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16445 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16445 INSPECTION DIVISION •• JOB INSPECTION RECORD `n PERMIT EXPIRATION JOB ADDRESS Y -EK-( v\ ��7' UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER J \S CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE I 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 PREGUNITE TO COMPLY WITH THE APPROVED P4Q (�D CITY OF PERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. II'"'�� POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 9-�-T- S; h % UNDERGROUND /SLAB �k^'O}"'"'S �`-'��<hgNto 8 PLUMBING Clty Of CiUpBilIDO 7 � L ' ELECTRICAL ISSUANCE DATE MECHANICAL BLDG ELECT.I PLO MECH ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR _INFORMATION PLUMBINGVALUATION $SFT, ' � � ) E MECHANICAL ' ELECTRICAL _ PERMII T° FRAMING `Ir INSULATION - SrORICI TYPE CONSTR, OCC GROUP , RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEENLSIGNEO ROOF. SG F1 FLOOIIAIIEA TOTALACREAGE NOTE:NO FINAL INSP.SHALL BE MADE BEFORE A DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING Res IND CON PB Om APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ \I ROUGH SAN.4 ASSESSORS PARCEL No I PLUMBING ELECT.ENERGY TUBS&SHOWER PAN PLUMBING ENERGY TRAa NO PARCEL NO MECHANICAL MECH.ENERGY ' ELECTRICAL -BUILDING ENERGY Acc DATE ACC.FILE No FRAMING ELECT.FINAL TEST INSULATION PLUMBING zoN ING ENG SITE NO. GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY T,Za COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ No \ EXTERIOR SHEAR - - ELECTRICAL RELEASE FLOODIONE A w c. INTERIOR SHEAR FIRE DEPT. Y ❑ N❑ Y ❑ N❑ SHEET13OCK GRADE XTERIOR LATH FEE SUMMARY BUILDING NITERIOR LATH TEMPORARY APPROVALS BUILDING S;00 SCRATCH COAT ELECTRIC - PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE , OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H 4 ONE,WORKING DAY BEFORE REQUIRED-INSPECTION. PLUMBING 00� PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! nTOTAL PLEASE READ REVERSE SIDE BEFORE - CALLING FOR FINAL INSPECTION. OFFICE COPY L APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY . -BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT e. 16445 ADDRESS,,, J 67 62�ie! WAY BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME ' Q"' NA " 2SY�7h1'3 DTV. ELECTRIC PERMIT FEE ONE NAME AcraRs UTLETS-SWITCHES-RECEP 10.00/1.00 6)WNEK LIC.NO. LIGHTING FIXTURES 10.00/1.00 GONTRACroRs CONTRAS PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 16.00 DATE OF APPLICATION ^ OORRCHITECi PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER Llc.NO. ISIGNSTRANS. 3.00 moo iss Ervc' SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION zIP TEMP. METER OR POLE INS. 0.00 C.[ Gu •� APPLICANT'S MOTORS SEE E ADDRESS SERVICE CHANGE 2- u, ,0 BE00 G� ad ), oo LICIiNSEU CONTRACTORS UECLARAI'ION / - a Lwi sit I hereby affirm that I ten licensed under provisions of Chapter 9 y< w (commencing with Section 7000)of Division 3 of the Business and Ino BLDG. ELECT. PLG. MECH. ISSUANCE DATE F 7 z Professions Code,and my license is in full force and effect. z O w - License Class Lim Number 0m -w Date.Contractor r F M a w a OWNER-BUILDER D17CLARATION BUILDING PERMIT - o A 0 MISC.- REFER TO ORD INFORMATION w g m I hereby affirm that I am exempt from the Contractor's License FiL J Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION r �� g/FT. Code:Any city or county which requires a permit to construct,alter, Be BE 4 p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. SDELEC. K m IS requires the applicant for such permit m file a signed statement that TOTAL d w be is licensed pursuant to the provisions of the Contractor's License PER MIT TO E z a Law(Chapter9(commencing with Section 7000)of Division 3 of the 4 0 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Ie H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. P, by any applicant fora per mitsubjects S500),licuntmueivilpenalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundredproperty, dollar,(ray employees �ir Las owner anon,property,a my employees with re is nas ot BACK F LOW PROTECT. DEVICE 4.00 their sole compensation,will(S the work,and the structure is not OCC.GROUP RES.UNITS intended or offend for sale (Sec. 7044, Business and Professions DRAINS-FLOORROOFAREACONDE 500 Code:The Contractor's License Law docs not apply to un , , , . owner of ' . property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5,00 sa FT.ELDER AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale If,however,the bwlding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.1 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. 36.00 RES IND CON PB other ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ licensed contractors to construct the project ISee. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:1'he Contractor's License Law does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts for such projects with a contractods)licensed pursuant 10 the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt undcrSw. ,B.&BC.for this WATER HEATER W/VENT 6.00 reason_ Owner A,yyw` `I,46jj,toit•4 pate(Y_ _ WATER SYSTEM 5.00 ACCDATEACC.FILE NO. W KhRS'C'OMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to wif-in ame, or a certificate of Workers'Compensation Insurance.or it certified ZONING ENG.SITE NO. copy thereof(Sec.3800.Lab.C.). Policy Nn. Company 0 ❑ Certified copy is hereby famished PRINK ENERGY$ Z 2 ❑ Certified copy is filed with the city inspection division. 24 C- p Applicant IMISC.- REFER TO ORD. Y ❑ N❑ Y ❑ NE) j N C17RTIFICA'I'1:OF EXEMPIION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > CONIPEN'SATION INSURANCE, PLG.CONTR. LIC.NO. PLG. CL 0 (This section evil mol be completed it' the permit is for one TOTAL Y E) N❑ Y [:jN❑ U O hundred dollars(S 100)orlc,s.) 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY 0 F mit is issued1 shall not employ any person in any manner so as m Uone suhjeel to the Works fnntpensation ED Laws of California. Date BUILDING Applicant >_ 0NOTICE, TO APPLICANT: IL after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 /S d F2 entption,you should become subject to the Work,,'Compensation St. to it urs of the Labor Code, you must for haith comply with APPLIANCE 5.00 PLAN CHECK U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10,000C.F.M.1 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1C.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construnionlending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of lire work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U,) 8.00 Lenders Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 1 certify thm I have read this application and ,are that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree in comply with all city unit county PLUMBING ordinances and slate laws rotating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 hereby aUOtorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-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 liabilities,judgements, costs and expenses whichruCONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 ra ling of this peen'. MECH.CONT. LIC.NO. MECH. C TOTAL TOTAL Sign sof Applicant/Contractor Date 1 OFFICE COPY