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18606 (4) POST THIS CARD.NEAR FRONT OF BUILDING • PERM1II� Ses�6 CITY .OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD ,• / IL,f./'PE RMI �XP•IRA�ION JOB ADDRESS�lL3 C.[i(7 L`�E UNIT# _LOT# �aI J: A' IPE RMIT-E XZR ES4 F WORK OWNER eo C )5 R IS NGT �T`1RTE� WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 dA OFPERMITISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER 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 f NJ tl_ i a PLUMBING f' ELECTRICAL - - - IssunrvcE GnrEJPfL MECHANICALF�DOR. �ar. � ' SLOG ELECT. PLG. MECH R t ❑ DD NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR �(��1Vc' INFORMATION �1 ��ff��117744 OK.1 R+�` Q VALUATION $/f T. ' PLUMBING MECHANICAL PERM To ELECTRICAL FRAMING STORIES -TYPE CYNSTR INSULATION • OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT. 00 TOTAL TOTAL ACREAGE '• -_ ROOF NOTE^NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID W + BUILDING USE ' ROOF SHEATHING RES" IND CON PB ' om., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ 0 ❑ ASSESSORSPARCELNO ROUGH SAN.# t PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO TUBS&SHOWER PAN - PLUMBING ENERGY . - MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC.PILE No. FRAMING ELECT.FINAL TEST ZONING ENG,SIT E NO." - INSULATION PLUMBING GAS TEST GAS - MECHANICAL FIRE SPRINK ENERGY'T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y F "� ° F-1NED EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZOrvE A.L UC. ❑ "❑ INTERIOR SHEAR ' FIRE DEPT. Y "[- SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH - BUILDING- - BUILDING SZ. INTERIOR LATH TEMPORARY APPROVAL ' SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE = NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED oOcuPANcv SEISMIC FEE 9 OCCUPANCY OF"BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT'FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX ' J 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 BUILDING PROJECT IDENTIFICATION - ,PERMIT NUMBER BUILD[ 5 0 G �C�2 ` APPLICATION & PERMIT 18606 O C AUD R .I R BUILDING-ELECTRICAL-PLUMBING-MECHANICALJ 0 OWNER'S 'III _ PLAN CHECK VALIDATION NAND CL f/ - �3 OTV. ELECTRIC PERMIT FEE ,` CONTRACTORS - E NAME 1. OUTLETS-SWITCHES-RECEP 10,00/1.00 $. " - UCNO. LIGHTING FIXTURES 10.00/1.00 ,2 ONTesCTOR's `. APPLIANCES-RESIDENTIAL 4.00yAI q µ/ o41.L�1/ PHOrvE &0141/1 PANELS 10.00 DATE OF APPLICATION ' AP HITECT - PLAN CHECK FEE P.C.N0. OR . - PANELS (OVER 200 AMP) 20.00 - ENGINEE , ICf•1 UC.NO. SIGNS TRANS. 3,00 ARCH O ENG. - .PERMIT VALIDATION I��y A �X7 Dun" SPECIAL CIRCUIT 5.00 !(O b TEMP.METER OR POLE INS.. 20.00 /O ADDRESS MOTORS SEE FEE SCH. APPLICA SERVICE CHANGE 20.00 r• /� wTO K�/C.L o o LICENSED CONTRACTORS DECLARATION •.! (y' a v rHj1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE Z "' (commencing with Section 7000)of Division 3 of the Business and OUT ¢ BLDG: ELECT. PLG. MECH. r N i Profession Cade d my license Is N full for -�/� 11,`LYyYI Z i o Licenseff��(ass _Lic.Number Wy VI Cupertino "� _ m H w Date `J;/s�T Contractor , ¢ Y s BUILDING PERMIT ¢ a n OWNER-BUILDER DECLA ATION INFORMATION wg LL y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION '$/FT. Fu0 J Law for the following reason.(Sec,7031.5,Business and Professions PERMITISSUANCE 10.0012-09 N Code'.Any city or county which requires a permit to construct,alter, 2 2 ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. K requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO _a w Pa he is licensed pursuant to the provisions of the Contractor's License Fz> Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe I - I�rJ111 s o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ I- o the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR, n3 �2 by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than rive 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,AREA,COND.• 5.00 • O b 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 SQ FT.FLOOR AR TOTALACREAGE .� himself re through his own employees,provided that such improve- hiumus mself a not through or offered eesale.If,ed that suhebuilding GAS-EA.SVSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 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 ❑'.I,as owner of the property,am exclusively contracting with _ ❑ ❑ ❑ ❑ •❑ licensed contractors to construct the project(Sec. 1044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0. 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 contraclons)licensed pursuant to SEWER-SANITARY-STORM EA.@OOft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ I 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 I have a certificate of consent to self-insure. ZONING or a certificate of Workers'Compensation Insurance,ora certified ENG.SITE NO, copy thereof(Sec3800,Lab.CJ. ' Policy No. Company 0 ❑ Certified copy is crcby furnished. FIRE SPRINK ENERGY T-24 Z Z ]�'Certifie py ed ith the city inspection division. O AFplicat ,.L.- �' MISC.- REFER TO ORD. Y ❑ N❑ y ❑ No Fy PERMIT ISSUANCE 10.00 ,Ob FLOOD ZONE A.L.U.C. O: CERTIFI rE OF EXEMPTION FROM WORKERS' LI > COMPENSATION I NSURANCE PLG.CONTR. LIC NO. PLG.• ❑ V❑ . N❑ Il O (This section need not be completed if lire permit is for one TOTAL •�0 VN❑ 0 Z hundred dollars IS 100)or less.) U O 1 certify that in the performancncl'the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY LL H , mit is issued,1 shall not employ any person in any manner so as to U became subject to the Workers'Compensation Laws of California. CL Dme Applicant ALTER OR ADD TO MECH. 5.00 '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. provisions of the Labor Code, you must forthwith comply with - FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10AMC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC.FEE �. - 1 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 ISeC. - - MICROFILM 3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's'Name e - HEATING UNIT(OVER 100,000B.T.U.)8.50 ELECTRIC IT . Address Lendr's / F _ [-certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 A information is correct I'agree to comply with all city and.county - - PLUMBING ordinances-and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)BEE FEE SCH. 'MECHANICAL (We) agree to save, indemnify and keep harmless the City of misc.- REFER TO ORD. ' v Cupertino against liabilities,judgments, costs and expenses which .. CONST.TAX /3 may in any w -accrue against said City in consequence of the PERMIT'ISSUANCE 10.00 • rant this tit. MECH.CONT. ,LIC.NO. MECH. _ TOTAL TOTAL ? Signa re Ap i nUContractor `DBIC e.J OFFICE COPY