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15775 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER ` W CITY OF CUPERTINO 15775 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS .)..1-06 � A&"t c05 2/1"'. UNIT# _LOT# PERMIT EXPIRES IF WORK-i OWNER c- ---c— s1k z— CONTRACTOR . 4 — IS NOT STARTED WITHIN, INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. 'FOUNDATION - ANCE OR 180 DAYS FROM NOTE: - LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT vALmnnoN CUPERTINO STANDARDS. GARAGE SLABS' y. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB , PLUMBING 3' ELECTRICAL ISSUANCE DATE MECHANICAL - , - RLDC ELECT. PLG. ME R. El El 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDQI���DING PERMIT WOOD FLOOR O«11N1"FORMATION + VALUATION PLUMBING SIFT. MECHANICAL - ELECTRICAL PERM T To FRAMING ' STORIES TYPE CONSTR. INSULATION OCC.OROUP 'E UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sD,Fr FLooR AREA TOTAL ACREAGE DIAPHRAGM - - THE CONSTRUCTION TAX IS PAID' - BUILDING USE ROOF SHEATHING- - - RES IND CON Pe oa... APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED pFINALS DATE INSP. El ID El ❑ ROUGH SAN,tl nSSESSORS PARCEL NO, PLUMBING ELECT.ENERGY rRnn No. PARCEL No TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ELECTRICAL' - BUILDING ENERGY .ACC.DATE. ACC.FILE NO FRAMING ELECT.FINAL TEST zow"c END SITE No. INSULATION PLUMBING GAS TEST GAS FIRF] . NK ENERGY T- MECHANICAL N COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE yam , jam- Y ❑ "❑ " ❑ � FLOOD ZONE A.I.U.C. INTERIOR SHEAR FIRE DEPT, - Y❑ "❑ Y ❑ N❑ SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH .TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS TF FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINA L IS SIGNED BY BUI LDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC O� ' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL Q IMPORTANT! CONST.TAX ' PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY I APP ' (CANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY — BUILOINGPROJECTIDENT]FICATION PERMIT NUMBER_ tolcoss APPLICATION & PERMITAOD�ra q [Z ' �{ BUILDING — ELECTRICAL—PLUMBING—MECHANICAL 1!"' I J J ER'a M Chrle sire NAMp7y, ELECTRIC PERMIT FEE PLAN CHECK VALIDATION NAME /// m r e r s• PHONE CONTRACTOR'S NAME // S'�' �6 OUTLETS-SWITCHES-RECEP 10.00/1.00 LQhS LIC.N Y LIGHTING FIXTURES .10.00/1.00 C•ONTR ACTORS SI ,4r,e APPLIANCES-RESIDENTIAL 4.00 ADDRESS (p —/ �/��` C m lY PHONE I��-OSJ PANELS 10.00 b DATE OF APPLICATION ORRCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .P.C.'NO. ENGINEER LIC.No. SIGNSTRANS. r 3.00 ADDRESS ENG. SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION ' ZIP EMP.METER OR POLE INS. 20.00 APPLICANT s ADDDRESSDRESSMOTORS SEE FEE SCH, SERVICE CHANGE 20.00 ,/ y (/ w o o LICENSED CONTRACTORS DECLARATION �V/p 4�a a E,w [,hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE r (commencing with Section 7000)of Division 3 of the Business and A a u ' BLDG. ELECT. PLG. MECH. r w i License Codc me my Ilcerme is in full force en �1 0 i m W License Cl.Class— Lia Number_y�p. .p.�.� - El Date Contactor El 1:1a y f y BUILDING PERMIT ¢ a a OWNER-BUILDER DECLARATION R a U INFORMATION w ; a N I hereby affirm that 1 am exempt from the Contractor's License MISC.— REFER TO QRD. to .. Oj Law'forthe followingonson.(Sec.7031.5,Buslnessand PoRessiona PERMIT ISSUANCE VALUATION Code:•Any city or county which requires permit to construct,site,. 10.00 aca, ap improve,demolish,crrepairany structure,priorto its issuance,also ELEC.CONTR. LIC.NO. ELEC. AP A I, requires the applicant for such permit to file a signed Statement that TOTAL ` PERMIT O w o m he is licensed pursuant to the provisions of the Contractor's License �9a8M� F z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe v F i ef 9usincss and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT Ps I"(Et IF the basis for the alleged exemption.Any violation of Section 7031.5 C ALTER-DRAIN . STOB�S TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty WATER (EA.) �1 of hint more than hundred ndred dollars(S500)J: ALTER- 10e ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 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 SO.PT.FLOOR AREA TOTAL ACREAGE himself re through his own employees,provided that such improve- mentsarenotintendcdorofmployeesarovided that Sthe building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion, the owner GAS-EA.SYSTEM-OVER 4 (Eq.) 2.00 BUILDING USE builder Will have the burden of Pnrvmg thin he slid not build or im- RES IND' CON PB Omer prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 3000 0 I,as owner of the property,am exclusively contracting with . ❑ ❑ ❑ ❑ ❑ licensed conrmetors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The.Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who I LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contreetons)licensed pursuant to the Contractor's License taw. SEWER-SANITARY-STORM EA.200ft/10,00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec.—,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0, WORK E RS'COMI1FNSATION DECLARATION WATER TREATING EQUIP[ 5.00 1 hereby affirmthat 1 have a certificate of consent to self-insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy there f Lc.380 ab;`.),l,�� ^ S'(� hV'r Policy No �L+'1J" T•S�- �F— { Q ❑ Certified copy is herehylnnished. —•• FIRE SPRINK ENERGY T-24 Z Z IX Certified o y rs filed with the city inspection division. - O APPhcmH / � _ MISC.- REFER TO ORD. Y❑ N❑ Y N❑ rn CERTIFICATE OF EXEMPTION FRO ORKIIRS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. LLI > - COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. PLG, CL CL (This section need not be completed it the Perlll it Is for one TOTAL Y❑ N❑ Y [:] N Z ❑ hundred dollars IS f 00)or less.) U O 1 certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to O W become subject to the Worksco'Compereation Laws of California. BUILDING y Dam Applicant ALTER OR ADD TO MECH. 5.00 } to NOTICE TO APPLICANT: If, He,making this Certificate of Bx- F Z enption,you should become subject to the Workers'Compensation APPLIANCE 5.00 - PLAN CHECK provisions of the Labor Code, you must forthwith comply with AIR HANDLING UNIT(TO 10 FEE U such provisions or this permit shall be deemed revoked. p00GF.M.1 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.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. HEATING UNIT(TO 100,000 B.T.U.) JLQQ MICROFILM 3097,CDC.). Lender's Name Lender's Address HEATING UN IT(OV E R 100,000 B.T.U.)9.50 ELECTRIC I certify that l have read this upplic flon and state that(tic above VENTILATION FAN (SINGLE) 4.00 ' information n correct. I s relati g to b With all city and county / PLUMBING ordinances and stain laws relating to building construction..and BOILER-COMP(3H.P.or100,000B.T.U.) •EBG hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000BTU)SEE FEESCH.' MECHANICAL (� above-mentioned property for inspection purposes (We) agree to save, indemnify and keep harmless the City of, MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE W.00O CONST.TAX may in any way accrue against Said City in consequence of the matin of this permit MECH.CONT. LIG NO. MECH. / /a *W TOTAL 30 f TOTAL Sig mof Applicant/Contractor ^Date ' OFFICE COPY ,, f ADDITIONAL PERMIT FEES BU I LDING PROJECT I DENT[FICATION VAwAnax ADDRESS ADDRESS �a b i✓�% --�- CWrvERs E PRorvE 73Z-�775L FEE SUMMARY xAMTRACTORE/ BUILDING �ACIs uc.xo��/.zsp6 PLAN CHECK CONTRACTOR5 FEE AODREEsFF� (�r / �JW/.Xf"/c PRorvE7�y��s�F' SEISMIC FEE CITY. ELECTRIC PERMIT EEEE UTLETS-SWITCHES-RECEP ,�� ELECTRIC '-rD LIGHTING-FIXTURES I PLUMBING APPLIANCES-RESIDENTIAL PANELS MECHANICAL SIGNS SIGNS TRANS. TOTAL SPECIAL CIRCUIT EMP.METER OR POLE INS. PERMIT VALIDATION MOTORS SEE FEE SCH. 0 SERVICE CHANGE 66 Z H ° TOT •YD -1 WGI ILL(GGC N LU -2 CITY. PLUMBING PERMIT FEE a Oa ELECT.cE AT MECH, D_ o Z) 2 ALTER-DRAIN&VENT-WATER IEA.) ❑ ❑ ❑ U O BACK FLOW PROTECT.DEVICE Qw DRAINS-FLODR,ROOF,AREA,COND. } A FI%TURES-PER TRAP F z GAS-EA.SYSTEM-11NC.4OUTLETS I () GAS-EA.SYSTEM-OVER 4(EA.) �EC221988 INDUSTRIAL WASTE INTER. �E� LAWN SPRINKLERS-1 INC 5 V.B. (sn(s) of Cupertino LAWN SPRINKLERS-OVER 5(EA.) SEWER-SANITARY-STORM EA.2001t/ WATER HEATER W/VENT WATER SYSTEM WATER TREATING EQUIP, TOTAI OTY. MECHANICAL PERMIT FEE ALTER OR ADD TO MECH. APPLIANCE AIR HANDLING UNIT(TO 10=C.F.M) AIR HANDLING UNIT(OVER 10p0OC.F.M.) EXHAUST HOOD(WITH DUCT) HEATING UNIT(TO 100,000 B.T.U.) HEATING UNIT(OVER 100,000 B.T.U.) VENTILATION FAN(SINGLE) BOILER-COMP(3 H.P.Or 100,000 B.T.U.) BOILER-COMP IDD•,100000 BT111 SEE FEE SCH, TOTAL