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16627 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16627 INSPECTION DIVISION • JOB INSPECTION RECORD 1,' �Q PERMIT EXPIRATION . JOB W ADDRESS (D/d,3 .4/1 OUNIT# _LOT# - 1 �L� pp PERMIT EXPIRES IF WORK OWNER CONTRACTOR C(/,}fe�, LO(>- 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 TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION PREGUNITE _ CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ✓ " - - UNDERGROUND /SLAB r PLUMBING ELECTRICAL - ISSUnNCE DATE BLDG ELECT PLG, MECH MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR - _ VALUATION SIFT. PLUMBING Q _ OO MECHANICAL v PERn+IT To ELECTRICAL FRAMING INSULATION STORIES TYPE CONSTR OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED sa.FT.FLauR AREA TOTAL ACRear,E ROOF NOTE:NO FINAL SP.SHALL BE MADE BEFORE IN DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUIL DI usE ROOF SHEATHING Res IND CON PR DOE- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 11 ❑ 0 ASSESSORS PAHCE L NO. ' - ROUGH SAN.N PLUMBING - ELECT.ENERGY TRACT NO, PARCEL NO. TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL - MECH.ENERGY ELECTRICAL - ACC DATE acc.FILE rvo BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING ENG SITE NO. . INSULATION PLUMBING GAS TEST - GAS - MECHANICAL FIRE SPRINK ENERGY T2 i COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NE] Y ❑ . No FL EXTERIOR SHEAR ELECTRICAL RELEASE ZONE pLuc. INTERIOR SHEAR FIRE DEPT. v E]❑ N� Y ❑ N� SHEETROCK - . GRADE FEE SUMMARY EXTERIOR LATH- - BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR'INSPECTION BY PHONING 252-4505, ELECTRIC H ONE WORKING DAY BEFORE REQUIRED INSPECTION., PLUMBING 6 �� z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL I - IMPORTANT! coNsr.TAX PLEASE READ REVERSE SIDE BE FORE TOTAL CALLING FOR FINAL.INSPECTION.. OFFICE COPY h PLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY . ��. BUI LD1 NG PROJECT I DENT[FICATION :PERMIT NUMBER BG 10ING �, ' APPLICATION & PERMIT ��] AI V ESS t(4 1' BUILDING—ELECTRICAL—PLUMBING—MECHANICAL _ OWNER'SPLAN CHECK VALIDATION, " QTV. - ELECTRIC PERMIT FEE PHONE CONTRACTORS OUTLTS E -SWITCHES-RECEP 10.00/1.00 •� P 1 ND. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 ADDRESS ST PHONE PANELS 10.00 DATE OF APPLICATION PC. N O. OR H CT PANELS (OVER 200 AMP) - 20,00 PCAN CHECK FEE A,N ENGINEER ' xuc.NO. SIGNS TRANS: 3.00 • ARCH.OR ENG. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS ZIP EMP.METER OR POLE INS. 20.00 APPLICANT - MOTORS ANSEE FEE SCH. ADDRESS , v�rJ' SERVICE CHANGE 20.00 I. DSEi /b w 00 LICENSED CONTRACTORS DECLARATIONf IT V -: r a U w 1 hereby affirm that I am licensed under PECOS of Chapter 9 ISSU NCE ATE yst (commencing with Section 70001 of Divi a Bus' ess and °' Professions Co .a., license is in full BLDG. ELECT. PLG. MECH. io,y License lass Lie,NumIs B w r w Uate' Contractor — g - BUILDING PERMIT a w OWNER-BUILDER DECLA ION INFORMATION , 3 LL o 1 herebyaffirm that I am exempt from the Contractor's License MISC.— - REFER TO ORD' p VALUATION $/FT. Foa uLaw forthe following reason,(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit tp construct,Plteq Q ¢¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. - IC requires the applicant for such permit m file a Signed statement that TOTAL PERMIT TO d w m" he is licensed pursuant to the provisions a]the Contractor's License p Law(Chapter 9(commencing with Section 7000)of Division 3 of the z o Business and Professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT ` FEE r e the basis for the alleged exemption.Any violation of Section 7031.5 ,STORIES' TYPE CONSTR. i by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER IEA. 5.00 of not more than Eveltundred dollars($500).1 ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE . 0 OCC.GROUP - RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business aid Professions DRAINS-FLOOR,HOOF,AREA,C 5.00 t\ - Code:The Contractor's License Law does not apply t0 an owner of - properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP SD.IT,FLOOR AREA TOTAL ACREAGE himself or through'his own employees,provided lltat such Imprnve- menlsarenoLintended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLET .00 _ or improvement is sold within one year of completion,the owner- GAS'-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have'dm burden of proving that he did not build or im- RES IND CON PB- Omer prove for purpose of sale.). IN DUSTRIAL WASTEINTER. 30.00 ❑ ❑ ❑ ❑ ❑ ❑ 1,as owner of the property,am exclusively contracting 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's License Law docs 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 contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL No. the Contractors License Law. ❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT — reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC:FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 : _ I hereby affirm that I have a certificate of consent to set C-ireure. ZONING ENO.SITE No- or o certificate of Workers'Cosurance,or a certified copy thereaf(Sce.3800,Lab.CY - Policy No. Com ony Jr,YT Kti O ❑ Certi' Is yfumahed FIRE SPRINK ENERGY T-24 Z Z amt r ed,with the city inspection division. MISC- REFER TO ORD. _ O Applicant - 1 Y ❑ N❑ Y ❑ N❑ F-' rn PERMIT ISSUANCE or- — r'FLOODZONE AL.U.C. — CHR f ATE OF EXEMPTION FROM WORKERS' LU > COMPENSATION INSURANCE PLG.CONTR. _ LIC.NO. PLG. /1so N❑ V❑ N❑ Q. (This Section need not be completed if the permit is for one TOTAL :) 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 5 mit is issued, I shall not employ any person in any manner so as to Ow become subject to the Workers'Compensation Laws of California. BUILDING Date ' Applicant ALTER OR ADD TO MECH. 5.00 ' } y NOTICE TO APPLICANT: If,after making this Certificate of 1: _ - ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK -u provisions of the Labor Code, you must forthwith comply with 'FEE ' U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10/100 C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER.10000 CF.M.) 6.00 SEISMIC.FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is Issued(Sec. MICROFILM 3097,cw.C). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Nome HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address HE: I Certify that l have read 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 ,0 ordinances and state laws relating 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-.CO 0 MP lover 100,000 BTU)SEE FEE SCH. MECHANICAL above-menlimwd property for inspection purposes. (We) agree to save, maify and keep harmless the City of MISC.- :REFER TO ORD, up a' itie judgments,'costs and expenses which PERMIT ISSUANCE - 10.00 CONST.TAX may 'n a se eerue ainst said City In consequence of[he rap' s enttiL MECH.CONT. LIC.NO. MECH. TorAL TOT 4AL m - Sig ature Appant/Contractor Date - OFFICE COPY