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16429 POST THIS CARD NEAR FRONT OF BUILDING PFRMITNUMBER CITY OF CUPERTINO 16429 INSPECTION DIVISION JOB INSPECTION RECORD • uV )t .`�� - 'PERMIT EXPIRATION JOB ADDRESS_ UNIT# _LOT# 11 PERMIT EXPIRES IF WORK OWNER Njo C/'+" CONTRACTOR Z e.rJ IS NOT STARTED WITHIN INSPECTION DATE rINSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATIONANCE.OR 180 DAYS FROM NOTE: - LAST CALLED INSPECTION. UFER ALL GRADING,AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED'PLANS AND CITY OF PREGUNITE CUPERTINO STANDARDS. PERMIT VALIDATION GARAGE SLABS (•.",}�� POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED C pp UNDERGROUND /SLAB SFP 22 1988 VfVfVf/// PLUMBING ' -./—2;, - 1 l ELECTRICAL City of Cupertino ISSUANCE DATE MECHANICAL BLDG eL.E�cIr PLG. ECH • - ElIta1l ❑ M❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION $/FT. PLUMBING MECHANICAL ' ELECTRICAL PLHMIr TO l - FRAMING J eL INSULATION STORIES PE CONSTR. OCC GROUTRES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF I NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so FT rLooR AREA TOTAL ACREAGE :•. DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING ' - nes IND CON re 00— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE 'INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN,# PLUMBING ELECT.ENERGY - ' TUBE&SHOWER PAN PLUMBING ENERGY THACT NO PARCELNO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO FRAMING ELECT,FINAL TEST ZONING ENG SITE NO ' INSULATION - PLUMBING GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY r 2e COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ A ❑ "� FLOOD ZONE ALUC. EXTERIOR SHEAR ELECTRICAL-RELEASE N� � INTERIOR SHEAR FIRE DEPT. • ❑ N - SHEETROCK - GRADE - FEE SUMMARY EXTERIOR .LATH BUILDING - INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC _ (j_ PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOGCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC c F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o ONE GIVE JOB ADDRESSWHEN PHONING. Z ' - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL ,1 IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL ° OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PRO CT IDENTIFICATION PERMIT NUMBER to ILOINnAPPLICATION & PERMIT "q29 C A ' ADORE "- I Ivo J y� BUILDING— ELECTRICAL—PLUMBING—MECHANICAL e` OWNER'5 PLAN CHECK VALIDATION NAME//�� l^1CITY. ELECTRIC PERMIT FEE g4 " `� PHON �W:^f NAMEGUNTIABT/O�P/_ —L' OUTLETS-SWITCHES-PIECED 10.00/1.00 Glot:_ Yl uc NO OSejp LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ADDRESS SJfn a PPLIANCES-RESIDENTIAL 4,00 ORE55 NONE ' ✓T PANELS 10.00 DATE OF APPLICATION� �.� RR ITecT N - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. 0. OR ENGINEER LIC.NO. SIGNS TRANS. 3.00 _iRADDRESS ENG. SPECL CUIT 5,00 PERMIT VALIDATION ZIP EMP.IAMETERIRCPOLE INS, - 20.00 A - MOTORS E FEE SCH. ADDRESSDDRESS SE eA� p /d'L ISERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATIO aw v w I hereby affirm that 1 am licensed under provisions BusinessChapter anti ISSUANCE DATE :° (commencing with Section 7000)of Division 3 of tire Business anti BLDG. ELECT. PLG. MECH. i Professions Code nJ i i license is in full force nd c : ❑ ❑ ❑ o0 w o License CI s_ I.ic.Nourb a m J Date— �,.�Comractor /r� rc a OWNIiR-0BUILDER DECLARATION CIV of CupertlRo BUILDING PERMIT a ¢o o u INFORMATION K ; LL H I hereby affirm that I am exempt Pruni the ContractorREFER TO ORD 's License MISC.— VALUATION F LL 0< Law for the following reason.(Sec.7031.5,Businexsand Professions PERMIT ISSUANCE 10.00 Le Code:Any city or county which inquires a permit to construct,alter, p improve,demolish,or repair any structure,prior la its issuance,also ELEC.CGNTR. LIC.NO. ELEC. A C u requires the applicant for such permit to file a signed statement that TOTAL O'( PER MIT TO A'au m,n he is licensed pursuant to the provisions of the Contractor's License F Z Q Law(Chapter 9(commencing with Section 7000)of Division 3 ofthc `- . i O Business and Professions Cade)or that Ile is exempt therefrom and CITU. PLUMBING PERMIT FEE col eG IY H p (he basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. dim by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN (EA.15.00 of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as ggCK FLOW PflOTECT. DEVICE 4.00 their sole compensation,will do the 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 ' : Code:The Contractors License Low does not apply to an owner of property who builds or improves Ihercon,and who does such work FIXTURES-PER TRAP 5,0D SO,FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- •'- cents are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I1NC.40UTLETS 6.00 or improvement is sold within one year of completion, the Clinic r- builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00. BUILDING USE prove for purpose of Sale.). RES IND CON . P l Omer ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ Ellicensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply V.B.. . 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 contmctonsl licensed pursuant 10 the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lain exempt unJerSea BAP C.for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.GATE ACG FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent Io self-insure, ZONING ENG.SITE NO. or o certificate of Workers'Compensation Insurance,or u certified copy thereof(Sec.3600,LahC.). Policy No. Comp y ❑ Certified copy is 1, biiy(urnislird FIRE SPRINK ENERGY TQA z Z 'Sw Certi�ye� �Qo�On jf Uf7e with th� it nspLZlion division. � O pp ImmN�Ar l��G(�� MISC.- REFER TO ORD. Y ❑ N❑ v❑ IN i CC y C17RTIFICATI:OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU d COMPENSATION INSURANCE . PLO.CONTR, LIC.No. PLG. � 0 (Phis section need not be completed if the permit is for one TOTAL Y❑ N❑ Y E] NE] hundred dollars(S 100)or It.I V O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT - FEE FEE SUMMARY LL P- mit is issued,I shall not employ any person in any manner so as to _ O Wbecome subject to the Workers'Compensation Laws of California. Datc Applicant - ALTER OR ADD TO MECH. '5.00 BUILDING C. } m NOTICE TO APPLICANT: If,after making this Certificate of Ex- F Z eniption,you should become subject to the Workers'Compensation APPLIANCE 5.00 -PLAN CHECK provisions of the Labor Cade, you most forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender's Address ELECTRIC I cerlily that I have real(his application and stale❑int the above VENTILATION FAN (SINGLE) 4.00 '. inlorntalion is mrrcil. I agree to comply with all city and county .BOILER-COMP)3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING hereby ordinances and slate lawn relating In is cip, construction, and hereby am hard s representatives of this city Ia enter upon the BOILER-COMP IOver iD0,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to Savo, indemnify and keep harmless the City of MISC.• REFER TO ORD. upartial againstjinthilitics,judgments, costs and expenses which PERMIT ISSUANCE 10.001CONST.TAX may in any w accrue ago' s( enid Cl ty in consequuncc of the matin of it IIA (� MECH.CONT. LIC.NO. MECH, TOTAL TOTAL e� Sig r re of Applicant/Conimcmr Daily OFFICE COPY i