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16339 POST-THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER ' CITY OF CUPERTIN0 16339 INSPECTION DIVISION JOB INSPECTION RECORD ^K, PERMIT EXPIRATION JOB ADDRESS—IOO /✓`-'Z �� L/�'u UNIT# LOT# ' ^ � PERMIT EXPIRES IF.WORK OWNER " "& C 7-7- CONTRACTOR �f ^V C7, IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION 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. , GARAGESLASS ✓' ../ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING f,. ELECTRICAL ISSUANCE DATE MECHANICAL BLDG ELECT I PLG. MECH; 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED e BUILDING PERMIT ��F NFORMATION WOOD FLOOR LUA ION PLUMBING MECHANICAL C,ty ELECTRICAL PERMIT TO FRAMING - U INSULATION DORIES TYPE CONSTR. , OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ,• fl00F NOTE:NO FINAL INSP,SHALL MADE BEFORE 5O FT FLOOR AREA TOTALACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ' BUILDING USE ROOF SHEATHING RES IND CON PB APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH SAN.N ASSESSORS FARCE L NO ' � ' ,PLUMBING ELECT.ENERGY hj TRACT NO PARCEL NO. TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL MECR ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION, PLUMBING �_ _faq C•.�� _^ GAS TEST GAS MECHANICAL U1 FIRE SPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ NL FLOOD ZONE EXTERIOR SHEAR ELECTRICAL RELEASE A _.0,C, l_q_gq @: INTERIOR SHEAR FIRE DEPT. WE,. v❑ "❑ Y L NL SHEETROCK GRADE N FEE SUMMARY EXTERIOR LATH - BUILDING _ INTERIOR LATH - - TEMPORARY APPROVALS' BuiLDING SCRATCH COAT I ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM .- ARRANGE FOR INSPECTION BY PHONING 252-4505, liNIIIIiIIIIII ELECTRIC I �hy . -� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING . N z PLEASE GIVE JOB ADDRESS WHEN PHONING - - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BBUUILLRDINSp APPLICATION & PERMIT 1 C A J 6S ja �' r BUILDING—ELECTRICAL—PLUMBING—MECHANICAL I U WN 'S - NAME PLAN CHECK VALIDATION -/ � DTV. ELECTRIC PERMIT FEE ( $ ONE!/ CONTRACTORS NA E UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 1 rs'Z ONTRAC 'a ADD as I& r APPLIANCES-RESIDENTIAL 4.00 1 'tutu S PHONE 4.2 W.21/ PANELS 10.00 DATE OF APPLICATION ARCHITECTOR PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. ENGINEER LIC.NO. SIGNS TRANS. 3,00 ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION zIP TEMP.METER OR POLE INS. 20.00 �n APPLICANTS ADDRESSMOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 '02 LICENSED CON'T'RACTORS DECLARATION a i w I hereby affirm that I am licensed under prnvisiousof Chapter9 ISSUANCE DATE ' a w (commencing with Section 7000)Of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H Professions Cod a d my license is in full for MJp/jflc ❑ o0 m D Licen lass Lu.Numbe 7�/V H y H J Date 4�_ _ me(Or Q < Y - 121151118 UILDING PE MIT rc tt w ¢ OWNER-BUILDER LIIfiR DECLARATION o A D INFORMATION X ; LL H I hereby affirm that I lin+exempt from the Contractor's License MISC.— REFER TO ORD ID ygT10N $/FT. HLL04 Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE — (`px" Code:Any city or county which requires a permit to construct,alter, Zce ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.DDNTR, LIC.NO. ELEC. / D u requires the applicant for such permit to file a signed statement that TOTAL M/V d w m m he is licensed pursuant to the provisions of the Con Nacmr's License PERMIT TO ri > Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe 4 o Business and Professions Code)Or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE 7 4 TE m the basis for the alleged exemption.Any violation of Section 7031.5 TORIES TYPE CONSTR. n by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 of net more than five hundred dollars($5001.): ❑ 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 (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,an I who does such work FIXTURES-PER TRAP _&W SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. meals are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INCAOUTLETS 6.00 or improvement is sold within one year of con+pletion,the Owner builder will have the burden of proving that Ile did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE prove for purpose ofsaleJ. INDUSTRIAL WASTE INTER3000 RES ,ND CON ' PB Omer . . ❑ I,as owner Of the property,am exclusively contracting with Q ❑ ❑ 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 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 for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. -TRACT NO. PARCEL NO. ❑ lamexemptunder Sec. ,II.&P.C.forlhis WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKBRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby infirm that I have a certificate(A nmsent TO sell=insu ru, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy ihercol'(Sec.3800,Lab.C.). ' Policy No. Company 0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is Bled with the city inspection division. FO sipplicaut MISC.- REFER TO ORD. YF] N[] I Y ❑ NE] CC m CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.u.C. LU > COMPENSATION INSURANCE PLG,CONTH. LIC.NO. PLG. _ ❑ ❑ O ❑ Z (This union need not be completed if the permit is for one TOTAL / �• Y N Y N hundred lollars(S 100)orlcss.) V O I certify that in the perlormance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not employ any person in any so us to U becoyy��supp�� eWorkers�' Lmpen55pp�/'on m, alllornia. 0 0. Date7�p Applicant J{raepYn— ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICIi"10 APPLICANT': If,alter making this Certificate of Ex. H Z emption,you should heconto subject to the Workers'Compensalion APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 �--1�s CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE V D I hereby affirm that there is a construction lending agency for EXHAUST HOOD IW ITH 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.)9.50 Lender's Address ELECTRIC l certify thml havercadtllisapplicationand,lutethattheabove VENTILATION FAN ISINGLE) 4.00 information is correct 1 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned properly for inspection purpnuua (We) agree to save, indemnify and keep h:u Riess the City Of MISC.- REFER TO ORD. _ Caperino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the m ngofthispermit �,/ MECH.CONT. UC.NO. MECH. / ,- 1e"S44� TOTAL TOTAL 71� J signature of A pplican/ on tractor Uale OFFICE COPY