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9244
" _ POSTTH.ISCARQ!NEAR FRONT OF BUILDING-,.., ' ,C : , pff> CUPERTINO INSPECTION DIVISION J06 INSPECTION RECORD l �OloSJadla.;.. JOB ADDRESS; IIII _ ;UNIT# - LOT #. OWNER' N. - • CONTRACTOR�1 - ` :�-INSPEC ION ' '.' DATE'',. : INSPECTOR INSPECTION RECOR FOUNDATION J S UFER SEISMIC FEE PREGUNITE MICROFILM ELECTRIC PLUMBING POUR NO CONCRETE UNTIL ABOVE HAS BEEWSIGNED - r.- UNDERGROUND /.�SLAS'ar`.?.,. ` PLUMBING TOTAL ELECTRICAL MECHANICAL DO NOT POUR FLOOR - UNTIGABOVE.HAS BEEN - SIGNED WOOD. FLOOR ` r'., PLUMBING.,: ; .. MECHANICAL ELECTRICAL' - FRAMING.; INSULATION•.. PLACE NO:SUBFLOOR UNTILABOVE'HAS:BEEN SIGNED 4 ROOF' ;.- ...... D IAPH RAGM," - - MECHANICAL ". - ELECTRICAL - - FINALS DATE "FRAMING - SAN # INSULATION .. PLUMBING G AS. . MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH - INTERIOR ELECTRICAL "jrf_jf LATH EX, TERIOR r,.,. FI RE.DEPT. -- SHEETROCK" GRADE - SHEARINTERIOR-._- - - BUILDING. ooL -S�l SHEAR EXTERIOR - TEMPORARY. APPROVALS FIREWALLS.' -. ELECTRIC GAS NO TAPE"' PLASTER UNTIUABOVE�HAS_BEENr SIGNED. OCCUPANCY 7CCUPANCV OF BUILDING IS NOTP,ERIA ITTED'UNTIL.BUILDING FINAL ISSIGNED BY BUILDING IN ARRANGEFO;RANSPECTION BY PHONING 252 -450E ONE WORKING.DAY. BEFORE REQUIRED INSPECTI PLEASE GIVE JOB ADDRESS'WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — .K IMPORTANT! PLEA.SE;READA EVE RSE SIDE BEFORE - '. CALLING FOR FINAL INSPECTION. OFFICE COPY PERMIT NUMBER 9944 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. BUILDIN INFORI VALUATION PERM ip ©0 (, RES FIRE SPRINK Y I] N0 ENERGYT.24 - Y 13 N❑ FLOOD ZONE .. y A.L. U.C. Y�. IN FEE SUMMARY-; BUILDING PLAN CHECK FEE SEISMIC FEE MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TAX TOTAL APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT lDENTIFICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER G 9244 eulLOI SS ADD 55 OWNER PLAN CHECK VALIDATION NAME f PHONE OTY. ELECTRIC PERMIT FEE V //,? ry a TORS NA E Ic. No. UTLETS - SWITCHES - RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CON T ac RESS. R C ADD APPLIANCES - RESIDENTIAL 4.00 PANELS 1 10,00 NONE DATE OF APPLICATION T OR ENGINEER LIC. ND, PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P. C. NO. ISIGNS TRANS. 3.00 noo iss ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 ZIP APPLI CANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 -1/(0 %S /' LICENSED CONTRACTORS DECLARATION TEMP. POLE 30.00 I hereby effinn that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000) of Division 3 of the Business and Professions CWWNIR-BUILDERDECLARAT is in full for and ec Licens Class c. Numbe _ - �r BLDG. ❑ I ELECT. ❑ PLG. MECH. ❑ ❑ Dale OntraC[n BUILDING PERMIT N I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (See. 7031.5, Business and Professions Code: Any city circularity which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed Statement that he is licensed pursuant to tine provisions of the Contractor's License Law (Chapter 9 (commencing with Section 700() of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged esoin,tion. Any violation Of Section 7031.5 INFORMATION MISC.- REFER TO ORD VALUATION Y ,f- •:.. O U V (J $ /FT. PERMIT ISSUANCE (w ELEC. GONER. LIC. NO, ELEC. TOTAL oZ0 � PERMIT TO wl,4, OTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. f by any applicant for a pemnit subjects the applicant toa civil penalty of not more than fivehumred dollars ($500).): ❑ I, as owner of the property, or my ennploynes with wages as their sole compensation, will do the work, and the structure is not " (TVry/� je ALTER-DRAIN & VENT-WATER (EA.) 5.00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS- FLOOR, ROOF, AREA,COND- 5.00 intended or offered for sale (Sec. 7044, Business and Professions 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. PT FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such improve- s m e ,of intended or offered for sale. IL however, the building f ni improvement is sold within one year of completion, the owner. builder will have the burden of proving that he did not build or im. prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - 1 INC. 4OUTLETS 6.00 GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES INO CON PR Omxr ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code The Cnntracor's License Law does not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS- I INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects will, a contmo os) licensed pursuant to cite Contmctoi s License Law. SEWER - SANITARY -STORM EA. 200ft /10.00 TRACT NO. PARCEL NO. ❑ Inn <xempt under Sec. ,BRI'.C. for tlnis reason WATER HEATER W /VENT 6.00 Owner Dare WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORK It RS'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 5 ZONING ENG. SITE N0. J of ✓u copy thereof(Sec. 3800, I.A.C.). Policy No Contrary ' ❑ Certified o yis hereby fu ishetl. Ji 6 ❑ Cerfifie try is Eled Ikt' I n n ec mn 9•' Applicant wrlL s MISC. - REFER TO ORD. FIRE SPRINK V N ❑ ❑ ENERGY T -34 V N ❑ ❑ ER'1'IFICATE OIr FXIih1PT ION PROM WORKERS' PERMIT ISSUANCE in no �- FLOOD ZONE A.L.UC. PLG. CONTR. LIC. NO. PLG. TOTAL a�� COMPFNSA'I']ON INSURANCE (This .,firm need not be completed if the permit is for one Y ❑ N ❑ Y ❑ N ❑ hundred dollars IS 100) or Im I I certify that in the performance of the work for which this per- mil is issued, I Shull not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers 'Compensation Laws of California. Date- NOTICE '1'0 APPLICANT: IL after making this Certificate of Ex- - OR ADD ALTER O ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK emption, you should become subject to line Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions o, this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 AIR HANDLING UNITIOVER IO,OODC.F.M.) 6.00 SEISMIC FEE 6 CON'STRUCHON LENDING AGENCY I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 are performance ance of the work for which this permit is issued (Sec. HEATING UNIT (TO 100,000 B.T.U.)" 8.00 HEATING ITIOVER 100, 000 B.T.U.)9.50 ELECTRIC a Q Lender's None Lender's Address I certify that I leave read this application and state that d county information n cormcr. I agree to comply with all airy and county ordinances and Sulu IuwS refining to building construction, 'nd VEN7ILAT N FAN (SINGLE) 4.00 PLUMBING _ C%L` BOILER - COMP I3 H. P. or 100,0000.T.U) 6.00 BOILER -COMP (over 100,000 BTU) SEE FEE SCH. - MECHANICAL 1 clay authorize representatives of this city to enter upon the 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 may in any ay 'ecru, agai said City in consequence oC tl e CONST. TAX pERM1T ISSUANCE 10.00 ZF4 • anllttg pcnnit. MECH. CONE. LIC. NO. MECH. TOTAL S� / TOTAL ,�� 9 'n Ilan C nNilGf Or D'J INSPECTOR COPY