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16568 POST THIS CARD, NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16568 INSPECTION DIVISION JOB INSPECTION RECORD. ?y ` /r PERMIT EXPIRATION JOB ADDRESS40 �.3 /U,�A/ .�E/TN �1([I,UNIT4 _LOT# //JJ PERMIT EXPIRES IF WORK OWNER LC — C6 CONTRACTOR LS L.. ,r, co N— IS NOT STARTED WITHIN ' I P CTION 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 PEIWIT VAuoATION CUPERTINO STANDARDS.' . GARAGE SLABS l POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED „I •- ' UNDERGROUND /SLAB PLUMBING r L< •� / ELECTRICAL I ISSUANCE DATE MECHANICAL - - RED(!. ELECT. PLG. I MECH, . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING .PERMIr WOOD FLOOR \�� INFORMATION. VALUATION SIFT. PLUMBING C4-- 7'U 7 Ir 1l�� .LUVa 1 MECHANICAL - V ELECTRICAL - PERMIT TO FRAMING - INTORio� MRD INSULATION STORIES TYPE CONsnA. OCC.GHOUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn FT FEooR AREA TOTAL ACREAGE D DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUII.DING USE. ROOF SHEATHING - RES . IND CON P9 Go— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 ❑ ❑ ❑ L ROUGH SAN.q ASSESSORS PARCEL NO. PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL - MECH.ENERGY • ELECTRICAL . .� BUILDING ENERGY - ACC DATE ACC.FILE NO, FRAMING - ELECT.FINAL TEST ZONING ENG SITE NO, INSULATION PLUMBING.. GAS TEST GAS - MECHANICALFIRE SPRINK ENERGv,T-24 ' -� V_[] N❑ V ❑ -E] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING . EXTERIOR SHEAR ELECTRICAL RELEASE _g'�yg� FLOOD ZONE A.L uL. - INTERIOR SHEAR FIRE DEPT. , 0 N� YL ry� SHEETROCK GRADE - FEE SUMMARY EXTERIOR LATH - BUILDING - INTERIOR LATH TEMPORARY APPROVALS BUILDING ` SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE S NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERM ITTED UNTI L BU ILDING FINAL IS SIGNED 13Y BUILDING INSPECTOR. MICROFILM w ELECTRIC ARRANGE FOR INSPECTION BY PHONING 252-4505, r ONE WORKING DAY BEFORE REQUIRED INSPECTION. . PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. z - SEE,,PERMIT FOR EXPIRATION DATE - MECHANICAL _ D_ TAX IMPORTANT! ' CONST. PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL S/7 OFFICE COPY NJ ` APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATI ON - PERMIT NUMBER BUILDING - APPLICATION & PERMIT ADDRES1 I ^ I U U U r(ryEM1/J/1V\ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION " E In ELECTRIC PERMIT FEE ONE 01 CONTRACTORS A E /((J�� q-��/� UTLETS-SWITCHES-RECEP 10.00/1.00 ,/r/x--ILh1 No 43; {0 LJIGHTING FIXTURES 10.00/1.00 kAP.. .�SR TRACTOR'S PPLIANCES-RESIDENTIAL 4.00 _ ' NE ANELS 10.00 CHEOF APPLICATION' N PLAN CHECK FEE PC.NO.P ANELS (OVER 200 AMP) 20.00N IGNS TRANS. ` 3.00 n PECIAL CIRCUIT 5.00 PERMIT VALIDATION (Q� zn,LJEMP.METER OR POLE INS. 20.00 APPLICANTS TORS SEE FEE SCH. ir� . SERVICE CHANGE 20.00 woo , /v/ LICENSED CONTRACTORS DECLARATION - Q 7 a i w I hereby affirm that I am licensed tinder provisions of Chapter 9 UANLE DATE (commencing with Section 7000)of Division of the Business and ELECT. PLG. MECH. rm i Professions Code, my license is in full f`r O. ❑ 2 O m - License C s Lic.Number 0 N r w Date_ CoNtuclor ¢ ae s ��1"` VVV y BUILDING PERMIT ¢ tea OWNER-BUILDER DECLARATION - - s o a u INFORMATION a ; Ii r I hereby alfirm that I am exempt from the Contrite License MISC.- REFER TO ORD w VALUATION E/FT. uoa Law for the following reason.f5ec.7ires3 Business Professions PERMIT ISSUANCE •'1'0:00' Q CE - J' Code:Any molish counlywhiny structurep riort ots issuance,also //� K¢ < improve,demolish,or repair any structure,prim to its issuance,also ELEC.CONTR. LIC.N0. - ELEC. wD LL requires the applicant for such permit t0 file a signed statement flat ' , TOTAL -� PERMIT TO m he is licensed pursuant to the provisions of the Contractor's'License F, z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the �i��.�`a �//f� a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE \� � It =$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. . by any applicant for a permit subjects the applicant toaeivilpenalty ALTER-DRAIN&VENT-WATER IEA.) 5.00 of not more than five hundred dollars 15500).1: • ❑ 1,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(Sce. 7044, Business and Professions DRAINS-FLOOR,ROOF;AREA,COND. 5.00 - Code:The Contractor's License Law docs not apply to an owner of property Who builds orimproves thereon,and who docs such Work FIXTURES-PER TRAP 5.00 so.FT.FLOOR AREA TOTALACREAGE Itinsetnot hrough own Cored to,sale. If,ed evehat r,the improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 meats are not intended or offered for sole.If,however,the bowne r. or improvement is sold within one year of completion,build owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE prove of will have the burden of proving that he did not yui1J or int- RES IND CON PB Other I prove for purpose of sale.), INDUSTRIAL WASTE INTER. 30.00 ❑ d as owner of the property,he exclusively contracting with ❑ ❑ Cl- ❑ ❑ I licensed contractors to construct the project[Sec. 7044,Business LAWN SPRINKLERS-i INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractors License Law does not apply to ancontracts owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 a the Contractor's forsu License witlu Contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the COplmdois LiCenu Law. TRACT NO, PARCEL NO. j ❑ lam exempt under Sec,-,B&P.C.for Ibis WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 PCG DATE ACC.FILE N0. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 ihereby affirm that I have a certificate of consent to sel Ginsom. ZONING ENG.SITE NO. or Certificate of Workers'Compensation Insurance,or a certified copy thereof(See.3800,Lah.C.1.C1iLr� ' Policy No. Company-�79-7 O ❑ Certified copy is hereby furnished a FIRE SPRINK ENERGY T 24 Z Z ❑ Certific 'o y 's fled�yHh the city inspection division. O Applicant-V alJ O.A.A i.r-- MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑ ~ va PERMIT ISSUANCE 10.00 � - CERT'IPICAI'B OP EXEMPTION PROM WORKERS' FLOOD ZONE A.L.uC. d > - COMPENSAT10N INSURANCE PLG.CONTR. LIC.NO. PLG. C N❑ YE] N❑ This section need not be Completed If the permit is for one TOTAL D Z hundred dollars(5100)or less) IJ O 1 certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY LL F mil is issued,I shall not employ any person in any manner so as t0 Ow become subject to the Workers'Compensation Laws of California. BUILDING r/ Sa ED Date Applicant ALTER OR ADD TO MECH. r } to NOTICE TO APPLICANT: If,after making this Certificate of Ex- � Z emptian,you should become subject to the Workers'Compensation gppL1ANCE - 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith Comply with U such provisions or this permit shall be deemed revoked. / AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 FEE 1C CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE `• I hereby affirm that there is a construction[Coding agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance ofInc work for which this permit is issued f5ec. MICROFILM Lend r'sNI. . "� - EATING UNIT ITO 100,000 B.T.U. S. Lender's Name HEATING UNIT(OVER 100,000 8.T.U.)9.50 Lender's AAdress ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 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-COI H.P.or 100,000 B.T.U.) 6.00 hereby authorim representatives of this city to enter upon the BOILER-COMP (Over 10.000 BTU)SEE FEESCH. MECHANICAL UV • above-mentioned property for inspection purposes. �- (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. - Cupertino against liabilities,judgments, costs and expenses which CONST.TAX ma m un wa acffttrCC against mp1 C1'� yh const one of the PERMIT ISSUANCE •-iB.68 ng of is ptrm'{ '- 1 _ 1 'I / Y 1 I � / MICH.� CONT.� LIC.NO. TOTAL C`V .TOTAL L$ Ls- 7 Signature of Applicant/Conttmaor Date f1►Ly�p_y OFFICE COPY