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15433 POST THIS CARD NEAR FRONT OF BUILDING .. PERMIT NUMBER CITY OF CUPERTINO 15433 INSPECTION DIVISION JOB INSPECTION RECORD . PERMIT EXPIRATION JOB ADDRESS 10215 Empire Avenue uN1T# _LOT# PERMIT EXPIRES'IF WORK DINNER Gustive An er CONTRACTOR - 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 CIN OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ✓ PLUMBING ELECTRICAL yp IssuANCE uarE MECHANICAL ? — BLuc ELECT PLG, MEM+, 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION SIFT. � , MECHANICAL - ELECTRICAL PERMIT TO c_ r FRAMING - INSULATION STCHIES TYPE CONSTR. OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED , ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE $O,FTFLOOR AREA TOTAL ACREAGE. DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING BUILDING USE RES IND CON PB APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED I FINALS DATE INSP. ❑ ❑ IT ❑ ❑ N ROUGH S ` ASSESSORS PARCEL NO AN. 'F — PLUMBING ELECT.ENERGY TUBS B SHOWER PAN PLUMBING ENERGY TRACT No PARCEL NO MECHANICAL MECH.ENERGY. ELECTRICAL BUILDING ENERGY ACC.OATE ACC PILE NO FRAMING ELECT.FINAL TEST. INSULATION PLUMBINGM__T70011 ZONING BNc.sIrE:No. GAS TEST - GAS MECHANICALFIRE SPMNE ENERGY T.aa COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING j `" ❑ "❑ ° ❑ "❑ EXTERIOR SHEAR ELECTRICAL RELEASE ZONE AL UC INTERIOR SHEAR FIRE DEPT, v ❑ N Y ❑ NO SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDIN INTERIOR LATH - TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 00 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 1 DENTI FICATION PERMIT NUMBER I ,--�) BUILDING APPLICATION & PERMIT 15433 ADDRESS102-IS- o 21J �EmP IQL �0G ' BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S "AME_T 1' ('^/� /L�} [` •� 'j� QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION • `�" It I ' Y� PHONE Js-� CONTRACTOR 61 T / � r�-p p��•Q �7f UTLETS-SWITCHES-RECEP 10.00/1.00 M`6'I✓ �-`��IrTq"1`�Ic.N0. 3�6Dd LIGHTING FIXTURES 10.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 ADDRES 1 fill 1 �� E PHONE IZ�- ��T I PANELS 10.00 301 GATE OF APPLICATION - ORCHITECT PANELS OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.NO. SIGNS TRANS. 3.00 ADDRESS E"G SPECIALCIRCUIT 5.0Q PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 I^, APPLICANT$ MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 - o FOO LICENSED CONTRACTORS DECLARATION Fi w I hereby affirm that 1 am licensed under provisions of Chapter 9 _ ` Q, (Commencing with Section 7000)of Division 3 Of the Business and ISSUANCE DATE BLDG. ELECT. PLG. MECH. F y z Professions Cade,a d my license is in lull fart and f ❑ ❑ ❑ 2 o w- Liccnsc Cl Lic.NumbeY� E� � h r� Dan,�i�r nr Cnntmctar ¢ w st �I OWNER-BUILDER DECLARATION BUILDING PERMIT a a A INFORMATION X ; y I hereby affirm that I am exempt Gam the Contractor's License MISC.- REFER TO ORD u O J Law for the following reason.(lice]031.5,Business and Professions VALUATION $/FT. - s PERMIT ISSUANCE 10.00 Code:Any City or county which requires a permit to construct,alter, Qea Q p Improve,demolish,or repair any structure,prior to Its rommee,also ELEC.CONTR. LIC.N0. ELEC. o ¢ requires the applicant for such permit to file a signed statement that TOrgL A w m he is licensed pursuant t0 the provisions of the Contractor's License PERMIT TO - r z s- Law(Chapter 9(commencing with Section 70001.E Division 3 of the P�d ¢ O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a ; by any applicant for a permit.Subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.15.00 of not more than five hundred dollars(S500)): ❑ 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 fur sale(Sec. 7044, BUSRICSS 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,and who does such well FIXTURES-PER TRAP S.UO 50.FT.FLOOR AREA TOTAL ACREAGE hinisulf or through his own employees.provided that such improve- mentsareno(intendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or int. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ I,as owner of the property,ain exclusively echnneting 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'sohLJil License Law does not apply toan trowner of properly who.atlastrimproves ensed uand who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contmctortsl licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-,II.&P.C,for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM - 5.00 ACG GATE ACC FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to sal Ginsure. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Conhpany O ❑ Certified copy is hereby Ill n.ished. Z a / ❑ Cert i(i y If le th he city inspection division. FIRESPRINK ENERGY T 24 `x AUplicam_ �9gy_k� MISC.- REFER TO ORD. Y0 NEI Y ❑ NE) ~ y0 PERMIT ISSUANCE LU - CIikT'IItlCATEOPIAX IFROM WORKERS' 10.00 4 FLOOD ZONE A.L.U.C. W > COM1iP1iNSATI0N INSURANCE URANCE PLG.CONTR. LIC.NO. PLG. q�uf/ 1 Q This section need not be complelxd if the permit is In,one TOTAL Ow Y❑ N❑ Y❑ N❑ Z hundred dollars IS 100)or less.) U O 1 certify that in the performance 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 manner So as to O W become subject to the Workers'Compensation Laws of California. a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } rA NOTICIi TO APPLICANT: If,after making this Certificate of Ex- F Z emption,you should become subject to the Workeri Compensation LI 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U such movisioln or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.fvt) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOAOOCEM.) 6.00 SEISMIC FEE 1 herchy attic... Bud there is a mnstruction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this parmit is issued(Sec. MICROFILM 3097.Civ C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC 1 orlily that)llave read this application and state that the above VENTILATION FAN (SINGLE) 4.00 T information is correct. I agree to comply with all city and county PLUMBING dQ ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 hereby archon, representatives of this city to enter upon the g01 LER-COMP (Over 100,000 BTU)SEE FEE SCH. above-mentioned property for inspection purposes. MECHANICAL (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 may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 canon f It permit MECH.CONT. LIC.NO. MECH. G 3 y8 t TOTAL TOTAL Signature of Applicant/Conti ctor Date OFFICE COPY