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16026 POST THIS CARD NEAR FRONT OF BUIILDING PERMIT NUMBER I CITY OF CUPERTINO 16026` INSPECTION DIVISION JOB INSPECTION RECORD ��-� - PERMIT EXPIRATION - 'Lp• JOB ADDRESS Cu��3, {UAL�E"� /�. '_UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR d ". 1 ZE L C "N C .I IS NOT STARTED WITHIN ° � INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMITISSU- FOUNDATION _ ANCE OR 180 DAYS FROM ' NOTE: - LAST CALLED INSPECTION. ; UFER ALL GRADING AND DRAINAGE SHALL BE.INSTALLED PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAi IDATION CUPERTINO STANDARDS. GARAGE SLABS ''^•"� POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - (� �• "'J UNDERGROUND /SLAB PLUMBING ' ELECTRICAL ELECT.ISSUANCE DATE MECHANICAL I BLUc ELECT. PLc. MECR. Ev ❑, ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT ' - INFORMATION WOOD FLOOR VALUATION _ SIFT. PLUMBING A MECHANICAL 0 ELECTRICAL' PERMIT r � - - FRAMING INSULATION TORIES Tv ECONSTR OCC GROUP FEB UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.1T FLOOR ANSA TOTAL ACREAGE ROOF NOTE:NO FINAL INSP SHALL BE MADE BEFORE' S' DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES ' IND CON PB D,I,,., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ 110'- ASSESSORSPAHCELNO ,. ROUGH SAN.a PLUMBINGELECT.ENERGY - THACINO.. PARCEL NO TUBS&SHOWER PAN, - PLUMBING ENERGY- MECHANICAL MECR ENERGY ELECTRICAL ACC onTe_ ACC FILE No. ,. BUILDING ENERGY ' FRAMING - ELECT.FINAL TEST _ zoNlNc ENG SITE No. INSULATION PLUMBING' 6. GAS TEST GAS FIRE SPRINK ENERGY T24 MECHANICAL O,1o� YE] ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING , ' "� N❑ EXTERIOR SHEAR . ELECTR I CAL.RELEASEGLyOOOZONE A.L.00 O.'LO YO ' NY ❑ INTERIOR SHEAR FIRE DEPT'. ❑ L N _ " ' SHEETROCK p- GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVAL 'BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEUSIGNED IOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR, MICROFILM - ARRANGE FOR INSPECTION BY PHONING 252-4505, , ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION.' PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERM IT.FOR EXPIRATION DATE - '', MECHANICAL IMPORTANT! CONST.TAX '. PLEASE READ REVERSE SIDE BEFORE © TOTAL 41-7 CALLING FOR FINAL INSPECTION.. 0FFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY PERMIT NUMBER ' BUI NGPR JECT I DkriTIFICATION APPLICATION &PERMIT ' SoILDING 16026 6 0 2 6 c 1(,4/ CO 'AS /UN BUILDING-ELECTRICAL-'PLUMBING=MECHANICAL OWNER'SI, Q ,\ PLAN CHECK VALIDATION NAME L/ OTV. ELECTRIC PERMIT FEE r tr y�0 PRONE [t: CONTRACTOR'S NAME / OUTLETS-SWITCHES-RECEP 10.00/1.00 -„ ��/ 0 ST LIC.NO, LIGHTING'FIXTURES - 10.00/1.00 CONTRACTGE - PPLIANCES-RESIDENTIAL 4,00 ADDRE (_ _ V] {2 PHO E�� byqPANELS 10.00 DATE OF APPLICATION I. ARCHITECT 1 . PANELS (OVER 200 AMP), 20.00 PLAN CHECK FEE P.C'NO. OR r '- ENGINEER LIC.No. SIGNS TRANS. 3.00 ARC H.OR ENG. - PERMIT VALIDATION ADDRESS a SPECIAL CIRCUIT 5.00 ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT'S ADDRESS - MOTORS • - SEE FEE SCH. '/tea(`/`,""�••�`� ` (JS ` . SERVICE CHANGE 20.00 /O// a' o 0 LICENSED CONTRACTORS DECLARATION a v I hereby affom that I am licensed under provisions of Chapter 9 ISSUANCE DATE z ac (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. rD Professions Code,' d my license is in full Cor�q 1' - ❑ ❑ ❑ o,z F'V License Gas Lic.NumberG /`f- D/� Dace ('J Contractor' ¢ Y s �. , - BUILDING PERMIT ¢ ¢w a OWNER-BUILDER DECLARATION MISC.- REFER TO ORD INFORMATION. K ; u H I hereby a�rnt that I am exempt from the Contractor's License VAW ATION S/FT. r a-o Q Law for the following reason.(Sce,7031.5,Business and Professions PERMIT ISSUANCE 10.00 /`°J Code:Any city or county which requires a permit to construct,alter, n IS ¢4 2O improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. u K- D ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO " m u- he is licensed pursuant to the provisions of the Contractors License :n in Low(Chapter 9(commencing with Section 7000)of Division 3 of the ���j��/,OR lM OV� < business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE ( - Oa STORIES TYPE CONSTR. ¢ H the balls for the alleged exemption.Any violation oCSec[ion 703 LS a ;m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($5000.). ❑ 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 - Code:The Contractor's License Law does not apply to an owner of Property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SO:FT.FLOOR AREA TOTAL ACREAGE hinhsclf 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 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 he did not build or int . . . - RES IND CON PS Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with - ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I 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 conlmets for such projects with a contractor(s)licensed pursuant to the Contractors License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner - Data WATER SYSTEM 5.00 ACC.DATE ACG FILE N0. WORKERS'COMPENSAT ION DECLARATION' WATER TREATING EQUIP. 5.00 ' I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0, or a certificate of Workers'Compensation Insurance,or a certified copy the rC-'-e f�(5�.j .C.). Policy X ny NA�� I�NroN ZNS O uO Certified copy Is hen^by furnished. FIRE SPRINK ENERGY T-74 Z Z �q{ Certified Is led h Ith(Tt re I Inspection division. O Ji ad, n.�m { Cl(�� - MISC.- REFER TO ORD. rY❑ N❑ Y ❑ IN E] - CERTIFICATE EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE' A.L.U.C. LU FI DJ COMPENSATION INSURANCE PLG.CONTR. - LIC.NO. PLG. a (This scetum need not be completed if the permit is for.mw TOTAL Y❑ 'N❑ Y E] N❑ hundred dollars($100)or Tess.) U O 1 certify that in the performance of the work for which this per- OTY: MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,I shall not employ any person In any manner so as to U Dine subject to the WOrkere'Compmh cation Laws of California.'^ �/� y Dute Applicmt ALTER OR ADD TO MECH. 5.00 BUILDING 74j } Ua NOTICE TO APPUCAN'C If,after making this Certificate of Ex- ' F Z emotion,you should became subject to the workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Cade, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,00011F.M.) 4.00 CONSTRUCTION LENDING AGI'-NCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMICFEE 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(Sec. -MICROFILM 3097,Civ.CJ, HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lenders Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC . I certify that I 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 slate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of INS city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-nhentioned property for inspection purpous. - (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. - upertino against liabilities,jud nts, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way a rue again slid City in conse'acne of the ranti this per L / MECH.CONT. LIG N0. MECH. I TOTAL TOTAL L �r?` Signator o Applicant oniractor 7 ate M OFFICE COPY