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16222
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER . CITY Of CUPERTINU INSPECTION DIVISION 16222 .4 `• JOB INSPECTION RECORD ^ -_ /y/—^� per//' . _ �•' �. 1 'PERMIT EXPIRATION JOB ADDRESS �-1.Z3, 6". V+' �" ` '•" lam UNIT# _LOT#' ^•+ - , #'eye} L �• PERMIT. EXPIRES IF WORK �. OWNER' 14 CY7 ^ .:p'V %( /. .CDN 'ACT�R.O -+elll�. S1 )A., wJS NOT ,STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION ECORD . 180.DAYS OFPERMIT ISSU- i ` FOUNDATION,',.. �" ' - 'ANCE 'OR 1BO.DAYS.FROM '? _ NOTE:;, •� ° LASTCALLED INSPECTION. j LIFER' S ALL GRADING ANDDRAINAGESHALL BE INSTALLED, I. •+ - TO COMPLY WITH THE APPROVED PLANS AND CITY OF 'PERMIT VALIDATION PR EGUNITE CUPERTINO STANDARDS GARAGE SLABS .. ` rryD.' ,�/� •� -�...�`�,,,��, ... POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �'+✓WN �G '- UNDERGROUND /SLAB. . ('- ' 22 RLUMBIN..G Se ELECTRICAL Qy.O cup.er!IIU IssuarvcE OnrE - .. MECHANICAL, - ,i ; - .+, , BLDG! ELECT; PLC MEO+. I ,r BUILDING PERMIT DO NOT POUR FLOOR-UNTIL ABOVE HAS BEEN SIGNED INFORMATION WOOD FLOOR. . e�-ScC vALDAno� siET. PLUMBING ©k ni1�^ r v�+ ..••• MECHANICAL ✓ '` ` I) ELECTRICAL - - PERMIT TO FRAMING STORIES TYPE CONSTR. . INSULATION �- i• OCC.GROUP RES UNITS f .. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO�FT:FLOOR AREA TOTAL ACREAGE..: ' ROOFNOTE:NOFINAL INSP.SHALL BE MADE BEFORE 'I { THE CONSTRUCTION TAX IS PAID " *, DIAPHRAGM .. .. .. BUILDING USE ROOF SHEATHING _ ,R❑' I❑ ...❑N ED ❑ f APPLY NO ROOFING UNTIL.ABOVE HAS BEEN SIGNED •. - FINALS DATE INSP. ASSESSORS PARCEL Na. + ROUGH ' SAN.# i PLUMBING ' ELECT.;ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY 'TRACT NQPARCEL-NO. L•NO. . , MECHANICAL, r • •.r; MECH,'ENERGY ACC.DATE, ACC:FILE NO, i ELECTRICAL.. - ,BUILDING ENERGY FRAMING `' : s '- ELECT'FINALTEST` . I , zoNlNc ENG.slTervo ' INSULATION . + - PLUMBING - . GAS TEST GAS _ ' MECHANICAL _ FIRE SPRIrvN ' ENERcv T-24 T• COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _T`- : .Y ❑ "❑ ° ❑ I "❑' FLOODZONE A.L.U.C. -( EXTERIOR SHEAR' ' 'ELECTRICAL RELEASE v❑ rv❑ L7 + NEI SHEAR,' FIRE DEPT. :,, .+ GRADE SHEETROCK - � � � - FEE SUMMARY EXTERIOR LATH.- - ' BUILDING - - •- - ,� ' ., ` INTERIOR LATH °` - _ TEMPORARY APPROVALS BUILDING T �, E8U 4 ELECTRIC. - PLAN CHECK SCRATCH COAT s FEE �.. GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' 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 ONE WORKING DAY BEFORE.,REQUIRED INSPECTION. PLUMBING o�:• PLEASE.GIVE'JOB ADD.RESS.WHEN PHONING. Z MECHANICAL �. SEE PERMIT FOR EXPIRATION DATE ; IMPORT-AK ' o"sT..TAX PLEASEREAD:REVERSESIDE BEFORE jk70TAL {I " CALLING FOR FINAL INSPECTION. "' 75. I OFFICE COPY ," APPLICANT TO FILL IN INFORMATION WITHIN.RED LINES -:USE BALL POINT-PEN ONLY r BUILDING PROJECT IDENTIFICATION y ;PERMIT NUMBER a DING9 APPLICATION.&1PERMIT- (�t AODRE55 I' ►^� G-ELECTRICAL-PLUMBING-MECHANICAL : VZZZ UWAME ( IV ��. NAMF r yv U - PLAN CHECK VALIDATION` OTY. ELECTRIC PERMIT- FEE ELIDIg NONE CO TRACTOR'S NAME ��,( /1 - rte' a � o �7 UTLETS'-SWITCHES-RECEP 10,00/1.00 'or- ?". �"f I�!�I Ll N�a5 { LIGHTING FIXTURES '10.00/1.00 CCONTRACTORS ' ADDRESS ,' �a \ �' PPLIANCES-RESIDENTIAL 4.00 h �.I�V1I� j ' PHONFg' PANELS - _ '• 10,00 - ' -'DATE OF APPLICATION' ARCHITECT PLAN CHECK FEE, - P.C.NO. ' OR 'PANELS (OVER 200 AMP) .20.0.0 - -- . ENGINEER I - LIC.NO. � SIGNS TRANS. - ARCH,OR ENG, - PERMIT VALIDATION ADDRESS SPECIALCIRCUIT 5.00 ZIP EMP.METER OR POLE INS. 20.00 ADDRESS - MOTORS 'SEE FEE SCH. SERVICE CHANGE 20.00 �p trail 23 .. . r o O' LICENSED CONTRACTORS DECLARATION •� a 0. 1 hereby affirm that I am licensed under Provisions of Chapter 9. - ISSUANCE DATE (commencing with Section'7000)of Division 3 of the Business and, - - IIVSIIIIIILELECT. PLG. MECH. ✓y z Professions Cod• license is in full fore fpJet�^� ❑" ❑: ❑' Z O,.,- License Liu.Number - S. w f Date Contractor EpL •a m f - a• BUILDING PERMIT Mm w a OWNER-BUILDER DECLARATION •- - w ;LL i-- Thereby affirm filar I um exempt from tileR Contractor's License MISC. REFER TO ORD I MATION ' LL o a Law for the following reason.(Sec.7031.5,Businessand Professions H - g PERMIT ISSUANCE ABB 'NQ� S/FT. filo Code:Any city or county which requires a permit to construct,alter, OU ¢ ee¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 'q O /•'Q s•- C a requires the applicant for such permit to file a signed statement that - TOTAL 2z a'J w $ he is,licensed pursuant to the provisions of the Contractor's License PERMIT TO - ' Hzi Law(Chapler9(commencingwithSection7000)ofDivision3oftho S'�t 4 c Business-and Professions Cade)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE Ie I-r� the basis for rhe alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.. by any applicant for a permit subjects the applicant to a civil penalty gLTERDRAIN'&VENT-WATER IEA.) 5.00 of not more than five hundred dollars(8500).): - - ❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE .4.00 'OCs.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:Tile Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve• ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 _ or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder,will have the burden of proving that he did•not build or int BUILDING USE - prove for purpose of sale.). RES IND' CON PB Other ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 _ .❑ ❑ - El ❑`• El contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-i INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does nor apply to an ownerof property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00 } contracts for such projects with a contractohfs)licensed pursuant to the Contractors License Law..' - SEWER-SANITARY-STORMEA.200ft/10.00 r 'TRACT NO. PARCEL NO. ❑ I um 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 N0. WORKERS'COMPENSATION DECLARA'HON - WATER TREATING'EQUIP. .: 5.00 I hereby affirm that I have o certificate ofennsen Lro self-insure, - ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thercof(Sce.3800;Lab.C.) + Policy No. Company-I 0 ❑ It Tnd CD yis ht, famished. \ FIRE SPRINK ENERGY TRd Z � Cerlifed f e wit tl Z O Applicant . \'�k}�. .. MISC.- REFER TO ORD: . .Y❑ N❑. ' ..:Y Q NQ in rn CERTIFICATE"OF 17XEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. ' L COMPENSATION INSURANCE L PLG.CONTR. LIC.NO. PLGCL , Z (This section"need not be completed if the permit is for-one TOTAL Y,❑ NE] Y,❑ No hundred dollars IS 100)or less.) ' "0 O, 1 certify that in the performance of the work for which this Per- CITU. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to 0 W become subject to tiro Workeri Compensation Laws of California. a . Date - Applicant +BUILDING t . OU F } w NO]ICE TO APPLICANT: If,after making this Certificate of Ex ALTER OR ADD TO MECH. 5.00 - its. eruption,you Should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CH.ECK' r provisions of the Labor Code, you must fothwilh comply with FEE II r ZJ U such provisions or this permit shall be deemed revoked. _ AIR HANDLING UNIT(TO 10,000OF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1op00C.F.M.) 6.00 SEISMIC,FEE `I hereby affirm that H ere'is a construction lending agency 1'or EXHAUST HOOD(WITH DUCT) 5.00the ;h 309Ci,. ).performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 UU Lender's Address ELECTRIC - Z Z•r I certify that I have read this application and stare that the ubo4e VENTILATION FAN (SINGLET _ ' 4.00 ' information is correct.1 agree to comply with all city and county - PLUMBING ordinances and state laws retailing 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 to.,100,000 BTU)SEE FEE SCH. MECHANICAL 1 ( above-mentioned properly 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 PERMIT ISSUANCE 10.00 ' CONST.TAX may in a y way accrue against mid City inconsequence of the ranlln t f lh is Permit MECH.CONT. - - LIC.N0. MECH. '- TOTAL TOTAL 7Y Sign are of Applicant/CDcl..In, Ua[ C OFFICE COPY .