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15622 POST'TH.IS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 15622 INSPECTION DIVISION JOB INSPECTION RECORD // '7 PERMIT EXPIRATION 'C JOB ADDRESS ./0- 9 / s+ ��'�- �L✓d UNIT# _LOT# - - PERMIT EXPIRES IF WORK OWNER icX J, '�0 CONTRACTOa 1 Ji�--.� IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPRtTION 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 - ' UNDERGROUND /SLAB - PLUMBING _` 1 `•f . ELECTRICAL' Q ISSUANCE DTE MECHANICALp a ELECT PLG. MECR. �1 P 11 11 . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ILDING PERMIT WOOD FLOOR wtt+l INFORMATION VI�� VALUATION S/FT. PLUMBING MECHANICAL - +r PEHF11r o ELECTRICAL FRAMING INSULATION - - STORIES TYPE CONSTR OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED so FT FLOOR AH EA TOTAL ACREAGE . . - • ROOF NOTE:NO FINAL INSP.SHALL BE j� MADE: BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ' ROOF SHEATHING Res IND •CON P9' Om" APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED o FINALSDATE INSP. E El ❑ F-1 E) ! ASS SSOHS PARCEL NO, ROUGH SANS: PLUMBING - ELECT.ENERGY , TRACI NO PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY- . . MECHANICAL - MECH.ENERGY ELECTRICAL ACC,DATE ACC.FILE NO. BUILDING ENERGY - FRAMING .ELECT.FINAL TEST ZONING ENO.SITE NO. INSULATION - PLUMBING GAS TEST - GAS ' FIRE SPRINK ENERGY 1.24.' MECHANICAL - - - COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y Q N 'y.❑ NEJ EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD ZONE -.A.L U.C. . ' INTERIOR SHEAR FIRE DEPT. YO NO YL No SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH IBUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT PLAN CHECK ) ELECTRIC FEE ` GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL IS SIGNED BV BUILDINGINSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, . ELECTRIC * :'`' i ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0� PLEASE GIVE JOB ADDRESS WHEN PHONING. ZMECHANICAL —.SEE PERMIT FOR EXPIRATION DATE ,— 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 BUILDING APPLICATION & PERMIT ADDRESS 9 15622 Qac, S' �^i9/V/Z.�- (SL✓.G� BUILDING-ELECTRICAL=PLUMBING=MECHANICAL I OWN ER'S _ �� 1 - PLAN CHECK VALIDATION, QTY. ELECTRIC PERMIT FEE PXONF': J v CONT CTOR'S � t--r`'---�-^� / L[ OUTLETS-SWITCHES-RECEP 10.00/1.00 uc.NoJ 7 U LIGHTING FIXTURES 10.00/1.00 r. NTRACTORS - 1' PPLIANCES-RESIDENTIAL 4.00 - - ( / ADDRESS c V - X J PHONC 6 PANELS 10.00 GATE OF APPLICATION . ARCHITECT KECT PLAN CHECFEE P.C:NO. O " DR PANELS (OVER 200 AMP) 20.00 L ENGINEER _ + Lie,NO. SIGNS TRANS. 3.00 ADDRESS E"G SPECIAL CIRCUIT 5.00 PERMIT VALIDATION - A-1 e zlv TEMP.METER OR POLE INS. 20.00 ��• APPLICANTS c¢ z MOTORS SEE FEE SCH.VPJESYySIA!� rIJ" 5,13 SERVICE CHANGE 20.00 OO J •, ,r /�L�O�i. (/ LICENSED CONTRACTORS DECLARATION <u d hereby affirm that I am licensed under provisions of CIIDP(er 9 'ISSUANCE DATE- (commencing with Section 7000)Uf Division 3 ol'the Business and BLDG. ELECT. PLG. MECH. Professions Cl an m license is in full force an 1 eq.v 0.D Licenm Cla sS- SAY Lie.Number_. ❑ ❑ ❑ ❑ -F m r J Da[e_7J- 7j¢I/ Contractor :t ¢ a' OWNER-BUIL HR DECLARATION BUILDING PERMIT U MISC.- REFER TO ORD INFORMATION _TIE ¢ I K 3 A E. I hereby affirm that 1 am exempt from the Contractor's License ATION $/FT. H u o a Law for the following mason(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, 0 Q Q¢Q improve,derrinh$h,0(lePall any St NCInrC,prior to its issuance.aI50 ELEC.CONTR. LIC NO. ELEC. / n a Oo u requires tare applicant for such permit to file a signed statement that TOTAL C PERMIT T w m he is licensed pursuant to the provisions of the Contractor's License V Jr+. r z i Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe cpy aBusiness and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT 1'ee CC si-O the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(S500).1: ❑ 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 Profession's DRAINS-FLOOR;ROOF,AREA,GOND. 5.00 Code:The Contractor's License Law does not apply to an owner of Property who builds Ur improves thereon,and who does such work FIXTURES-PER TRAP 5.00 'SO.FT,FLOOR AREA TOTAL ACREAGE himself re through his own employees,for rsS provided that such improve. / mmselfo not intended or employees, molded that slhr building GAS-EA.SYSTEM-I INC.4OUTLETS 6.00 Ur improvement is will within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Goal,prove for purpose Ufsale.). INDUSTRIAL WASTE INTER. 30.00 O 1,as owner of the property,am exclusively contracting 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 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 u cici ruct.00 licensed pursuant to the Contractor's License Law. I SEWER-SANITARY-STORM EA.200ft/10.00 . TRACT NO, PARCEL NO. ❑ am exempt under Sec. ,B:&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK Ii RS'COMPENSATION LECLA RATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofcousenl to self-insure. •J or a certificate of Workers'Compensation Insuran`'e,or c rti fief ZONING - ENG.SITE NO. tKo copy eof Se- 3800,Lab.C.). Policy � '�.Comp any_ -1<' O ❑ Cc rtlfied copy is hereby furnished. FIRE SPH INK ENERGY TQ4' Z Z ❑ Certified copy is filed with the City inspection'division. MISC.- REFER TO'ORD. .p ❑ N❑ Y ❑ N❑ O Applicant~ rn PERMIT ISSUANCE 10.00 FLoo02orvE A.L.u.c. j CERTIFICATE OF EXEMPTION FROM WORKERS' LU _ COMPENSATION INSURANCEPLG.COrvrR. LIC.NO. PLG. CL Q ('firs section need not be Completed it the permit is for one TOTAL V N� Y❑ •�N❑ D,Z hundred dollars IS 100)or less.) U O I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY LL 5 mil is issued,I shall not employ any person in any manner so as to 0D become Subject to the Workers'Compensution Laws of California. BUILDING 63 (70 Date Applicant ALTER OR ADD TO MECH. 5.00 INDUCE TO APPLICANT: If,after making this Certificate of Ex- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK p3 f^ provisions of the Labor Code, you muss fothwilh comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 ' CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,OODC.F.M.) 6.00 SEISMIC FEE SO 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(Sea MICROFILM 3097,Civ.CJL HEATING UNIT(TO 100,000 B.T.U.) 8.00 ' Lender's Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) - 4.00 information is correct.1 agree to comply with all city and county PLUMBING 00 ordinances and State laws whiling to building Construction, and BOILER-COMP(3 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 property for inspection purposes. -(We) agree to save, indemnifyandkeep harmless the City of MISC.- - - REFER TO ORD. u agal iabiluies,jadg rets, costs and expenses which PERMIT ISSUANCE 10:00 CONST.TAX s a in any way ccrda against iit City in consequence of the - r lingof cr i . MECH.CONT. LIC.NQ MECH. - t �. TOTAL " TOTAL Startillue oTApTM&antIContr or Date - OFFICE COPY