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17287 POST THIS CARD NEAR FRONT OF BUILDING PER MIT NUMBER" CITY OF CUPERTINO 17287 INSPECTION DIVISION JOB INSPECTION RECORD i' PERMIT EXPIRATION JOB ADDRESS �+U'v UNIT#• _LOT# -I 1`� w PERMIT EXPIRES IF WORK OWNER /0/ Z3 A ^�"�/L C NrR-ncTOR - IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSLI FOUNDATION - ANCE OR 180 DAYS FROM 'NOTE: - UFER ALL GRADING AND DRAINAGE SHALL BE.INSTALLED LAST CALLED INSPECTION. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS - ,� J ; IIL. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB 1 PLUMBING ., MAR 1UCtLJ + • ELECTRICAL " '•• ISSUANCE DATE MECHANICAL BLD - ELECT PLG: mECR 1 a� ❑ Ell 00 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING ERMIT INFO R ION WOOD FLOOR - VALUATION slFr. PLUMBING MECHANICAL ELECTRICAL PERMIT 110 FRAMING STORIES TYPE CONSTR. INSULATION • _ OCG GHOUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT.FLOOR AREA TOTAL ACREAGE. ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE L aj1 DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING - RES No CON PB 0111.1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDFINALS - DATE INSP. El ❑ El 11 11I ROUGH , SAN.p ASSESS013S PARCEL NO, PLUMBING ELECT.ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO, PARCEL NO MECHANICAL - MECH.ENERGY .ELECTRICAL . BUILDING ENERGY ACC DATE ACC.FILE NO -FRAMING ' ELECT.FINAL TEST PLUMBING ZONING ENG.SITIE NO. ' INSULATION - GAS TEST GAS MECHANICAL _ FIRE SPRINK ENERGY T4< V N V ❑ NE] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.LUC. INTERIOR SHEAR FIRE DEPT. Y'❑ N❑ Y ❑ "❑ SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH - BUILDING INTERIOR LATH - TEMPORARY APPROVA BUILDING] 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 FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM• ARRANGE FOR INSPECTION BY PHONING 252;4505, ELECTRIC ' FLU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION;DATE MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL I Il OFFICE COPY APPLICANT TO FILL IN INFORMATION.WITHIN RED LINES USE BALL POINT PEN ONLY BUILDING PROJECT I DENTIFICATION PERMIT NUMBER BOIL°I"� ba�IG,o �/�pcshionlxl'rlc�/ APP LICATION & PERMIT � �n�� + ADDR ESE 101 ITr• IP011 6 � 421 I . ..y G - BUILDING -ELECTRICAL-PLUMBING-MECHANICAL ' ANER'a 1,1` PLAN CHECK VALIDATION " ` �1J QTY. ELECTRIC PERMIT FEE NAME , PQGfiG &)nwearPHDNE 250-5#387 CONTRACTOR'S NAME. OUTLETS d�,� OUTLETS-SWITCHES-RECEP 10.00/1.00 N*e �C LIC,N. A�1TI 503 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS utf-�. - ADDRESS Cn�n�t-AY1Qi APPLIANCES.-RESIDENTIAL 4.00 .. S, PHO E - PANELS 10.00 DATE OF APPLICATION OORRcmTECT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C, O. ENGINEER - ' uC-.0, ISIGNS TRANS. 3.00ARCHOR ' " ADDRESS ENG. SPECIAL CIRCUIT 5.00 ! PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 .�1�` ADDRESSTE ''J - MOTORS SEE FEE SCH. �• /IIYIL--77 �l� 26g-32 5,,140OY' Blvd q2? SERVICE CHANGE 20.00 (Qy ] 3I81C, J f 0 O LICENSED CONTRACTORS DECLARATION ¢ o u I herebyaffirm that I am licensed under provisions of Cha ler 9 ¢ z w p p ISSUANCE DATE va¢ (commencing with Section 7000)of Division3 of the Business and F N i Professions Code a y4hcense is in full Core;a9d f t. ELECT. PL❑G. MECH. i w o License Class Lic.Number �'�-� �� - H y r J Date Contractor a w ¢ OWNER-BUILDER DECLARATION ' BUILDING PERMIT - o a" INFORMATION w ; LL y I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER'TO ORD !moo ¢ Law for the following reason. 7031.5,Businessand Professions VALUATION $/FT. - < PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, L m � J1 aa ¢ improve,demolish,orELEC.CONTR. LIC.NO, ,repair any structure,prior to its issuance,also ELEC. a i O 2 requires the applicant for such permit to file a signed statement that - TOTAL - PERMIT TO E: Rem he is licensed pursuant to the provisions of the Contractor's License F z < Law(Chapter9(commencing with Section 7000)of Division 3 of the �/� - E i C Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE [-. Ic r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. d ; - by any applicant fora permit subjects the applicant to a civil penalty ALTER_-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(E500)J', I ❑' I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE .- 4.00 R their sole compensation,will do the work;and the structure is not occ.GROUP ES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EACON D. 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.FT.FLOOR AREA. TOTAL ACREAGE himself or through his own employees,provided that such improve ments are not intendedor offered for sale.If,however,the budding GAS-EA-SYSTEM-1 INC.4 OUTLETS 6.00 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- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE - prove for purpose of sale.). - .. ' RES IND CON . PB Other ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 licensed contract." to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0. and Professions Code:The Contractors 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.200ft/10.00 ' the Contractors License Law. TRACT NO. PARCEL NO. ❑ Ivo exempt under Sec.-,B&P.C.for obis' reason WATER HEATER W/VENT 6.00 ' Owner 'Dale WATER SYSTEM - 5.00 . ACC.DATE ACC.FILE NO. WORKERS:COMPENSATION DECLARATION, WATER TREATING EQUIP. 5.00 1 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.0-). - - Policy No. Company 0 '❑ Certified copy is hereby famished. Z Z ❑ Certified copy is nbal:with the city inspection division. FIRE ❑SPRINK ENERGY ❑ F O Applicant MISC.- REFER TO ORD. vO N Y T44 Y N' CC y, CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 - FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE, PLG.CONTR. LIC.NO. PLG, - ❑ [-]CL 0 ❑ 0 (This.sCctlou need not be completed if the permit iE for one TOTAL V N Y N hundred dollars IS 100)or iess.) - 0 O 1 certify that in the performance of the work for which this per- QTY: MECHANICAL PERMIT FEE FEE SUMMARY LL H on is iss ed I shall not employ an rsan'n un)r manner so as to, 0 w bee. b' t to the Workers'C p Its h rs of California. Date Applicant BUILDING' CL ALTER OR ADD TO MECH. 5.00 r� M } N NOTIC T APPLICANT'. If,a ter making this C ficate of Ex- LM1�l 2 emptici you should becomesubject t0[he Worker, Compensation APPLIANCE 5.00 PLAN CHECK provisions the Labor Code, you must,forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,OODQF.M.) '4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE 75 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. MICROFILM 3097,CiVCJ. HEATING UNIT.(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 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 -PLUMBING ordinances and state laws relating to building construction, and BOILER-COMPO H.P.or 100,000 B.T.U.) 6.00 hereby authorize 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. Cupertino against liabilities,judgments, costs.and expenses which PERMIT ISSUANCE - 10.00' CONST.TAX may in any way occ he against said City in,consequence of the (anti this r 1 MECH,CONT. LIC.NO. MECH. �1' ` �w� 3uBg TOTAL TOTAL 15 t Signature of Applicant 'ontractor Date OFFICE COPY