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17017 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 1 701 7 INSPECTION DIVISION JOB INSPECTION RECORD 0I , In L PERMIT EXPIRATION JOB ADDRESS I L V `CCAS a r UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER • CONTRACTOR IS NOT STARTED WITHIN INSPECTION - DATE IINSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE:. LAST CALLED INSPECTION. LIFER ' ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE r TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS n A f •2.^ 1 U POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED / DEC 2 IJO� 1 U ; • PLUMBING .NDERGROUND /SLAB � ELECTRICAL City O f CUpedino ISSUANCE DATE MECHANICAL BLDG ELECT PLG. MFCR ❑ ❑ ❑ . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BU ILVG PERMIT INFORMATION WOOD FLOOR VALUATION. $JFT. PLUMBING r. MECHANICAL ' ELECTRICAL / PERMIT TO =y.. FRAMING Flee, -oAL I STORIES TYPE CONSTR INSULATION OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO FT FLOOR AREA TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.SHALI,BE MADE BEFORE �.. DIAPHRAGM - THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IND CON PB O", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH SAN.N ASSESSOHS PARCEI.NO PLUMBING ELECT.ENERGY TUBS 8$HOWER PAN PLUMBING ENERGY TRACI NO PARCEL NO MECHANICAL MECH.ENERGY - ELECTRICAL BUILDING ENERGY ACC DATE ACC,FILE NO FRAMING ELECT.FINAL TEST INSULATION PLUMBING ZONING ENEC.SITE NO. ' GAS TEST GAS MECHANICAL - FIRE SPRINK ENERGY 1.24 COVER NO WORK UNTIL ABOVE'HAS BEEN SIGNED HEATING Y ❑ N❑ ` ❑ ND F ZONE A U C. EXTERIOR SHEAR ELECTRICAL RELEASE y\ INTERIOR SHEAR FIRE DEPT. YL,�.J N❑ v ❑ N❑. SHEETROCK - GRADE FEE 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 OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0� PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING, z - — SEE PERMIT FOR EXPIRATION DATE MECHANICAL — IMPORTANT! CONST.TAX. 'PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY 4PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT T. 17017 aooREss Q >r�� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 1 ' OWN, 'S PLAN CHECK VALIDATION NAME 1(1yrPHONE 730- OTY. ELECTRIC PERMIT FEE Bay NAMERAcrDRS UTLETS-SWITCHES-RECEP 10.00/1.00 LIC.NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR AAPPLIANCES-RESIDENTIAL 4.00 CONTRAS -. PHONE PANELS 10.00 DATE OF APPLICATION ' ARRCHITECT PANELS (OVER,200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER I-C,NO, SIGNS TRANS. 3.00 AARCH OR DDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 -L7 -a U APPLICANTDDRESSMOTORS SEE FEE SCH A lod 6Q - r;ve' SERVICE CHANGE 20.00. 1.1.¢0.0 LICENSED CONTRACTORS DECLARATIONDEC 11 �. a i w I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE - (commencing with Section 7000)of Division 3 of the Business and )'n a SLOG. ELELT. PLG. MECH. H z License Professions Code,and my license is in full force and effect lilt fit Cupertino ❑ 1:1 ❑2 z=o License Class Lie.Number Date � Contractor a u a BUILDING PERMIT ¢ ¢ a OWNIiR-BII1LDIiR DECLARATION ¢ Iau MISC.- REFER TO ORD INFORMATION La ,a N 1 hereby affinn that I am exempt from the Contractor's License VALUATION $/RT. F u o A Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE - 10.00 ZOp as Code Any city or county which requires a permit to construct,alter, - le ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELECPERMIT TO . D ¢ Captainthe applicant for such permit to file a signed statement that TOTAL Sm $ he is licensed pursuant to the provisions of the Contractor's License i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe q i ao Business and Professions Code)or that he is exempt therefrom and OTY, PLUMBING PERMIT FEE U,I (C I-oro the basis for the alleged exemption.Any violation or Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN IEA.) 5.00 of not more than five hundred dollars($500).7. - ❑ I,as owner of the property,or my employees with wages us BACK FLOW PROTECT. DEVICE 4.00 theirOCC.GROUP RES.UNITS sole compensation,will do the work,and the structure is not I intended or offered for sale(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,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE I himself or through his own employces,provided that such improve. ' ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-i INC.4 OUTLETS 6.00 or improvement is sold within one 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 im prove for purpose of sale.). RES IND CON PB Omer ❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 0 0 0 0 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 In:m owner of property who builds or improves(hereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1,00 contracts far such projects with a coolmetoris)licensed pursuant Io t1�Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO, PARCEL NO. .`(,A� la exempt wider Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 Rason Owner Date WATER SYSTEM 5,00 ACC.GATE ,ACC.FILE N0. , RKE 'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm Thal I have a certificate of consem to self-im.ne, ZONING ENO.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy I hereof(Sec.3800,Lab.C.). Policy No. Company - O 13 Certified Copy is hereby f ioushed' FIRE SPRINK ENERGY R94 Z Z ❑-Certified copy is fled with the city inspection division. MISC.- REFER TO ORD. O Applicant V [] N YE] N[] ~ rn PERMIT ISSUANCE 10.00 LU CIiRTIFICCOMPE PAA [ PTINS FROM WORK ERS' FLOOD ZONE A.L.U.C. W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N Y ❑ N[ Q. Z l (This section aced no[ be completed if the permit is far one TOTAL hundred dollars 1$100)or le'ss.l U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shat]not employ any person in any manner so as UI Q ALTER OR ADD TO MECH. 5.00 W become subject to the Workers'Compensation Laws of California. Date Applicant BUILDING }-W NO'1'IC17 1'0 APPLICANT: If,atter making this Certificate of EX. Z emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permil sha11 he deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.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(Sue. MICROFILM 3097,Cle.C.). HEATING UNIT(TO 100,000 B.T.U.) 6.00 Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC 1 certify that I have read this application and store that the above VENTILATION FAN (SINGLE) 4.00 Information is correct. I agree to comply with all city and county PLUMBING ordinances and.state lawslrelBting to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the abovomenlioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL (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 accrue against said City in consequence of the granting of this permit. MECH.CONT. LIC.NO. MECH. TOTAL TOTAL r(e rU Signature of Applicant/Contractor Date OFFICE COPY