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16130 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO INSPECTION DIVISION 16130 r JOB INSPECTION RECORD A / PERMIT EXPI`RATION. JOB ADDRESS d61.2_3 ,V, UNIT# LOT# PERMIT EXPIRES IF,WORK OWNER �L,L��•Q.-7,� j'/CR CONTE CTOR /�J S" MG ISNOT STARTED WITHIN INSPECTION DATE I INgPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATIONALL ANCE OR 180 DAYS FROM UFER GR� ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED.INSPECTION. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF. vcRe+rt VALIDATION CUPERTINO STANDARDS. GARAGE SLABS --^' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED- UNDERGROUND /SLAB IGNEDUNDERGROUND /SLAB PLUMBING ELECTRICAL - ISSUANCE DATE I MECHANICALp .lJ.= o/ r BLDG, ELECT %PLG. MECH.. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR A 4CIOJ*)RMATION A ATION ., $IFT. PLUMBING MECHANICAL ' ELECTRICAL - - PERM To FRAMING IIyT ,rU� L y V INSULATION STORIES v T OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO,IT FLOOR AREA TOTAL ACREAGE , ROOF. NOTE:NO FINAL INSP.SHALL BE MADE BEFORE !• DIAPHRAGM - THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING - - HES' IND CON vB APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP- ❑ ❑ ❑ ❑ ❑ ROUGH SAN.a AESESSORSPAFCEL,NO. ' PLUMBING - ELECT.ENERGY TRACT NO. PARCEL NO ' TUBS&SHOWER PAN PLUMBING ENERGY - . MECHANICAL MECH.ENERGY ELECTRICALBUILDING ENERGY - ACC DATE ACC FILE NO FRAMING - ELECT.FINAL TEST Z ZONING ENG.SITE NO. ' INSULATION - PLUMBING GAS TEST - GAS i MECHANICAL FIRE SPRINK ENERGY T 2 - Z ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y E] "❑• ` 1:1 "❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L U C• INTERIOR SHEAR FIRE DEPT. v❑ "❑ v ❑ "❑ SHEETROCK - GRADE - FEE SUMMARY EXTERIOR LATH IBUILDING J INTERIOR LATH - - TEMPORARY APPROVAL BUILDING ,1', SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN 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 F� ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING ~ &. o PLEASE GIVE JOB ADDRESS WHEN PHONING. z7 - SEE PERMIT FOR EXPIRATION DATE MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL 7/ CALLING FOR FINAL INSPECTION.' OFFICE COPY . APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUI LDI NG PROJECT IDENTIFICATION " --. - ..PERMIT NUM BER BUILDING p�,q 4 4 c0 PPLICATION & PERMIT ///''''''��� AOOR Ess 1 {� O G GYfno Cat BUI DIN ELECTRICAL—PLUMBING—MECHANICAL I u OWNER'S PLAN CHECK VALIDATION NAME CITY. ELECTRIC PERMIT FEE f}/C ORD /�asler PHGNF 9(v 3�` �7 j�.0 CONTRACTORS NAME j�/\�c �L.� // . OUTLETS-'SWITCHES-RECEP 10.0011.00 {,(� �p J' �/✓/ v> �ryG ua N.9�?O—U6 LIGHTING FIXTURES 10.00/1.00 •�+ CONTRACTOR'S - ' APPLIANCES-RESIDENTIAL ,., 4. 00 . //O q x4,t Tr ad". ONE 367 1^�.72 PANELS 10.00I GATE OF APPLICATION S ARCHITECT PLAN CHECK FEE' OR ��¢ y� /� ..J. / PANELS 10V ER 200 AMP) � 20.00 _ a ErvGIY'�ji riN/I eY�Ip I1 LICNo.O/O�p SIGNS TRANS. 3.00 - - ARCH.OR ENG. s^� OO PERMIT VALIDATION - ADDRESS SPECIALCIRCUIT ' 5,00 /27A0 /1iYor t;04)1 ZP EMP.METER OR POLE INS: 20.00 ADDRESS - - MOTORS ,SEE:FEE SCH. _ SERVICE CHANGE ' 20.00 0 0 0 LICENSED CONTRACTORS DECLARATION G v I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE GATE m % (commencing with Section 7000)of Division 3 of the Business and ¢ - •BLDG. ELECT. PLG. ,MECH. o iH 7 z Professions Codyl / �y lice se ie in full f0"Lr Mpff �/ I1�R�N$�� m O Liters Cass - Lic.Numher fV V Y" El _ w H w DateG PER Contractor � . 5 ¢o i o OWNER-BUILDER D12CLARATION f _ � MAT OR T w30: LL y 1 hereby affirm that I am exempt from the Contractor's License MISC.—' REFER TO ORD u o Law for the following reason.(Sec.7031.5,Business and Professions �.VALUATIO $/FT. H— g PERMIT ISSUANCE- 10.00 °p� Code:Any city or county which requires a permit to construct,alter' 11 aWTtVE+ Sca Q p improve,demolish,or repair any structure,prior to its issuance,also. ELEC.CONTR. - LIC.NO. ELEC. 7 O'It requires the applicant for such permit to file a signed statement that TOTAL w w he is licensed pursuant to the provisions of the ) fDi,,im License I . PERMIT • `• r V Y E z¢ BLaw(Cha nd Procomonis Codeng )orll,Section is exempt therefrom the E 4 O Business and Professions Code)or that hu is exempt therefrom and QTY. PLUMBING PERMIT FEE rc H$ the basis for.the alleged exemption.Any violation nl'Section 7031.5 ( STORIES aby any applicant for a permit subjects the applicant toacivil penalty p ALTER-DRAIN&VENT-WATER,(EA.) 5.00 of not more than five hundred dollars(S501D): �J ❑ 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(Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. .5.00 s' Code:The Contractor's License Law does not apply to an owner of - property who builds or improves rhercon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE himself or throughhisownemployees,for sale. If,ed ever,the improve- GAS-EA.SYSTEM-1 6.00 mems are not intended or offered for sale.If,ed that s the improve- ments improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4'IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- provefor purpose ofsale.). INDUSTRIAL WASTE'INTER. 30.00 RES IND CON PB . Other O I,as owner of the property,am exclusively contracting with - ^ El- El El E) C1licensed contractors�to construct the project(See. 7044,Business LAWN SPRINKLERS-,1 INCAS 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 contractor(s)licensed pursuant to -SANITARYTRM EA200ftI1000 -SO . . the Contractor's License Law. SEWER3 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT " r-..w. ' reason' Owner Date WATER SYSTEM - " 5.00 ACC.OATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP: 5.00 1 hereby affirm that I have a certificate of consem to self-insure, - o '�1y' rY�fiyfeyf'Compen�sa)tio[nr Ins/u-r-arca,or a cetli(ied ZONING ENG.SITE NO. C�F17eJlroTOe (16;3,ob.C.). - Pohe No. Company - , 0,-- ❑ Certi(ie copy i5 hereby furnished. ' .FIRE'SPRINK- ENERGY T-24 Z'z ❑ CertiO� y By�I wI�•tm city inspection division. O AppliMISC.- REFER TO ORD. y ❑ :N❑ - r❑ N❑ ~ w+ PERMIT ISSUANCE - - (2 - LU — CERTIFICATEOFCOMPENSATION INS FROM WORKERS' - FLOOD 20IN A.LUL.. W COMPENSATION INSURANCE PLG.CONTR. LIC.NO: ,PLG: ^1 EL Z (This section need not be completed if the permit is for one - _ ' TOTAL I Y❑ N❑ Y ❑ ;'N❑ hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- GTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,1 shall not employ any person in any manner so as W U become subject m the Workers'Com ensation Laws of California.. U tL Date I Applicant - p ALTER OR ADD TO MECH. - 5.00 'BUILDING ' } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- - �/ F Z eruption:you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN'CHECK provisions of the Labor Code, you must forthwith comply with l DEN such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4:60 `i- — CONSTRUCTIONLENDINGAGENCY i AIR HANDLING UNIT(OVER 10=C.F.M.),6.00 - SEISMIC FEE 1 hereby affirm that there We 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 HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 'ELECTRIC . Lender's Address- I certify that I have rend 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 ordinances and .state laws relating to building Construction, and BOILER-CUMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorite representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL V" above-mentioned property for inspection purposes. 7 �S (We) agree to save, indemnify and keep harmless the City of misc.- REFER TO ORD. , Cupertino against liabilities,judgments coils and expenses which PERMIT ISSUANCE .00 �o), CONST.TAX, may in any s y accru .again said fy in consequence of the m ing permit MECH.CONT. LIC.N'�O// MECH. /p e. 3 T3 / TOTAL a 7,3 TOTAL 371 7S ignature of Applicant/Contractor a D. /�d OFFICE COPY . ;