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15003
ell. N • POST THIS CARD NEAR' FRONT OF BUILDING. ' CITY OF CUPERTINO15003 INSPECTION DIVISION JOB INSPECTION RECORD - S 'J JOB ADDRESS �U� - S, lJ C`'gN -13L ✓�� UNIT# •LOT# " OWNER vV L�L�- rr "-, CONTRncioR Etc R-��-t�`O LIZ t'C-17!L �C_,: PERMIT NUMBER PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTEDWITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. - INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION - NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED.PLANS AND CITY OF CUPERTINO STANDARDS. �UFER -PREGUNITE PERMIT VAI.m AT1DN - .- ISSUANCE DATE - ELECT -PLG. MECH.. © I ❑ ❑ GARAGE SLABS POURNOCONCRETE UNTIL ABOVE HAS BEEN SIGNED -Q ; f—' wY-7 A./a. vCT' Y- .' UNDERGROUND / SLAB PLUMBINGr ((-fr�C Qt: —5-- C ELECTRICAL MECHANICAL pQR DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOORINFORMATION " VALUATION $,FT. - PLUMBING MECHANICAL. - ELECTRICAL " � PERMIT TO L - LLsL� ' FRAMING 'INSULATION - STORIES TYPE CONSTRI - OCC. GROUP RES UNITS ' II PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - • 'NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID ' SO. GT.FLOOR AREA ' TOTAL ACREACE DIAPHRAGM - ROOF SHEATHING BUILDING USE Res IND CON Pa On ❑ ❑ ❑ ❑ ❑ `40PLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE . INSP. ASSESSORS PARCEL NO. ROUGH SAN.# PLUMBING ELECT. ENERGY TRACT NO. PARCEL NO. O TUBS & SHOWER PAN - PLUMBING ENERGY. MECHANICAL MECR ENERGY ACC DATE ' ACC, NCE NO - ELECTRICAL _ BUILDING ENERGY FRAMING ELECT. FINAL TEST ZONING ENG. SITE NO. INSULATION - PLUMBING - GAS TEST GAS FIRE SPOINK Y ❑ N ❑ ENERGY 1 2 ❑' "� MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD TONE ❑ N❑ A.L. U.C. Y 'N❑ EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT.v SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS ., SCRATCH COAT . ELECTRIC PLAN CHECK FEE - GAS - "' SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY,'. OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. n ARRANGE FOR INSPECTION BY PHONING M-4505, I" ONE.WORKING DAY BEFORE REQUIRED INSPECTION. , 0 PLEASE GIVE JOB ADDRESS WHEN PHONING.. . Z —SEE PERMIT FOR EXPIRATION DATEIMPORTANT!.PLEASE MICROFILM ELECTRIC PLUMBING ' PTOTA READ REVERSE SIDE BEFOREL CALLING FOR FINAL INSPECTION. OFFICE COPY O ZZ, N CC LU CL U,g LL U Oa run L+: 4 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY: I BUILDING PROJECT IDENTIFICATION " " APPLICATION & PERMIT BUILDING -ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER I 5 OO BUILDING AODR as S• (,(u Q JU OWNER'S NAME, OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION - We PHONE - , 'DATE OF APPLICATION. CONTNAMERACTOR'S Zj JeC CLLO gleC, LICNO.CIO-'Ig $( UTLETS- SWITCHES -RECEP 10.00/1.00 G'% 1LIGHTING FIXTURES 10.00/1.00 - CNTR ADDRESS Ons �y) ( L(O S. Il (e PHONE ( ) 703 PPLIANCES- RESIDENTIAL 4.00 - PANELS 10.00 ORRCHITEcr ENGINEER uc. No. PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C, NO. SIGNS TRANS. 3.00 ARCH. OR END ZIP SPECIALCIRCUIT _ 5.00 PERMIITTrVALIDATION EMP. METER OR POLE INS. 20.00 APPLICANTS ADDRESS MOTORS SEE FEE SCH.- SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECCARATION I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. LiccGtIiZ'I,� T142,....__- Lic. Number 4423Q I One, / 08 Contractor_-eGu BLDG. ❑ ELECT. PLG. MECH. ❑ ❑ - BUIL NG PERMIT OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason. (See. 7031.5, Businessand Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also INFORMATION MISC. - REF D VALUATION PERMIT ISSUANCE 11t1 ELEC. CONTR. LIC. NO. C requites the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000)of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.$ TOTAL -� PERMIT TO �s� 7 , DTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant loo civil penalty of not more than five hundred dollars f $500).): ALTER -DRAIN -WATER IEA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 Oct. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. . 5.00 intended Or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work FIXTURES - PER TRAP 5.00 SD, PT. FLOOR AREA TOTAL ACREAGE mproves himself o,through his own employees, provided that such improve.- punts are. not intended or offered for sale. If, however, the building punts or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im- prove for Purpose of sale.L -❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business GAS-EA.SYSTEM-11NC.40UTLETS 6.00 GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND. CON PB Omar ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. -30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 - - ASSESSORSPARCELNO. and Professions Code'. The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who - LAWN SPRINKLERS -OVER contracts forsuch projects with a contractor(s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO.' WATER HEATER W/VENT 6.00 ❑ I am exempt under Sec.-, B &P,C. for this reason Owner Date WATER SYSTEM 5.00 PCC. -DATE ACC. FILE NO. ' WORK ERS'COMPFNSA'fION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy therecffSec. 3800, Lab.C.). Policy No.Company E'•l3= '❑ Certified copy is here by furnished. 3.C. Ig Il ❑ Cerlif •B' COP isd with pection Division. Applicant (�(r. FIRE SPRINK v N ❑ ❑ ENERGY T 14' v N ❑ ❑ MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. CEB'TI FICAT E OF 1: XEMPTION hROM WORKERS' PLG. CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ N❑ Y ❑ N❑. QTY MECHANICAL PERMIT FEE - FEE SUMMARY hundred dollars IS 100) or less.) ' I certify that in the performance: of the work for which this per- mit is issued, I shall not employ any person in any planner so as to become subject to the Workers Compensation Laws of California. Date Applicant NOTICE: TO APPLICANT: If, after making this Certificate of F.x. cmplion, you should become subject to the Workers' Compensal ion provisions of the Labor Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10MC.F.M.) 4.00 PLAN CHECK FEE AIR HANDLING UNIT (OVER 10MIC.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AG13NCY EXHAUST HOOD WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T.U.) 8.001MICROFILM I hereby affirm that there is a construction lending agency for the performance oLthe work for which this permit is issued (Sec. 3097, Co, C.). Leader's Name HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC 77 Lender's Address VENTILATION FAN (SINGLE) 4.00 PLUMBING ' I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and BOILER -COMP(3 H.P. or 100,000 B.T.U.) 6.00 - BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of upertino-against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 MH. CONT. LIC. NO. EC MECH. - TOTA` TOTAL 'an}}��g'ppf this per ok. P .9'ela z� YIzS I e8 Signature of Applicant/Contractor Date OFFICE COPY