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16494 POST THIS CARD NEAR FRONT OF BUILDING PER MIT NUMBER :. ;= :CITY OF CUPERTINO 16.494 INSPECTION DIVISION JOB INSPECTION RECORD -77I�' PERMIT EXPIRATION JOB ADDRESS /d/o1J W �Q�-FE '�,,,9 UNIT# LOT# n PERMIT EXPIRES IF WORK OWNER CONTRACTOR E, S IS NOT STARTED WITHIN , INSPECTION I DATE 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 PLANS AND CITY OF PERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. � ,,.-•.--• POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .� PLUMBING UNDERGROUND /SLAB PO I - { DATE,` (� • ELECTRICAL q J O I ISSUANCE MECHANICAL - BLDG ELECT, PLG. •MECM. Dy lob`° ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR - VALUATION PLUMBING, MECHANICAL ELECTRICAL PERMIT rO s, FRAMING • INSULATION - STORIES TYPE CONSTR, I OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 50 fi.FLOOR AREA TOTAL ACREAGE DIAPHRAGMTHE CONSTRUCTION TAX IS PAID BUILDING USE - ROOF SHEATHING - Res' IND CON PB o..•. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El ❑ EEl ED _ ASSESSORS PARCEL NO ROUGH SAN.N PLUMBING ELECT.ENERGY TRACT NO. PARCELNO TUBS&SHOWER PAN - PLUMBING ENERGY MECHANICAL - - MECH.ENERGY ELECTRICAL ACC DATE ACC Rae No BUILDING ENERGY FRAMING ' - ELECT.FINAL TEST zanlNc ENG,SITE No. INSULATION PLUMBING - GAS TEST GAS FIRE SPRINK ENERGY T•24 - MECHANICAL v ❑ rv[:] n ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLDDD 20rvE ,I ALu,C. EXTERIOR SHEAR ELECTRICAL RELEASE v E rv0 Y ❑ NE] INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING -1 INTERIOR LATH ,TEMPORARY APPROVALS BUILDING - SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION,BY PHONING 252-4505, ELECTRIC 1-- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT FOR EXPIRATION-DATE - MECHANICAL IMPORTANT! CONST.TAX . PLEASE READ REVERSE SIDE BEFORE TOTAL ESTI CALLING FOR FINAL INSPECTION. OFFICE.COPY i APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ' .,WUI LOI NG PROJECT I DENTI FICATION -pERMIr NUMBER aU14yNGRE55 _ APPLICATION & PERMIT 1 C A (1 A . ' AOOt S BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 16`F J 4 PLAN CHECK VALIDATION NAME - QTY- ELECTRIC PERMIT FEE M � PHONE NANTRperORs OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME uc.No. 33H LIGHTING FIXTURES 10.00/1.00 cDoR's APPLIANCES-RESIDENTIAL 4.00 ' . \_1 ADDRESS REss J+IIb'�90.OS7z, 7 M PANELS 10.00 DATE OF APPLICATION ". ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.0 ANO. OR ENGINEER � LIC.NO. SIGNSTRANS. 3.00 aacH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS , , ZIP EMP.METER OR POLE INS. 20.00 r APPLICANT s ,. MOTORS SEE FEE SCH. ADDRESS Ess SERVICE CHANGE - 20.00 q o o LICENSED COMRACTORS DECLARATION a v u I hereby affirm that I am licensed under provisions of Chapter 9 ANCE DATE !. - z w (commencing with Section 7000)of Division 3 of the Business and ELECT. PLG. MECH. Nz Professions Code an license is in full for' f t47 �❑ ❑ ❑ z o m - License Cluxa-r_Y Lic.Number � - ❑ 0 z r Dole 41.96' Contractor-..s.r 9LLgws _ Q BUILDING PERMIT E wu OWNER-BUILDER DECLARATION INFORMATION w3 LL N• 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD - u_ o ¢ Law for the Ibllowingreason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE VALUATION S/FT. m a Code:Any city or county which requires a permit to construct alter, - �'1.L ¢ a 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC:CONTR. LIC.of ' ELED. w 0 , requires the applicant for such permit t0 file a Signed statement that TOTAL ' w he is licensed pursuant to the provisions of the Contractor's License , Fzi Law.(Chapter 9(commencing with Section 7000)of Division 3 of the ¢ Business and Professions Code)or that lie is exempt therefrom and QTV- PLUMBING PERMIT FEE ¢r o the basis for the alleged exemption.Any violation of Section 7031.5 'STORIES- TYPE CONSTR. a by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 - - of not more than five hundred dollars($500).): ❑ 1,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 T PER TRAP 5.00 50,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that Such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00 memare oat intended or offered for sale.If,however,the building or imsprovement is sold within one year of completion,the owner- . GAS-EASYSTEM-OVER 4 IEA.) '2.00 BUILDING USE builder will have the burden of proving that h .e did not build Or im- RES IND 'CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑. 1:1 1:10 1,as owner of the property,am exclusively contracting with _ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-'1 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 LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractoRs)licensed pursuant to _ SEWER-SANITARY-STORM EA.200ftI10.00 TRACT NO. PARCEL NO. the Contractor's License Law. ❑ lam exempt under Sea .BAP.C.Lpthis WATER.HEATERW/VENT . 6.00 , reason Owner Date- WATER SYSTEM 5.00 ACC.DATE Asa FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 1 hereby affirm that I have a certificate of consent to self-insure, - ZONING ENG.SITE NO. or a certificate of Workers Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.CJ. N( Policy No. Company �� _ Q ❑ Certified copy is hereby furnished. - FIRESPRINK ENERGY T-24 Z APPLPClicCert"K py iy V N will the inspection division. MISC.- REFER TO ORD. V❑ ❑ ❑ N❑ xnf LOT PERMIT ISSUANCE 10.00 . FLOOD ZONE A.L.0 c. ccCFiRTI PIC ATE EXEMPTION FROM WORKERS' W >_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. . Y,❑ N❑ Y❑ N❑ D. O (This section need not be completed if the permit is for one TOTAL :D 2 lium red dollars IS 100)or kxsJ L) O 1 certify that in the performance of the work for which this per- QTV MECHANICAL PERMIT FEE FEE SUMMARY LL H- mil is issued,I shall not employ any person in any manner so as to O W become subject 1.the Workers'Compensation Laws W'California. �j Date Applicant ALTER OR ADD TO MECH. -5.00 BUILDING J 7�`-- } W NOTICE,TO APPLICANT: If,after making this Certificate of Ex- r F Z emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK provisi.ns of the Labor Code, you must forthwith comply with FEE 1J �S U such provisions or this permit shall he deemed revoked. AIR'HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10, 0IC.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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.CJ. Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC; Lender's Address 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 ' information is correct. I agree to comply.with all city and county BOILER-WMP13 H.P.Or 100,000 B.T.U.) 6.001PLUMB ordinances and stale Idws.rchfirg to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECH above-mentioned property for inspection purposes. , , (We}agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST may In any way accrue against said City in conkequence of the _ rayntytg of this enniit MECH.CONT. - LIC.NO. MECH. n /n A.... _D' �f•30'B�f( TOTAL - - TOOd StS alureof Applicant mractor ^Date OFFICE COPY '