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16864 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO' 16864 INSPECTION DIVISION JOB INSPECTION RECORD „ JOB ADDRESS2 PERMIT EXPIRATION . - _L.�7 — I� .1 • .,(/���T UNIT# _LOT# PERMIT EXPIRES IF WORK jOWNER D `��Z(l�V\(V CONTRACTOR - IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION-RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION - ANCE OR 180 DAYS FROM NOTE: UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT'VACIDATTON - CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED . UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL -BLDG ELT, I PLG. MECH ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED .- BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION $/FT. PLUMBING � ,` , MECHANICAL PAIDo ELECTRICAL i PERMIT 1 INSULATION 'q, FRAMING ( 7 � (/I 1'` STORIES TYPE CONSTR City . of cuperting - OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SU,PT FLOOII wH[A iOTwL ACREAGE ipI• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE I DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE, ROOF SHEATHING I ❑ ❑ CON PB )IIIII VE � -APPLY NO ROOFING UNTIL ABOHAS BEEN SIGNED FINALS DATE INSP. Assessoas PARCEL No ROUGH SAN.N r PLUMBING ELECT.ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO MECHANICAL MECR ENERGY ELECTRICAL - BUILDING ENERGY ACC DATE ACC FILE NO FRAMING ELECT.FINAL TEST INSULATION PLUMBING zoNlNc ENG.SITENo. GAS TEST GAS FIRE SPHINK ENERGY T.24 MECHANICAL Y [D N� NO No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE AL uc. INTERIOR SHEAR . , - FIRE DEPT. Y❑ NE] Y ❑ N❑ SHEETROCK I IGRADE FEE SUMMARY ' EXTERIOR ,LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRICPEEN CHECK CQ1 .,4/{^ GAS ( r ? NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM . LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC �—� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL -IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL F r CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY it .: ... BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 1686 4 ADORE55 7 Oho BUILDING -ELECTRICAL-PLUMBING -MECHANICAL OWNER'S. ! (�• PLAN CHECK VALIDATION NAME, • 900 ZOTV. ELECTRIC PERMIT FEE PNG 64taA CONTRACTOR'S ' NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 ,fD LIC.No. LIGHTING FIXTURES 10.00/1.00 137- CONTRAC7Ofls ADDRESS APPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10,00 DATE OF APPLICATION ^ ARCHITECT - PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 _ ENGINEER uc.NO, SIGNS TRANS. 3.00 ARCH.Ess ENG. _ SPECIAL CIRCUIT S.QQ PERMIT VALIDATION ' .•.` - ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. A (( LcS LZU b12 PA ' SERVICE CHANGE PAlp 20.00 o o- LICENSED CONTRACTORS DECLARATION Fi w 1 hereby affum that I am licensed under provisions of Chapter 9 NOV I ISSUANCE DATE <u (commencing with Section 7000)of Division 3 of be Business and DG. ELECT. PLG. MECH. H O i Professions Code,and my license is in full force and effect ❑ E3z O - License Class ui Fuel UumContru Number City of.Cupertino 9 w r a 'c ¢ a ' OWNISR.BUILDIiR DECLARAHON BUILDING PERMIT E o o.D INFORMATION X 3 I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD to a. u w vs Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 121,90 VALUATIONr p9 S/FT. Code:Any city or county which requires a permit to construct,alter, O D 2rc ¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 3 0 O c regmms the applicant for such pnrlml to NIC u signed statement that TOTAL r w $ he is licensed pursuant hs the provisions of the Contractor's LimnSe PERMIT T H. Law(Chapter 9(commencing with Section 7000)of Division 3 of Rte 2 SK I Ir f4 O Businim and Professions Code)or that he iscxempt therefrom and CITY. PLUMBING PERMIT FEE �L _ Ie I- �a the basis for the alleged exemption.Any violation of Section 7031.5 RIES I TYPE CONSTR. by any applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN -WATER (EA.) 5,00 of no core than five hundred dollars(55001.)'. I,as owner of the properly,or my employees with wages ns BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or 0ffcred for sale(Sec. 7044, Business and Professions DRAINS-FLOOR, ROOF,AREA,COND. 5.00 Code:1'he 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 SD,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. matt,are not intended or offered for sale.It,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4(EA) 200 builder will have the burden of proving that b - . . . e did not build or int- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Otbar O I,as..net of the property,am exclusively contracting with ❑ ❑. ❑ ❑ ❑ licensed contractors 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 Lnw 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 contracroost licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sea ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Dnte/ �. WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORKIiRS'COMPIiNSn'f1ON D17CLARATION WATER TREATING EQUIP. 5.00 - I hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE N0. or a certificate of Workers'Compensation Insurance,or a cerlilicd copy Ihereof(Sec.3800,Lab.C.). - Policy No. Company Q ❑ Certified copy is hereby funtished. FIRE SPRINK ENERGY T-24 Z ZO ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. Y N v N Applicant nt ❑ ❑ ❑ ❑ ~ In PERMIT ISSUANCE 10.00 UJ - CISRTIFIC(70 OP SAEIO TINS FROM WORKERS' FLOOD zorvE, A.L.u.c. W � COMPENSATION INSURANCE: PLG.CONTR. LIC.NO. PLG. 0- Z (This Section need not be-completed if the pencil is for one TOTAL Y❑ N❑ v❑ N❑ hundred dollars IS 100)or less.) L) O 1 certify that in the performance of the work I'or which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY W 1-' mit is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of Califontia. Uate - Applicant BUILDING 0 U a ALTER OR ADD TO MECH. 5.00 } m NOT'ICIi TO APPLICANT: If,eller coking this Certificate of fix- ? eniption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with FEE C lJ L) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10.000CF.M.) 4.00 . CONSTRUCTION LENDINGAGENCY AIR HANDLING UNIT(OVER 10=C.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 lin which this permit is issued(Sec. MICROFILM 3097,Civ.CJ, I HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC 3D V I certify that 1 have read this application and sett,that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply.wifh;III city unA county PLUMBING ordinances and state laws relating to building construction, and BOILER•OWP 13 H.P.'Of 100,000 B.T.U.) 6.00 - hereby ausho Tee representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purpous. (We) agree to save, indemnify and keep harmless the City of IS - 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 in ling oft is IT it. SUCH.CONT, LIC.NO. MECH. ` TOTAL TOTAL azure Applicant Contractor Uute OFFICE COPY.