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16927 POST THIS CARD NEAR FRONT OF BUILDING' PERMIT NUMBER - CITY OF CUPERTINO 1692 INSPECTION DIVISION JOB INSPECTION RECORD r'' S 10. `v PERMIT EXPIRATION JOB ADDRESSS_� U t Z3 J� VV D _UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER ( e 'P CONTRACTOR It j V%P_ C IS NOT STARTED WITHIN ' INSPECTION DATE INSPECTOR INSPECTION RECORD IOU DAYS OF PERMIT ISSU- FOUNDATION 'NOTE:- - ANCE OR 180 DAYS FROM UFER p ' . ALL GRADING AND DRAINAGE SHALL LAST BE INSTALLED CALLED INSPECTION." PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. / POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �� "uT J O ! UNDERGROUND/SLAB " PLUMBING - - _ - ."✓Nw.�� , ELECTRICAL - ISSUANCE DATE MECHANICAL - 1 Z^ 12 - Loc ELECT, PLG. MECH. In C�1 N t ❑ ❑ ❑ ,I DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ;9,- STbA'!- /-iI f4ff BUILDING PERMIT WOOD FLOOR —L/- C 111 - INFORMATION PLUMBING _ VALUATION SIFT. MECHANICAL 'ELECTRICAL TERMIT TO FRAMING C& 'INSULATION ` - STORIES TYPE CONSTI OCC GROUP RES UNITS PLACE NO SUBFLO R UNTIL ABOVE HAS BEEN SIGNED . ROOF P.NOTE:NO FINAL INSSHALL BE MADE BEFORE so.Pr.FLooR AREA TOTAL ncRPAr.E DIAPHRAGM THE CONSTRUCTION TAXIS PAID I ` BUILDING USE ROOF SHEATHING RES IND CON PB o,I„•, ` APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE. INSP° ❑ ❑ ❑ ❑' ❑ ASSESSORS PARCEL NO ROUGH SAN* - PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO. TUBE 8 SHOWER PAN - PLUMBING ENERGY - MECHANICAL - MECH.ENERGY ELECTRICAL / BUILDING ENERGY ACC DATE .ACC.FILE NO FRAMING ELECT.FINAL TEST ' ZONING' ENG.SITE NO. INSULATION PLUMBING - GAS TEST , GAS MECHANICAL FIRE SRRINK ENERGY T.za ± COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ E] NE] EXTERIOR SHEAR ELECTRICAL RELEASE cLooO ZONE I -A.Cu C. INTERIOR SHEAR FIRE DEPT. 1 Y❑ N❑ Y ❑ "❑ SHEETROCK ` - GRADEFEE 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" OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL.BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM' ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC n IFI— ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT!' . Y . CONST.,TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. f * ' OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY .BUILDING PROJECT I DENTIF CATION 'PERMIT NUMBER BUILDING VIAI vo APPLICATION & PERMIT [`9,2 7 /(jv\ I,"I ADDRESS 3 U wU BUILDING —ELECTRICAL—PLUMBING—MECHANICAL %°` OWNER'S . PLAN CHECK VALIDATION "AME QTY. ELECTRIC PERMIT FEE PHONE CONTRACTORS '�5 UTLETS-SWITCHES-RECEP 10.0011.0017.15-d NA J, J Or �0 LI G HTING.F IXTURES 10.00/1.00 me/c rlis No. CONTRACTOR SQq rA � g ppv PPLIANCES-RESIDENTIAL 4.00 N ADDRESS ♦ y��//'•' — ')I, �yI�NE PANELS ,10,0025.0- DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc.No. �� SIGNS TRANS. 3.00 r176 ARCH.09 ADDRESS E"G SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT'S MOTORS4j4C SEE FEE SCH. i 0 ADDRESS SERVICE CHANGE 20,00 _ w 00 LICENSED CONTRACTORS DECLARATION S, U P I hereby affirm that I am licensed under provisions of Chapter 9 I ( (,Q (��-�.�p �� -. r Db ISSUANCE DATE : "' (commencing with Section 7000)-of Division 3 of the Business and OG" ELECT. PLG. MECH. i Professions Co a by my license is in full to oheG' CSO 7C i T License Class Lie.Numbe "�7 - ❑ ❑ ❑ Date Confinetor (H P: x E BUILDING PERMIT ¢ ¢w u OWNER—BUILDER DECLARATION INFORMATION O MISC.— REFER TO ORD F g.a H 1 hereby affirm that I so exempt from the Contractor's License VALUATION $/FT. ac LL Law for following reason. 703L5,Business Professions PERMIT ISSUANCE 10.00 2rJj Code:Any city or county which requires a permit to construct,alter, QQ ¢ 0 Improve,demolish,Or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC.NQ ll ELEC. eT i < u requires the applicant for such permit to file a signed statement that o _/e TOTAL 7t3� PERMIT TO ` wm he is licensed pursuant to the provisions of the Contractor's License Hzi Law(Chapter 9(commencingwith Section 7000)ofDivision 3 oflhe ¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ��./ ¢ o the basis for the alleged exemption.Any violation of Section 703 1.5 STORIES TYPE CONS R. aim by any applicant for a permit subjects the applicant toa Civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00 of mot.'are 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 forsale (Sec. 7044, Business,and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,mrd-who does such work F IXTUR ES-PER TRAP 5.00 sO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If;however,the building GAS-EA.SVSTEM-11NC.4OUTLETS 6.00 or improvement is sold within comm year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or owner, RES IND CON PB Oilier prove for purpose of sale.). - INOUSTRIALWASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ F-1- licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I ONCE 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 the Contractor's License Law. SEWER-SAN ITARV-STORM EA,200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6,00 reason Owner Date WATER SYSTEM 5.00 . ACC.DATE ACC,FILE NO, WORKERS'COMPENSATION 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 thereof Sec 3800,Lab.C).Sy"A Policy No. ompany Q ❑ Cet copy is Iter by famished. FIRE SPRINK ENERGY T-24 Z Z ❑ Cert" copy, is Ib W city iI ,/f(on division. MISC.- REFER TO ORD. 0 Applicant r!'E V ❑ N❑ Y ❑ N❑ CrTPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c. CERTIFICATE OF EXEMPTION FROM WORKERS' IL > COMPENSATION INSURANCE- - PLG.CONTR. LIC.NO. PLG. CL O (This Section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ =) 2 hundred dollars IS 100)or less.) - U O 1 certify that in the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F _ mit Is issued,I shall not employ any person in any manner so as to U become subject to the Workers Compensation Laws of California. UJ . Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } ti NOTICE TO APPLICANT: If,after making this Certificate of Ex- F. Z emptlon,you should become subject to the Workers'Compensation APPLIANCE5,00 PLAN CHECK . provisions of the labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=QF.N0 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10j000QEM.) 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(Sea HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM 3097,CN CJ. Lender's Name HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC Lender's Address 1 certify that 1 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 PLUMBING ' -COMP(3 H.P.oI'100,0008.T.U) 6'.00 ordinances and state laws relating to building construction, and BOILER hereby net representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL 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 CONST.TAX ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 Ia ing of llris ermit MECH.CONT. -LIC.NO. MECH. .f' TOTAL TOTAL 7��b ignature Df Applican t/Contractor. Date OFFICE COPY