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16817 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER. CITY OF CUPERTINO7 INSPECTION DIVISION 681` JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS��6 93- 40 ,7,+ 4 ✓o- � "UNIT# _LOT# - - PERMIT.EXPIRES IF WORK ' OWNER CONTRACTOR; IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD ' - 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS.FROM FOUNDATION - - NOTE: 11 - UFER - ALL GRADING AND DRAINAGE S ALL BE INSTALLED . LAST CALLED INSPECTION. PREGUNITE TO COMPLY WITH THE APPROVE PLANS AND CIN OF PEIam VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING - ^'�__ (.1 ;� ( C 1. U ELECTRICAL- � ISsun"cE LATE MECHANICAL , - / Q A SLUG,, ELECT, I PLG.. ,. MECII T \� El El - ❑" ❑ '' DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �� ?'V1 BUILDING GPER NIT WOOD FLOOR �� CJ VALUATION $TFT. PLUMBING MECHANICAL - - r - "�i &e ELECTRICAL PERNI T'TP FRAMING aLrcr/f INSULATION STORIES TYPE CONSTR. � � - OCC;GHOUP , RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - + ROOF - 'NOTENO FINAL INSP,SHALL BE MADE BEFORE s11 I T,I I.GOIH AncA rolAl 1C11IAGL DIAPHRAGM, THE CONSTRUCTION TAX IS PAID .. BUILDING USE ROOF SHEATHING RES IND CON --PB Dw., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. E) ❑ E 0 0 ASSESSORS PARCEL NO ROUGH SANA - - PLUMBING ELECT.ENERGY TRAC.1 N0. PARCELNO. TUBS&SHOWERPAIN - PLUMBING ENERGY '• MECHANICAL MECH.ENERGY ELECTRICAL ACC.DATE .ACC FILE NO - - BUILDING ENERGY ' FRAMING ELECT.FINAL TEST ZONING - ENG.SITE NO. INSULATION PLUMBING - - GAS TEST GAS MECHANICAL FIRE SPRINK 'ENERGY TZ4 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y "o EXTERIOR.SHEAR - ELECTRICAL RELEASE - FLOODmNE �A:L,D.c. I • INTERIOR SHEAR FIRE DEPT. Y❑ Nol Y ❑ NQ, SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING,- INTERIOR LATH - TEMPORARY APPROVALS BUILDING SCRATCH COAT, JELECTRIC PLAN CHECK -1 - GAS' ' FEE NO TAPE OR PLASTER.UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY'PHONING 252-4505, ELECTRIC E� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ' O Z PLEASE GIVE JOB ADDRESS WHEN PHONING. � - SEE PERMIT FOR EXPIRATION DATE —. MECHANICAL; IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL _CALLING FOR FINAL INSPECTION. 'OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN.ONLY MBER . • BUILDING PROJECT lDENTI FICATION PERMITNU APPLICATION & PERMIT ° 16817 BUILDING ADDRESS . �� ,� ,� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL �^:' OWNER'S PLAN CHECK VALIDATION NAME ,5 QTY. ELECTRIC PERMIT FEE ' PHONE Z I. NoMERAcroR's OUTLETS-SWITCHES-RECEP 10.00/1.00 uc.No. LIGHTING FIXTURES 10.00/1.00 CONTRACTORS 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 LIC.NO. ISIGNS TRANS. 3.00 AARCH,OR DDRESS ENG. SPECIAL CIRCUIT 5.66 , PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 ADDMOTORS SEE FEE,SCH. � ,> ADDRESS SERVICE CHANGE 20.00 0 0 o LICENSED CONTRACTORS DECLARATION w oISSUANCE DATE I hereby aflirm that am littnsed undo provisions of Chnpfer9 - , a z (commencing with Section 70001 of Division 3 of the Business and BLDG. ECT- PLG. MECH. z 0 License Class Lie.Number El ❑ w z Professions Code,and my license is in full force and effect. �..A- �\ o m- O DateContractor r - w \\� B41.WDING PERMIT .. w owN1iR.B UILDER DECLARATION - Cr\\�1INFORMATION W o u m 1 herebyaffirm that I am exempt from the Contractor's License MISC.•- REFERTO ORD u p VALUATION $/FT. HU0 < Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 10.00 ut Code Any city or county which r,quirsa permit to const ruct,alter, rt ¢¢ o' improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. wO u requires lire applicant for such permit to file a signed statement that TOTAL PERMIT TO m he is licensed pursuant to the provisions of the Contractor's License r z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the O LS�r S�U�T(/ x o Business and Professions Code)or that he is exempt therefrom and QTY- PLUMBING PERMIT FEE R F� the basis for the alleged exemption,Any violation.1 Stiction 7031.5 - STORIES TYPE CONSTR. i by any applicant for a permit subjects the applicant toa civil penalty of not more than five hundred dollar,(S500),): ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ I,as owner of tare 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 properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5,00 So,FT.FLOOR AREA TOTAL ACREAGE r himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 IINC.4 OUTLETS 6.00 or imposocilienI is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA.) 200 - builder will have lire burden of proving that h . . e did not build or im- BUILDING USE Roo 11 for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES CON PB Omer 1,us o of the property,.,,I exclusively contracting with ❑ ❑ ID ,❑ El1i nsed contractors to construct the project(Sea 7044,Business LAWN'SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO, and Professions Code:'I'he Contractor's Licenx Law docs 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 contmetons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 lire Contractors License Law_ TRACT NO. PARCEL NO. O lam cr�mpt I= A�_� ,BARC.for this WATER HEATER W/VENT 6.00 ' c.V t Owner. . Dae .•-�_ WATER SYSTEM 5:00 ACC.DATE ACC.FILE N0. SCJ WORT:F-RS'COMPENSATION DECLARATION WATER TREATING EQUIP,- 5.00 I hereby affirm that I have a certificate of consent to sell:insure. -. _ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITENO. mpy thereof(Sec 3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is Bled with the city inspection divicine. MISC.- REFER TOOR D. O Applicant V❑ N❑ V ❑ N❑ CC W CERTIFICATE 017 EXEMPTION FROM WORK ERS' PERMIT ISSUANCE - 10.00 FLOOD ZONE W > COlf1'[;NSATION INSURANCE PLG.CONTR. LIC.NO. PLG, CL O (This section Recd blot be colo NereJ it the permit is forone TOTAL Y❑ N❑ Y ❑ IN Z) Z hundred dollars IS 100)or IS,,I U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued.I shall not employ any person in any manner so'as to U become subject to the Workers'Com enmhion Laws of California. w Duh, ice A,, I ant p .BUILDING uq-r r a I'10 'ALTER OR ADD TO MECH., 5.00 r' �V+ �- } m NOTICH 1'O Aimild eco If,bjcr making this ,,'Certificate ,a Ex- - F Z_ emvision you should become subject m the Workers'Ccomply it.h APPLIANCE 5.00 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 10,000 C.F.M.) 4.00 • CONS"IRUCTION IJINDING AGENCY AIR HANDLING UNIT(OVER 10DMC.RM.) 6.00 SEISMIC FEE I hereby aflirm that there is it e.muncim,lending agency for _ EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.1. - HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's NamAdd e H EATI NG U N IT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC 1 certify that I have read this application end stale tk t le abuse VENTILATION FAN (SINGLE)' 4,00 informationis correct I agree to comply with all city and county PLUMBING ordinances and state laws relating to bIIIdiIb truction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 - hereby uutrolLe representatives of this city to enter upon the BOILER-COMP(Over 100000 BTU)SEE $CII. MECHANICAL above mentioned property for Inspection purposes. S (we) agree to W. indemnify and keep harmless the City of MISC.-• ' ' REFER TO ORD. • _ letter firm against liabilities,judgments, costs and expenses which CONST.TAX may N uny .way - uc mainsl aid City is consequence of the PERMIT ISSUANCE "10.00 •r ming o pti it. - MECH.CONT. I 'LIC.NO. - MEETHA` \ ( 8S_ TOTAL t�v Signalureof Applicant/Contractor Date . OFFICE COPY