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16223 POST THIS D NEAR FRONT OF BUILDING . PERMIT NUMBER CITTOF CUPERTINO 16223 INSPECTION DIVISION JOB INSPECTION RECORD', • 1 /' p• C •I D r�G PERMIT EXPIRATION JOB ADDRESS 2-'3 �' WD F"YC • K--a UNIT# ✓ � _LOT# ' PERMIT EXPIRES IF WORK OWNER a i' w--k_ CONTRACTOR1 S IS NOT STARTED WITHIN ; INSPECTION DATE INSPECTOR INSPECTI N RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR'180 DAYS FROM NOTE: LASTCALLEO INSPECTION. I UFER ALL GRADING•AND DRAINAGE SHALINSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLA TY OF PERMIT VALIDATION CUPERTINO STANDARDS. I GARAGE SLABS .111A-u t.Lt POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED AN Amo u- 1985 UNDERGROUND /SLAB PLUMBING Of_ , ELECTRICALISSUANCE RATE ' MECHANICAL . yBLOG ELECT. PLc. MPCR 1 1'❑ LSI ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION SIFT. MECHANICAL - .I ELECTRICAL - '''�'^ PERMIT TO FRAMING / fw /c- INSULATION STORIES# TYPE CONSTR_ OCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • - ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE' su,FT,TLooR AREA TOTAL ncREACE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING - - RES IND CON PB •O m., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.p PLUMBING ELECT.ENERGY - °t"'''ll TUBS&SHOWER PANPLUMBING ENERGY TRACT NO. PAHCEL NU;•.,F MECHANICAL MECH.ENERGY ' ELECTRICAL BUILDING ENERGY - ACC DATE ACC;FILE NO FRAMING ELECT.FINAL TEST ZONING PLUMBING ENG.SITE NO GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑ ❑ "O EXTERIOR SHEAR ' ELECTRICAL RELEASE FLOOD ZONE A U C. INTERIOR SHEAR FIRE DEPT. - Y❑ No v ❑ IN 1:1 SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH - BUILDING - INTERIOR LATH TEMPORARY APPROVALS BUILDING ' SCRATCH COAT ELECTRIC -22 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 ISSIGNED13Y BUILDING INSPECTOR. MICROFILM ARRANGE FOR.INSPECTION BY, INSPECTION. PHONING 252-4505, ELECTRIC � ONE WORKING DAt 1�1J � ' Y BEFORE R,EDU,IRED � PLUMBING i O PLEASE GIVE JOB ADDRESS`WHEN PHONING. ' ZMECHANICAL = SEE PERMIT FOR EXPIRATION DATE = IMPORTANT! CONST.TAX Y PLEASE READ REVERSE SIDE BEFORE 0 > .. TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY ttCPLICANT.TO FILL IN INF MATION WITHIN RED LINES - USE LL POINT PEN ONLY BUILDING PROJECT IDENTI FIN PERMIT NUMBER ADDRESS � APPLICATION & PE IT 16223 BUILDING —ELECTRICAL—PLUMBING—MECHANICAL S, OWNER'S AME - HONE _ QTY• ELECTRIC PERMIT FEE PLAN CHECK VALIDATION ONT ACTOR'S � 55 nME�� UTLETS-SWITCHES-RECEP 10.00/1.00 LIC.NO y .LIGHTING FIXTURES 10.00/1.00 COpNTRACTOR'S PPLIANCES-RESIDENTIAL 4.00 - PHONE PANELS 10.00 ARCRITECT DATE OF APPLICATION ENGINEER y OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ' uc.No. SIGNS TRANS. 3.00 a RCH.OR ENG. aooREss. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION zIPEMP.METER OR POLE INS. ' to O p APl+ucarvrs MOTORS aooREss: - SEE FEE SCH. SERVICE CHANGE 20.00 g F 0 OOO LICENSED CONTRACTORS DECLARATION a to w I hereby affirm that I am licensed under provisions of Chapter 9 ¢e. (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE F H 2 Professions Code ILmr'license is in full force f t BLDG. ELECT. PLG. MECH. ,00 Licenu Cis / Lie.Number ❑ ❑ ❑ • O w= u, Date Contractor x It city of c�FFftpp�,yy� ¢ R w OWNER-BUILDER R-BUILDER DECLARATION pe Un BUILDING PERMIT w ;LL m I hereby affirm,that I am exempt from the Contractor's License MISC.— REFER TO ORD INFORMATION F u O j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE VALUATION $/FT. � wr Code:Any city oremoty which requires a permit to construct,alter, to.= CLOD M ¢ ¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. CG ae requires the applicant for such permit to file a signed statement that ELEC. ' a w tq M he i5 licensed Paramount t0 the Provisions of the Contractor •yD s License TOTAL PERMIT TO r z < La.(Chapter 9(commencingwith Section 7000)of Division 3 oflhe --�y--p f i O Business and Professions Code)or that he is exempt therefrom and QTY, PLUMBING PERMIT FEE [ '-"V� e X r S the basis for the alleged exemption.Any violation OfSection 7031.5 a 3 by any applicant for a permit subjects the applicant toacivil penalty STORIES TYPE CONSTR. of not more than five hundred dollars(3500).): ALTER-DRAIN IL VENT-WATER (EA.) 5.00 ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT riot"sole compensation,will do tile .DEVICE 4.00 e work,and the structure is not. OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Cade:The Contractor's License Law does not apply to an owner of ' property who builds or improves Ihereon,and who does such work FIXTURES-PER TRAP - 5,00 himself or through his own employees,Provided that such improve. 50.FT.FLOOR AREA TOTAL ACREAGE mems are not intended or offered for sale.If,however,llu building GAS'-EA.SYSTEM-1INC.4OUTLETS 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 ice, GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE Prove for purpose ownerofsrutP INDUSTRIAL WASTE INTER. 30.00 RES IND CON PS Orhe, ❑ L as ownerof the property,am exclusively.7044,Business Q ❑ ❑ ❑ ❑ licensed contractors In construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 and an of Code:The Contractor's License s thereon, does not apply ASSESSORS PARCEL NO. to tr owner of property s wi builds t r improver thereon,umd who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contraclorts)licensed pursuam m ' the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 l am exempt under Sec. B.&P.C.for this TRACT NO. PARCEL NO. reason WATER HEATER W/VENT 6.00 Owner, Date WATER SYSTEM S.00 ACG GATE ACC.FILE NO. - WORKERS'CObe"' SA1'ION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a cerci Neale ofconsent ro set-insum, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0. copy thereof(Sec.3800,Lab.C.) p �^s ,.sB Policy No. Company )5 M �r Il/►t ' Certified copy is hereby furnished. Z Z Cetli Bled i I lh• Iry B division. FIRE SPRINK EN ERGY,T 24 0�' A pII m � MISC.- REFER TO ORD. Y N� v N� • CC W CE RTI FICATI:OF Ii X EM PTI ON FROM WORKERS' PERMIT ISSUANCE 10.00 LU � COMPENSATION INSURANCE FLOOD ZONE A.L.U.L. PLG.CONT LIC.NO. PLG. 1 O' (This dollars need not Inc Com Icted il'rhe N� p permit is for one TOTAL Y 0 N� Y 0 Z hundred dollars(5100)or less.) U O I certify that in the performance of the work for which this per- FEE SUMMARY LL U mit is issued,1 shall riot employ any person in any manner so as to QTY•WMECHANICALCHANICAL PERMIT FEE O W become subject to the Workers'Compensation Laws of California. y Dale Applicant DD TO MECH. 5.00 BUILDING } W NOTICI7 TO APPLICANT'. If,alter making this Certificate of lir- _ - � ? eruption,you should become subject to'the Workers Compenear' I - 5.00 PLAN CHECK provisions of rhe Labor Code, you mustforthwith comply withsuch provisions or this permit shall be deemed revoked. G UNIT(TO 10AWC.F.M.) 4.00 FEE CONSTRUCTION L17NDING AGENCY UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE I hereby affirm that there is a constructin lending agency forOD(WITH DUCT) 5.00 the performance of Ole work for which this permit is issued(Sec.30971 Civ.(.). IT(TO 100000 BTU ) 800 MICROFILM Lender's Name , . . . . Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Z,2 kOO . 1 certify that I have read[his application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county ordinances.and slate laws relating to building construe[ion, and BOILER-OOMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING hereby authorize representatives.of this city to enter upon the above-mentioned property for inspection purposes. BOI LER-COMP(0ve1 100,000 BTU)SEE FEE SCM. MECHANICAL -(We) agree IO save, indemnify and keep harmless the City of MISC.• REFER TO ORD. ain Perlin. against liabilities,judgments, coats and expenses which CONST.TAX may in any way accrue against said City iri consequence of the .PERMIT ISSUANCE 10.00 ra in of ispermit. MECH.CONT. LIC.NO. MECH. 1 r TOTAL TOTAL Ignat a (APplic t C ntractor Date OFFICE COPY