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17341 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 17341 INSPECTION DIVISION JOB INSPECTION RECORD O's • PERMIT.EXPIRATION JOB ADDRESS_(_..! ] cD .JISD� •_UNIT# _LOT# Ic - PERMIT EXPIRES IF WORK OWNER b I -&_ .Q CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. Pq EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF ' PEHMIT VALIDATION CUPERTINO STANDARDS.' GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED —� : UNDERGROUND /SLAB . I PLUMBING � �• ELECTRICAL ISSUANCE DATE MECHANICAL - I Luc ELEcrPLG, MECR El ® ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION SIFT. MECHANICAL ELECTRICAL o FRAMING p' INSULATION STORIES T'PEc NSTR Dcc GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sa.FT FLOORAREA TorAL Aca encs • DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IND CON PB Om., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED I FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH SAN.# ASSESSORS PARCEL NO PLUMBING - ELECT.ENERGY TUBS&SHOWER PANPLUMBING ENERGY LRACT No PARCEL No MECHANICAL MECH.ENERGY ELECTRICAL - BUILDING ENERGY ACC DATE Acc FILL NO FRAMING ELECT.FINAL TEST INSULATION PLUMBING "_ ✓ ---ZONING ENG SITE NO. GAS TEST GAS MECHANICAL FINE SHRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ -El ` ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD z67 ALU, INTERIOR SHEAR - FIRE DEPT. `'❑ DEll ❑ N❑ 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 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 Fw- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. . .U� Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL �1 CALLING FOR FINAL INSPECTION. l ,Dy OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .BUT TNG PROJECT IDENTIFICATION PERMIT NUMBER aDILo1NG , APPLICATION & PERMIT °• n ADDRESS �� c�8 •STAFF�I4D cD2 17 3`r GVPt--R / NU BUILDING -ELECTRICAL-PLUMBING-MECHANICAL +�• MIKE f{�lghlONE`/OWNERS PLAN CHECK VALIDATION NAME c/O1� OTY. ELECTRIC PERMIT FEE PrONE %L NAAME AcroRs OUTLETS-SWITCHES-RECEP 10.00/7.00 -eel uc.NO LIGHTING FIXTURES 10.00/1.00 DDRESCrORs As PPLIANCES-RESIDENTIAL 4.00 OOREs /�`- -y ^ -Oe WI'�G PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.N0. ENGINEER / LIC.No. SIGNS TRANS. 3.00 ARCH,OR A OGRESS ENG. / SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT oo Essrs MOTORS SEE FEE SCR. 1'S8T-AFPO" DP_ SERVICE CHANGE 20.00 w¢ z Foo_ LICENSED CON'T'RACTORS DECLARATION v 1 Irerehy Sri-,. that I :no licensed under provisions of Chapter 9 w a ?7 % (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE F w z I'rofessiuns Code,and my license is in full force and effect MAR �}] DG. ELECT. PLG. MECH. zo i In W License Class Lie.Number Ki rn F Dale Comractor i��sr11 ,�{p�� 1� Ki ¢ a Se a OWNER-BUILDER DECLARATION CW.sFl�UQeI�IQ BUILDING PERMIT E 0 A U INFORMATION X ; I, I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD LL O¢ Law for the following reason.(Sec.7031.5.Business and Professions VALUATION $/FT. - , PERMIT ISSUANCE 10.00 Code:Any city erectility which requinsa PCrmit IOCOnStfL$Ct,alter, ¢ ¢¢0 improve,demolish.or repair any structure,prior to its issuance,also ELEC.CONTR, LIC,NO, ELEC. E m¢ requires the applicant for such permit to file a signed statement that TOTAL 6 w he is licensed pormant to the provisions of the Contractors License PERMIT TO FiQLaw(Chapter 9(comnlenein,with Section 7000)of Division 3 ofthe E o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE a v M I- $ the basis for the alleged exemption.Any violation of Seolion7031.5I STORIES f TYPE CONSTR. Ate _ by any applicant for a permit subjects the applicant ra a civil penalty ALTER-DRAIN -WATER IEA.) $.00 of not more than five hundred dollars($500)): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered far sale (So,. 7044. Business and ProfessionsDRAINS-FLOOR,ROOF,AR EA,CON D. 5.00 W"440z,r, Code:The Contractor's License Law does not apply to an owner of fe Pro Perry who builds or improves thereon,and who does such work - FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE himself or through Ills own employees,provided that such improve- ments arenot intended oroffered fill sale.l L however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement Is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or int- BUILDING USE p efor purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer I,as owner of the properly,am exclusively contracting with. El El ❑ D 0 li ensed contractors to construct file project(Sec. 7044,Busines LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. 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 forsuch projects with a contracforts)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO, PARCEL NO. ❑ Iamexempt under Sec. ,BAP.C.forthis WATER HEATER W/VENT 6.00 00 reason Own Date � WATER SYSTEM 5.00 j ACC.DATE ACC.FILE N0. wOkRERS'COMPENSnTI 'S1iCLARATI WATER TREATING-EQUIP - 1 hereby affirm that 1 have a certificate ufccrosent to self-insure, nr a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab C.). Policy No.-Company- 0 o. Company0 ❑ Certified copy is hereby,furnished. Z Z ❑ Certified copy is fled with the city inspection division. FIRE SPRINK ENERGY T 24 F 0 Applicant MISC.- REFER TO ORD. N� v ❑ NEI � T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 1 .�LYL OOD ZONE A.LUL. W COMPIiNSA'I'ION INSURANCE PLG.CONTR. LIC.NO. PLG. CL D 1'1'his semidn need mol be comple@d if NIC permit is For one TOTAL Y❑ N Y N ::) Z hundred dollars IS 100)or less.) U O 1 certify that in the ped'onrance of me work for which this per- Q TY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Canlpensation Laws of California. w Date nnplicum OR ADD TO MECH. 5.00 BUILDING } Z NOl'ICIi TO APPLICANT: If,arms making this Certificate of lix- _ emplion,you should become subject to the Workers'CompensationNCE 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with FEE C.U. such provisions or this permit shall be deemed revoked. NDLING UNIT(TO 10000 OF-M.) 4.00CONSTRUCTION LENDING AGENCY NDLING UNIT(OVER 10.000C.EM.) 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 Lender's Address HEATI NG UN IT(OV E R 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 co and slate laws relating to building construction, and BOILER-COMP 3 H.P.or 100,000 B.T.U.) 6.00 < hereby mall.rloe representatives of this city to enter upon the BAILER-COMP (Over 100,000 BTU)SEE FEE SCR. above-mentioned property far inspection purposes. MECHANICAL (We) agree to wave, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 ctrl �Applicant/C�Gotracto MECH.CONT. LIC.NO. MECH. `j TOTAL TOTAL I SignaturD; c OFFICE COPY