc. C SIGNS TRANS. 3.00 ARCH,OR ENG. �"�r. r� L I PERMIT VALIDATION ADDRESS V V r( 10.7 SPECIALCIRCUIT 5.00 I I1N zIP EMP.METER OR POLE INS. 20.00 ADDR S MOTORS SEE FEE SCH. ADDRESS /�+ - �-I SERVICE CHANGE 20.00 J woo LICENSED CONTRACTORS DECLARATION < U U I hereby affirm that I am licensed under provisions of Ch.plcr 9 ISSUANCE DATE w¢ i (conunencing with Section 7000)of Division 3 of the Business and - BLOG. ELECT. PLG. MECH. G i Professions Code,and my license is in full force and effect L• ❑ ❑ " ❑ Z o A License Class Lic.Number I VI om r w Date CoNractor p�lya�e�4q '-P 4 : 2 , !Ay!H1 BUILDING PERMIT w OWNER-BUILDER DECLARATION INFORMATION w;n n I hereby affirm that I am exempt from the Cnnvuctor's License MISC.- REFER TO ORD VALUATION u o 4 Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 (-T O rm0 Code:Anycity orcounty which requires a permit to construct,alter, , 11 R ¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. no O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO a m m he is licensed pursuant to the provisions of the Contractor's License FZ> Law(Chapter 9(commencing with Section 7000)of Division 3 of the 4 Business and Professions Code)or that lie is exempt therefrom and QTY, PLUMBING PERMIT FEE It r o the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR. is. by any applicant for a permit subjects the applicant toa civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars($500).): 01,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 (Seo. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves Thereon,and who docs such work FIXTURES-PER TRAP -5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself re through his own employees,Provided that such improve. hie nts mself a through ot or offered ees,or provided that such building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or int- RES IND L CON PR Omar prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors m construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The CmHmStmr 5 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(,)licensed pursuant to SEWER-SANITARY-STORM EA.200ftI10.00 the CO nlraclor's License Law. TRACT NO, PARCEL NO. ❑' l am exempt under Sec. ,BAP.C.for 111 is WATER HEATER W/VENT 6.00 reason Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consult to self-insure, (it ENG.SITE NO. _ r a certificate of Workers'Compensation Insurance,or a certified copy thereofiSec.3800,Lab.C.). .. Policy No. ' Company - 0 Cetlified copy is here by furry shed. FIRE SPRINK ENERGY T-24 Cerlif co is filed s I city ,fiction division. ZZO Ap an MISC.- REFER TO ORD. YO N❑ y ❑ N❑ CCT CFRTIFICA'IIi OF EXEMPT'ION FR WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.UC. W COMPENSATION INSU NCh PLG.CONTE. LIC.NO. - PLG. CL •Y O N❑ Y [:] N❑ O (This section need not be completed if the permit is for one TOTAL Z) Z hundred dollar,IS 100)or less.) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation laws ofCalifornia. UJ Dale-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING Y4 } W NOTICE'TO APPLICANT: If,after making this Certificate of Ex- , ? emption,you should become subject to the Workers'Compensatiun APPLIANCE 5.00 PLAN CHECK proAIR HANDLING UNIT(TO of the Labor Code, you must forthwith comply wlllt FEE U such provisions or this permit shall be deemed revoked. GXi C,F.M.) 4.00 CONSTRUCTION,L17N DING AG17NCY AIRHANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE (OPV O 1 hereby affirm that there is a construction lending agency 1'or EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATINGUNIT(OVER 100,000B.T.U.)9.50 ELECTRIC Lender's Address I certify 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 BTUI 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. uperlino against liabilities,judgments, costs milt expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City 'n ronsequence o the rantin ofth' permit. MECH.CONT. LIC.NO. MECH. �J FW s97 2 G ' TOTAL TOTAL J $ nalureo Applicant/ mtracor lillite / OFFICE COPY /