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16019 POST THIS CARD NEAR FRONT OF BUILDING y PERMIT NUMBER CITY OF CUPERTINO . 16019 INSPECTION.DIVISION JOB INSPECTION RECORD QQ •� f1�/I �/� PERMIT EXPIRATION JOB ADDRESS �D DO O�., ��^ '�• •" UNIT# _LOT# .J ✓�• '/ "•� PERMIT EXPIRES IF WORK OWNER Fr� y�Il< . �t ,lN-Y � CONTRACTOR / .e IS NOT STARTED WITHIN INSPECTION D TE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION - - ANCE OR 180 DAYS FROM • NOTE: - , LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.. 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 PLUMBING ELECTRICAL - ..ISSUANCE DATE MECHANICAL - BLDG. ELECT,I PLG. MECH, - - - PAID ❑ � ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION SIFT. PLUMBING . r 'MECHANICAL ofCupertl 3a . •� ELECTRICAL PEHMIr To 1 FRAMING .. I�.IVi� ! • J I II•i. 'i� INSULATION STORES TYPE CONSTA. - OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE, SO,Fr FLOOR AREA TOTAL ACREAGE . DIAPHRAGM THE CONSTRUCTION TAX IS'PAID BUILDING USE ROOF SHEATHING HES IND CON PB Co", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El0 ❑' ASSESSORS PARCEL NO. ROUGH SAN.# PLUMBING ELECT.ENERGY " TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO, PARCEL NO MECHANICAL r MECH.ENERGY ELECTRICAL - BUILDING ENERGY ACC.DATE ACC.FILE NO FRAMING ELECT,FINAL TEST INSULATION PLUMBING ZONING ENG,SITE NO. • GAS TEST - - GAS - ' MECHANICAL FIRE SPRINK ENERGY T-34 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "E] IN[] EXTERIOR SHEAR ELECTRICAL RELEASE IFLOOD LONE A UC INTERIOR SHEAR FIRE DEPT. Y[:] "oY "'❑ 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 . OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR:INSP EC TI ON BY PHONING 252-4505, ELECTRIC - _ F- ONE WORKING DAY.BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE-GI VE JOB ADDRESSWHENPHONING. ;z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL 1 CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-- USE BALL POINT PEN ONLY •BU I LDING PROJECT I DENT]FICATI ON -PERM IT NUMBER , BmLmNG APPLICATION & PERMIT I ADDRESS S�TNa-r�i WY. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL Z" .16019 OWNER'S O - PLAN CHECK VALIDATION "A Ep4��K OTV. ELECTRIC PERMIT FEE SoGQBM4 vHONE co"TRns �.. , OUTLETS-SWITCHES-RECEP 10.00/1.00 $O NAME tic.NO.9SS2 10 ILIGHTING FIXTURES 10.00/1.00 CONTRACTORS ADORE PPLIANCES-RESIDENTIAL 4.00 - S 1�to(o PRONE soynn-va PANELS 10.00 DATE OF APPLICATION ARCHITECTPLAN CHECK FEE 11,C.NO. 0R PANELS (OVER 200 AMP) 20.00 ENGINEER LIC.No. SIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 aoo assns - MOTORS SEE FEE SCH. SERVICE CHANGE 20.00In M (7 O 0 LICENSED CONTRACTORS DECLARATION a 1 hereby affirm that 1 um licensed under Provisions.1 Chapter 9 ISSUANCE DATE l/ (commencing with Section 7000)of Dlvleton 3 of the Ousiness and BL❑O0. ELECT] PL❑G. MEC9. m i Professions Code. nd nr1{�llicerise is in full for xro`I( License Class-1.1/___Lia Number ? i �RSC'C- 9 r 1]atc Contractor JUL h'J90 a y f c BUILDING PERMIT ¢o W U OWNER-BUILDER DF.CLA RATION MISC.- REFE n0 INFORMATION X ; LL I- I hereby affirm that I am exempt from the Contractor's License v, I VALUATION SIFT. H LL O j Law for the following reason.(Sec.703 L5,Business and Professions PERMIT ISSUANCE -49:88 of Code:Any city or cmmty which requires a permit to construct,alter, ¢ Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO ELEC. / go O LL requires the applicant for such permit m file a m signed statement that TOTAL PER O u w m he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(commencing with Sectio"7000)ofDivision 3 ofthe ✓!I^-k'/J' a Business and Professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE ¢ ro the basis for the alleged exemption.Any vlulat ion ofSect ion 7031.5 STORIES I TYPE CONSTR. dam by any applicant for a permit subjects the applicant toa civil penalty - DRAIN-DRAIN&VENT-WATER (EA.15.00 of not more than five hundred dollars(5500).): ❑ I,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(Sue. 7044, Business mid PoloW..... DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to:In 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 or through de own employees,for le.11,however, r,t h improve' GAS-EA.SYSTEM-1 1NC.4 OUTLETS 6.00 mems are not intended or empl for sale.II',ed that s the building or improvement is sold within one year of<omplelion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or iia- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other ❑ I,as owner of the property,am exclusively Commuting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Conlmelor's License Law docs 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 contraetorfs)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sea ,B.&P.C.for tlli] reusori WATER HEATER W/VENT 6.00 Owner Data WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSAT ION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to half-insure, ZONING an a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. Lab copy thereof c.3800, rify fur.d. - /'✓ . P r Nr. Company'_ - - /�(�. r QCart it Tad co y is hereby fur. d. FIRE SPRINK ENERGY T@4 z ❑ anHdled Zs f ily inspection dlvistoli' MISC.- REFER TO ORD. O APPlicunt�_ - V ❑ N❑ V ❑ N❑ ~ rnLU - CGRTIICIEXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.LLC. W > COMITNSTION INSURANCE PLG.CONTR. LIC.NO. pLG, 0. 0 1 'rhis Section need not be completed if the permit is to,are TOTAL' Y,❑ N❑ Y❑ N❑ hundred dollars(S 100)or less.) U O 1I certify that in the performance of the work for which this per. CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,1 shall not employ any person in any manner so as to O L) become subject to the Workers'Campenmtlon Lawsaf California. BUILDING a Datc nPPllcant ALTER OR ADD TO MECH. 5.00 } W NOTICE TO,APPLICANT: If,after making this Certificate ol�lix- F 2 emption,you should become subject to ilia Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such Prnvisions or this permit shall be deemed revoked. AIRHANDLINGUNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION I.ENDINC AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE I hereby affirm Halt there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 31097 eCiv.C.)nee of the work lift which this permit is issued(See, HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Leader's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address - ELECTRIC �✓7Ls� 1 certify that I have read this application and state That the above VENTILATION FAN (SINGLE) 4.00 information n correct. I agree to comply with all city and county BOILER-COMP(3 H.P.Of 100,0008.T.U.) 6.00 PLUMBING informatio and stale laws relating c m comply with construction, and hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCM. MECHANICAL .-� (We) agree to save. Indemnify and-keep harmless the City of MISC.- REFER TO ORD. upertum against liabilities,judgments, costs and expanses which CONST.TAX' ay in any way accrue against said City in consequence of the PERMIT ISSUANCE -Uwe mn[i of it permit. - MECH.CONT. LIC.NO. MECH: .Ir TOTALa/ pu TOTAL .3S_ Signature of Applicant/Contractor Data 7 C OFFICE COPY