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17095 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUF,9ER CITY OF• CUPERTIN0 17095 INSPECTION DIVISION JOB INSPECTION RECORD - PERMIT EXPIRATION JOB ADDRESS / y 3 y- i 0 UNII'TAE LOT# PERMIT EXPIRES IF WORK OWNER sQ, X1/1. CONTRACTOR yy ,y L� IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU: 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 VALm ATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED w•GA• ! . , UNDERGROUND /SLAB PLUMBING d AN b Ift) 5 ELECTRICAL _ ISSUANCE DATE MECHANICAL cAy of cupe,};� UG. ELEcr. ElILGMECR. any �^+!ro"' ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION S/F.T. PLUMBING - MECHANICAL ELECTRICAL _ - PERMIT,ro- - I FRAMING STORIES TYPE CONSTR. INSULATION ' .", ' OCc GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.ITFLODR ARIA TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE . DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES JND CON Pe 00— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ El ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING - ELECT.ENERGY ' TRACT NO. PARCEL NO TUBS B SHOWER PAN PLUMBING ENERGY MECHANICAL MECH. ENERGY ACC.DATE - ACC,FILE NO. ELECTRICAL BUILDING ENERGY - FRAMING ELECT.FINAL TEST - zorvlNc ENG,SITE No. INSULATION . PLUMBING GAS TEST GAS ' FIRE SPRINK ENERGY T.]G MECHANICAL ❑ NI ❑ NC] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL.RELEASE ,�p G ' .FL000/ONE A.L u.c. . INTERIOR SHEAR FIRE DEPT. Y❑ N� ❑ N❑, SHEETROCK. GRADE - FEE SUMMARY EXTERIOR LATH BUILDING , BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC " - PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL'BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. . PLUMBING 0� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - . , . IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING'FOR FINAL INSPECTION.' OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENT[F I CATION TERMITNOMBER- BUILGING -APPLICATION & PERMIT 17095 AOOREss 3� N R K. /9U . BUILDING -ELECTRICAL-PLUMBING-MECHANICAL ; OvsPtH'S PLAN CHECK VALIDATION • NAMEOTY. ELECTRIC PERMIT FEE 'TAIII dcFFs. PHONE CONTRACTORS 0 UTLETS-SWITCHES-RECEP ' 10.00/1.00 •�D w ��. / uc.Na / ' LIGHTING FIXTURES 10.00/1.00 CONTRACTORS 1 AODREIs Ate,ervlN• 'A'• PPLIANCES-RESIDENTIAL 4.00 5�D00jr "s PHONE q�G Z PANELS _ 10.00 DATE OF APPLICATION ARCHITECTPLAN CHECK FEE PG.NO. OR PANELS (OVER 200 AMP) 20.00 , ENGINEER LIC.' c.No. SIGNS TRANS. 3.00 ARCH. RC iss ENG. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ' ZIP EMP.METER OR POLE INS. 20.00 ADDRESS i As MOTORS SEE FEE SCH. 1 I ADDRESS - SERVICE CHANGE 20.00 o o LICE-NSii D.CONTRACTORS DECLARATION a u. I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and G: ELECT. PLO. MECH. r i Prolessio�C a d1»y liccnsn is in Iull,lu d `yI z o 2 - License Cla //// Lic.Number V p ❑ g r 0 Date Contractor JAN 19 a r E BUILDING PERMIT ¢ ¢ w ¢ OWNER-BUILDER'DECLARATION INFORMATION Or a-c' MISC:- 111JI TO ORD X 3 u n I hereby affirm that I am exempt (Tom the Contractor's Lienno, VALUATION 5/FT. FLLOa, Law for the following reawn.(Sec.703 1.5,Businessand Professions •PERMIT ISSUANCE 10.00 Q� Code:Any City or County which requires d perms to construct,alter, re ¢ ¢ 2 improve,demolish,or repair any strorturc.prior to its ison,mr,Alm ELEC.CONTR. LIC.N0. ELEC O M requires the applicant for such permit to Filea Signed statement that TOTAL) ✓r U PERMIT TO w $ he is licensed punuunt to the provisions of the Contractor's License F z a Law(Chapter 9(Commenciagwith Section 7000)of Division 3 of the f E o Business and Professions Code)or that he is exempt therefrom and QTY, PLUMBING PERMIT FEE eL �L� ¢ H � thebasis for the alleged exemption.Any violation ofSection 7031.5 3 STORIES TYPE ONSTR. by any applicant fora permit subjects the applicant toacivil penalty ALTER-DRAINSt VENT-WATER (EA.) 5.00 or not mom than five hundred dollars(5500).): ❑ 1,as owner of the p,operty,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 u not intended or offered for sak (Sec. 7044, Business and Professioru DRAINS-FLOOR,ROOF,AREA.COND. 5.00 Code:The Contractor's License Law dote not apply m 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- ments arc not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 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 ire- RES IND CON Pe Oram prove for purpose of sale.). I N INDUSTRIAL I A L W ASTE INTER. 30.00 O 1,as o of the pro�nY,an,exclusively cool rad ing with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct thproject(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Profusions Code:The Contractor's License Law does not apply Itto an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contacts for such projects with a co nmcsmo licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL N0. the Comractur's License Law. ❑ lam exempt under Sec. ,B.&P.C.for Nis WATER HEATER W/VENT 6.00 mason Owner Date WATER SYSTEM '5.00 ACC.DATE ACC.FILE NO. W'ORKI>RS'COM PENSATION DECLARATION'- WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consem to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a cenified copy thereof(Sec.3800,Ush,C.). .•j f _ Policy No. Company.91 " O G( Certified copy a hereby furnished. FIRE SPRINK ENERGY T 24 z,Z G Certillc _ is 11 wit}yt 'Try in: on--cion. . O Applicant L�iC MISC.- REFER TO ORD. Y ❑ N❑ v N❑ CCN CERTIFICATE OE E XIiMPT1ON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.LUA. LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y[:] R❑ v F] N❑ CL 0 1'rhis section roved not be completed if the permit is for orae TOTAL hundred dollars IS 100)or less.) U O 1 Certify that in the pertonnancu of the work for which this Ifer- CITYMECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not employ any perwo in any manner w as to U become wbjeet to the Workers'Compensation Laws of California. LU Date Applicant _ ALTER OR ADD TOMECH. - 5.00 BUILDING } rn NOTICE TO APPLICANT': If,after making this Certificate of Ex- (- Z emption,you should become subject to the Workeri Compensation APPLIANCE .5.00 PLAN CHECK provisions of the Labor'Code, you most forthwith comply with FEE U such provisions or the permit shall be deemed revoked. AIR HANDLING UNIT(TO 10PMCF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10DWCRK) 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 Name HEATING UNIT(OVER 100,000 B.T.U.)950. Lender:Address ELECTRIC Os6� I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and count - PLUMBING ordinances and state laws rebating to building construction, and BOILER-CONP(3 H.P.Or 100,000 B.T.U.),6.00 hereby authowe representatives of this city to enter upon the BOILER-COMP.IOvar 1W,000 BTU)SEE FEE SCH. MECHANICAL ahove-mentioned properly for inspection purposes, (We) agree to save, indemnify and kttp harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, carts and expenses which PERMIT ISSUANCE .10;00 CONST.TAX my in any way accrue against said City in consequence of the GOT of this r rGot MECH.CONT. LIC.NO. MECH. , !fiti�Qt 9 TOTAL TOTAL SZJ• 6Q ignature of •plicait/Cuntractur Date OFFICE COPY