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17096 ti^ r POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO7096 INSPECTION DIVISION JOB INSPECTION RECORD /' }� PERMIT EXPIRATION v JOB ADDRESS y��S`L/�I I ('` IA' ll= UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER �1 e{.` V h Y VCONTRACTORL G %,I LC r .-C D _ IS NOT STARTED WITHIN INSPECTION DAT INSPECTOR I SPE TION RECORD .180 DAYS OF�PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE: - LASTCALLED INSPECTION. UFER 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 Le�Tn4. ewLu ec UNDERGROUND /SLAB . PLUMBING ELECTRICAL - { 8 1g89' �`4- ILSSUANCE DATE MECHANICAL 1^j9.6-j eg al C,e,,.g ec„ �JDG ELECT PLG. I MECR. ❑ ❑ L ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED /7�45e. f3/B/,j /-/zo.�7`" O�'ru'cq� BUILDING PERMIT WOOD FLOOR _ !J INFORMATION —/v J_J VALUATION $/FT. PLUMBING MECHANICAL ELECTRICAL veRMIT ro 'FRAMING L&q INSULATION STORIES T PE CONSTR. - OCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.rT.rTooTIAIITA TOTAL AcaeAeE DIAPHRAGM THE CONSTRUCTION TAX IS PAID t' ROOF SHEATHING BUILDING USE IVES IND CON PB Omn APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDFINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGHASSESSORS PARCEL NO SAN.p PLUMBING ELECT.ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY - TRACT No. PARCEL NO MECHANICAL MECH�ENERGY ELECTRICAL - BUILDING ENERGY ACC OnrE ncc.Elle No FRAMING ELECT.FINAL TEST INSULATION —PLUMBING ��... �ON1NG ENG,SITE No. GAS TEST GAS MECHANICAL FE SPRINK ENERGY R]i IR COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ v ❑ No EXTERIOR SHEAR ELECTRICAL RELEASE PL000eONE A.LU.c. INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y❑ N❑ SHEETROCK GRADE - FEE SUMMARY EXTERIOR LATH BUILDING- - INTERIOR LATH TEMPORARY APPROVALS 7ELECTRIC GSCRATCH COATELECTRIC ECKGASNO TAPE ORPLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCYFEEOCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. ILMELI ARRANGEFOR INSPECTION BY PHONING 252-4505ICONE WORKING DAY BEFORE REQUIRED INSPECTIONzPLEASE GIVE JOB ADDRESS WHENPHONING. Gz ..OD SEE PERMIT FOR EXPIRATION DATE — ICALIMPORTANT! AXPLEASE READ REVERSESIDE'BEFOREL CALLING FOR FINAL INSPECTION. 0� OFFICE COPY ,,APPLJCANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .BUI LD1 NG PROJECT I DENT]FICATI ON . PERMIT NUMBER BUILDING ' APPLICATION & PERMIT t1 AODPOESD !/ylWeQLX( BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1 17098 OWNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE U0-47 6k ONE NpM>ERAcroR's UTLETS-SWITCHES-RECEP 10.00/1.00 Whl T 6 11C.No 2iral-0 LIGHTING FIXTURES 10.00/1.00 A07ESS roR'sn 1yy c APPLIANCES-RESIDENTIAL 4.00 A07 Re lwe- PHONE L3�Y-03 PANELS 10.00 DATE OF APPLICATION _ ARCHITECTOR (1�• - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.,NO.' ENGINEER LIC.No, SIGNS TRANS.- 3.00 ADDRESS ENG' . . SPECIAL CIRCUIT 5.00 PERMIT VALIDATION zlP EMP.METER OR POLE INS. 20.00 APPLICANT'S ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE t, 1 20.00 H o O LICENSED CONTRACTORS DECLARATION_ A u I hereby affirm that 1 am licensed under n 3 of he of Chapter 9 y Q n (commencing with Section]000)of Division 3 of lite Business and �QQa ISSUANCE DATE r w 2 Professions Code,a nay license is in full fa e"" B DG. ELECT. PLG. MECH. g p e ❑ ❑ ❑ zz i m o Luens Cl Lic.Number F r a m j Dam Contractor_W, / (City of(Cupertino wu OWNER-BUILDER DECLARATION BUILDING PERMIT w ;u w I hereby affirm that 1 am exempt from the Contractor's License IMISC.- REFER TO ORD INFORMATION' r a O j Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCEVALUATION $/FT. j Code:Any city or county which requires a permit to construct,alter, 10.00 Krt sr improve,demolish,or repair any structure,Prior to its issuance,also ELEC.CONT R. LIC.NO, ELEC, 0 T requires the applicant for such penult 10]lie 11 signed statement that PERMIT TO a w m m he is licensed pursuant to the provisions of the Contractor's License TOTAL Fz > Law(Chapter 9(commencingwith Section 70001of Division3ofthe F i o Business and Professions Code)or mar he is exempt therefrom and OTV. PLUMBING PERMIT FEE { 1- o the basis for the alleged exemption.Any violation of Section 7031.5 a .- by any applicant for a permit subjects the applicant to a civil penalty STORIES T PE CONSTR. al'not more than five hundreddollurs($500).1: ALTER-DRAIN&'VENT-WATER (EA.) 5.00 ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 4.00 their sole compensation,will do the work.and the s a .cture is not OCC.GROUP RES.UNITS 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 SG.FT.FLOOR AREA TOTALACREAGE lornuclf re through his own amred fors,Provided that such improve mcnts are not intended or within offered year o It,completion, the building GAS-EA.SYSTEM-1 1NC.40UTLETS 6.00 im r will have is sold within one year of completion,the ownerGAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of Proving that he did not build or am- BUILDING USE 'J prove of sale J. RES IND CON PB Omer 1,as o ❑ L as owner of the properly,he rojectiv Se . 7044,Bu with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ licensed coum,C...I m construct me project(sac. 7044,Hammes, LAWN SPRINKLERS-1 INC 6 V.B. 6.00 to Professions Code:The who 's License s tit docs not dwho ASSESSORS PARCEL NO. m un owner of property who huilAs or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contractogs)licensed pursuant to rhe Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TR ACT rvO. PARCEL rvD. ❑ 1 am exempt under Sec. ,B.&P.C.lin this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM. 5.00 ACC.DATE ACC.FILE N0. WORKEkS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby of Ore that I have a certificate of-consent to self-insure. or a certificate of Workers Compensation Insurance,or a certified ZONING ENG.SITE NO. copy throw](Site.3800,Lab C Policy Na. Cnmpany / �IL }�ai}'7/dA,fv Certified cgpy is he%eshvl( d(aJ({a -ZG (p-�- Z 2 Certifie rpy is til wl ( h i1y on division. FIRE SPRINK ENERGY T2< � O nphcanr MISC.- REFER TO ORD. YL] No Y ❑ NEI CER 'ICn'1'E OF EXEMPTION OM WORKERS' PERMIT ISSUANCE 10.00 O FLOODZONE A.L.U.C. LU > COMPENSATION INSURANCEd O PLG.CONTR. LIC.NO. PLO (Ty� his s1dum need not be completed it the permit is for one TOTAL -�y V N Y[] N❑ Z hundred dollars($100)or less.) U O 1 certify that in the performance of the work for which(bis per- MECHANICAL PERMIT FEE SUMMARY LL 1- mit is issued,I shall not employ any person in any tramper so as to QTY' FEE O w become subject to the Workers'Campasa ma Laws of California. a LateNOI Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } h NOI'ICP: TO APPLICANT: If after making Otis Certificate of lix- Z emplim.you Should become subject to the Workeri Compensation APPLIANCE Provisions of the Labor Code, you must forthwith comply with 5.00 PLAN CHECK C) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F,M.) 4.00 FEE CONST RUCTION LENDING AGENCY. AIRHANDLINGUNIT(OVER 10pODC.F.M.) 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 liar which this permit is issued(Sec. ' 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have mad this application and state mut the shove VENTILATION FAN (SINGLE) 4.00 information n correct. I agree to comply with all city and county PLUMBING hereby and scam laws relating m building construction. and BOILER-COMP(3 H.P.OF 100,000 B.T.U.) 6.00 .0 hereby authorize reperlyforwee of this city to enter upon the above-nminioneJ property for inspection purpaus, BOILER-COMP (Over 100,000 BTU)DEE FEE SCH. MECHANICAL (We) agree 10 save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgmeals, costs and expemle,which uY in way ac rue at aid City in consequence of rhe PERMIT ISSUANCE 10.00 CONST.TAX mnti o this per �� MECH.CONT. LIC.NO. MECH. TOTAL D &g re of gppu<att/L tractor Uate e OFFICE COPY