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16563 (2) POST THIS CARD NEAR FRONT-OF BUILDING PF.FM1tIt NUMBER CITY OF CUPERTINO 16563 INSPECTION DIVISION JOB INSPECTION RECORD • /Oaa ^ PERMIT EXPIRATION JOBADDRESS �� fIVG UNIT# _LOT# �a - PERMIT EXPIRES IF WORK OWNER Fhn/�' R- CONTRnCTOR y�� IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM + NOTE: LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIt VALIDATION CUPERTI NO STANDARDS. GARAGE SLABS y^ r POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB' PLUMBING ELECTRICAL - ISSUANCE DATE MECHANICAL BLDG ELECT I PLG. I MECK ❑ ❑ 0 ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING v ALUATION SIFT MECHANICAL ELECTRICAL PERMIT To FRAMING _ pAID • ?Z,BG- INSULATION Ov,DRIES TYPE CONSTR 0 C12 8 D QCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' so.Fr.PLoou AI+cA ' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE TOTAL AC+re Act DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE • ROOF SHEATHING Es IND CON PB O.o., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ nssEssDNS PnRCEL NO ROUGH SAN.N PLUMBING ELECT.ENERGY - TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO MECHANICAL MECH.ENERGY ELECTRICALBUILDING ENERGY ACC.DATE ACC FILE NO FRAMING ELECT.FINAL TEST INSULATION - PLUMBING �.-�_ CONING ENG SITE No, GAS TEST GAS MECHANICAL FIRESPRINN ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZUNE AL u.0 INTERIORSHEAR FIRE DEPT. 'Y❑ N❑ Y ❑ "❑ 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 OCCUPANCY OF BUILDING IS NO'T PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 00 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL 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 PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT T 63 � J`J ADDnE55 56 Of`tT� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL F° OWNERS PLAN CHECK VALIDATION NAME A-KI ? QTY. ELECTRIC PERMIT FEE I f'-CA? PHO �W-c7 CON TRaCTO 'B Na E UTLETS-SWITCHES-RECEP 10.00/1.00 bU✓E'1 61AIC.ND LIGHTING FIXTURES 10.00/1.00 CONTRA"$C.TTO`R's ,�`[ ��/r/�/%j�///� {�f PPLIANCES-RESIDENTIAL 4.00 A pR /`��1• X571 PHONE V�//,a'O� PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN V PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER Llc.No, SIGNS TRANS. 1 3.00 ARCH,OR ENGSPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS ZIP TEMP. METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 o a z Foo LICENSED CONTRACTORS DECLARATION a v 1 hereby affirm that I am licensed under provisions of Chapter 9 2 w vHi a (commenting with Section 7000)of Division 3 0l the Business and ISSUANCE DATE ' H O Z Professions Co a y Iicensu is in full 4 ¢ f BLDG. ELECT. PLG. MECH. z o"n- License Class+1 Lic.NuretanTt o w Uatc Contractor-. �1 an yE¢ ¢ wa OWNIiR-BUILDGR DECLARABUILDING PERMIT s ° 4 e' MISC.- REFER TO ORD INFORMATION w g LL N I hereby affirm that 1 am exempt from the 's License u O a Law far the following recon.(Sec.7031.$,Business and Professions VALUATION u, - PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, an ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. u- requires the applicant for such permit t0 file a signed statement that TOTAL n w m he is licensed pursuant to the provisions of the Contractor's License ?G E�R`M_I-T TO H ¢ QLaw(Chapter 9(rofenencinywhir Seelion 7000)of Division 3 u free 00 4 a Business and Professions Code)or that he isexempt therefrom and QTY. PLUMBING PERMIT FEE ¢ H$ tine basis for the alleged exemption.Any violation of Sect ion 7031.5I STORIES TYPE CONSTR. ate _ by any applicant for a permit subjects tire applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 OF am more than five hundred dollars(5500).)'. ❑ I,as owner of the properly,or my employees with wages as BACK F LOW PROTECT. 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 Q� Code:The Contractor's License Law does not apply to an owner of property who builds or improve,thereon,wld wino does such walk FIXTURES-PER TRAP 5.00 SO.ET.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such im mprove- 68 mes are not intended or offered for sale.If,however,the budding GA$-EA.SYSTEM-1 INC.4 OUTLETS or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or int- BUILDING USE prove for purpose of sale.)' INDUSTRIAL WASTE INTER. 30. gF�� IND CON PB ower O 1,as owner of the property,am exclusively contracting with f Cu ertHl'/ ❑ ❑ ❑ ❑ licensed contractors : construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B.. 6.00 LLJJ ASSESSORS PARCEL NO. and Professions Code:The C'ontractor's License Law does not apply to antr owner of properly who builds t r improves melon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts forsuch cense L with a contructorl sl license.)pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA,200tt/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under See_.R ap.C.Icor this WATER HEATER W/VENT reason 6.00 O Owner Date WATER SYSTEM 5.00 ACC.DATE ACC FILE NO. WORK ERS'COM rliNSnTION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent r self-insure. ora certificate o1'Worker.'Conpren tion Insurance,or a certilied ZONING ENG.SITE NO- .Py '. 800,L b.CJ. �✓✓JJ��t Policy Comp my uz 0 ❑ c tit - copy is here y furnished. z 2 Celli is cop z fit d with the city inspection division. FIRE SPRINK ENERGY T 24 F O plicant MISC.- REFER TO ORD. v N[] Y N� c N CE I ICA 11:OF EXEldt,TION FROM WORK 1:RS' PERMIT ISSUANCE 1$00 FLOOD ZONE A.L.U.C. W COMPI\$ATION INSURANCE PLO.CONTR. LIC.NO. PLG CL Q (This xdirin need not be completed if the permit is for one TOTAL OO Y C] NEI Y❑ NE] Z hundred dollars(SI00)orless.) U O 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,I shall not employ any person in any mannerxo as to O w become subject to the Workers'Compensation Laws ol'Culiforom. Q. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE TO APPLICANT: If,after making this Cenil'icam of lix- N Z eruption,you 0muld become subject to the Workers'Compensation qpP APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you a rest forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 14.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,0170C.EM.) 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 Namc Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have mud ill:,apphcatmn and slate mal the above VENTILATION FAN (SINGLE) 4.00 information is correct t I agree to comply with all city and county / ordinances and state laws relating to building construPLUMBING ction, and BOILER-ODMPQ H.P.or 100,000 B.T.U.) 6.00 hereby authon, or of this City to enter upon the above-mentioned property for inspection purposes. BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against Viabilities,judgments, costs and expenses which CONST.TAX may in any way Ccruc against said Cfly in consequence of the PERMIT ISSUANCE 10.00 ran' of this p:) e LII MECH.CONT. LIC.NO. MECH. TOTAL TOTAL fydv Sign u e of APPhcmmf/Contractor Date OFFICE COPY