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14491 _ Ty POST THISICARD NEAIR FR(TNT+OF,BUILDING PERM„NUME,E; -CITYOF CUPERTINO . ' INSC PE TION DIVISION � 4.491 JOB INSPECTION RECORD PERMIT E XPIRATION - 3 JOB ADDRESS 10407 , AVENIDA LANE ----- •UNIT#" -LOT# - PERMIT EXPIRES IF WORK. OWNER JAMES SECY CONTRACTOR IS NOT STARTED WITHIN.' _ INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR,180-DAYS,FROM' NOTE: LAST CALLED INSPECTION. i , LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CIT'OF PERMIT VquonnON _ PR EGUNITE CUPERTINO STANDARDS. GARAGE SLABSti POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED R•`z ! �°r„..,,,.. >. ' UNDERGROUND /SLAB ri F PLUMBING ELECTRICAL:' ISSUANCE DATE 'MECHANICAL` y RLuc ' ELECT. PLc VECR © ` El DINFORRMATTIONIONO NOT POUR•FLOOR UNTIL ABOVE HAS BEEN SIGNED - euwo M T - ` - WOOD FLOOR vnLUATION SIFT. PLUMBING by�F MECHANICAL; - `' - ” PERMIT TO 'qy; ELECTRICAL .FRAMING _ STORIES TYPE CONSTR. 'INSU LATION .� r Ucc.CROUP RES UNITS .PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED So.PT`FL.L.F AREA TOTAL ACREAGE ' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ' 'SHEATHING RES- IND- .CON. PB GO— ROOFAPPLYAO ROOFING UNTIL''ABOVE HAS.BEEN SIGNED` " ,::XFINALS ,e 'S r c 'DATE, 4,ANSP:4,r ❑' ❑ '❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY TRACT No. PARCEL No TUBS'&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ELECTRICAL 7,2 ,YACC.DATE ACC.FILENO, BUILDING ENERGY 1 y • ' ' FRAMING ELECT.FINAL TEST � ` INSULATION PLUMBING zoNlNc ° BNc.SITE Nd.. GAS TEST;- GAS { FIRE SPRINK ENERGY 1 24 MECHANICAL v ❑ N❑ v-❑ .N❑• COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - ' EXTERIOR-SHEAR ELECTRICAL RELEASE FLOODZONE A.LUC .INTERIOR SHEAR FIRE DEPT. v ❑ N01 Y ❑ NO: SHEETROCK. GRADE FEE SUMMARY EXTERIOR LATH , BUILDING INTERIOR.LATH. TEMPORARY APPROVALS BUICDwG 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 FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, egecTRlc o�. ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. •'` z — SEE PERMIT-FOR EXRIRATION,DATE _. .. MECHANICAL' IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE!. TOTAL CALLING`FOR FINAL INSPECTION. OFFICE COPY, - g• rt k. C'- ' ` ADDITIONAL PERMIT FEES . 3 . BUILDING PROJECT IDENTI FICATION' ' t '. VALUATION BU 1 +,I1 Ip NG 'Y' nooses R UP �( rti r t i . roinmiR ` FEE SUMMARY w �Ir CONTRACTOR5 Vr 'BUILDING J � •d'!,S 1 d'- ', 7 uary ''-PLAN CHECK 3'� .. A. r ., CONTRACTORS -p;.. FEE + 3 ' fo('A i4 ApOREss 1 ,<' 'PRONE ,SEISMIQ-FEE ' _ n• tC 1 ;I .f QTY. ' ELECTRIC PERMIT v �. xFEIE a1 r t ..� 'ELECTRIC UTLETS SWITCHES.RECEP _ t r 1 _ u3.3 LIGHTING F.IXTURES ^,..;.•.t :'PLUMBING `� yN1•' 7'. PPLIANCES,R ESI D E NT I A L� PANELS F MECHANICAL( SIGNS w SIGNSTRANS.S 1 SPECIALCIRCUIT, 'y '1 a'r. y" 1 ,� PERMIT VALIpATION -" EMP METER OR POLE INS." ', f MOTORS 'SEE FEE S H! SERVICE CHANGE , '.7 SY/� �C1N't4.fl^—� ."•• •e Z''Z TOT'A 'L {1etf1J %�d"� '� N. a - ��", ' ISSUANCE GATE f w Jd QTY: PLUMBING PERMIT FEE f eLOc ELECT ,PLc ABECH. . ,. .. 4..p { t �"o ALTER-DR VENT WATER(EA.) 3 0 O '� O "7 ' + V 'C BACK FLOW PROTECT.DEVICE 1 w' - ` LC,V"' „DRAINS=FLOOR„ROOF,AREA;COND .-+, ` T A' 0a _ FIXTURES-PERTRAP ' ,.' }•2 GAS-,EA:SVSTEM 1,INC.4,OUTLETS ' V GAS-EA.SYSTEM-,OVER4IEA) :. INDUSTRIALWASTE.INTER. f + { A 1 LAWN SPRINKLERS-11NC5 V B •1 i� ,. LAWN SP.RINKLERS' OVER.5(EA) 3 - I d SEWER.SANITARV STOR M'EA.200ft1. ve l 1 WATER,HEATER W/VENT INATER.SYSTEM - 1 t - WATER TREATING EQUIP . i. A ,71 QTY. MECHANICAL PER FEE H `= ...' - .-. ALTER OR ADD TOILMECH:'.. • "- - '4> ���'�� �� }} 4 'k APPLIANCE '..,. ., •„-,-., ',,,. - 4.l If!. AIR,HANDLING UNIT(T0,10=C.F M 1,; AIR HANDLING UNIT(OVER 10)MC FMT , - . { ! t EXHAUST'HOOD'(WITH DUCT) - -•1 .... HEATING.UNIT TO 100,000 B T U) j.. . HEATING"UN IT IOV ER 100,0008 T U Id':.' ^.` VENTILATION'S FAN'(SINGLE) BOILER COMP I3 H.P.or 100,000 ax, 1 " BOILER COMP to 306000 Bial SEEFeFSC'r { •' TOTAL 1 __ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY •' PERMIT NUMBER ^' BUILDING PROJECT IDENTIFICATION, aUILDINc - APPLICATION &PERMIT TAD ESS ILtAve lax 0 BUILDING -'ELECTRICAL-PLUM6ING-MECHANICAL -.. -�" ERI l PLAN CH ECK VAU DATION NAME �,IVL"2 ;-7 A ELECTRIC PERMIT FE= r. PRGNE '� NOAMpRAc7onb OUTLETS-SWITCHES-RECEP 10.0011.00 uc.NO. 'j LIGHTING FIXTURES - 10.00/1.00 - CONTRACTOR'S PPLIANCES-RESIDENTIAL' 4.00 ' ADDRESS _ PHONE PANELS 10AO L DATE OF APPLICATION ARCHITECT - PLAN CHECK FEE P,C.NO. OPANELS (OWER 200 AMP) 20.00 OR. ENGINEER- IC.NO SIGNS TRANS. 3,00 - ARCH.GR ENG. . PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 r' zIv TEMP.METER OR POLE INS. 20.00 ' Ars ADDDRESSDRESS MOTORS SEE FEE SCH. ' SERVICE CHANGE 20.00 1woo - LICENSED CONTRACTORS DECLARATION a O , a O U 1 hereby affirm Ihat I am licensed under provisions of Chapter 9 ISSUAN E DATE -' N a $ (commencing will,Section 7000)of.Division 3 of the Business and - -BLDG. 'ELECT. PLG, MECH. y z Professions Code,and my license is in full farce.and effect. pi w License Class Lia Number ❑ P: Lf Date Contractor JAN I rc I w OWNER-BUILDER DECLARATION BUILDING PERMIT K f,LL I- I hereby affirm that I um exempt from tire Contractor's License MISC.- REFER INFORMATION u O¢ Law for the following reason.(Sec.7031.5,Business unJ Professions VALUATION $/FT. I- - PERMIT ISSUANCE 10.00 0 Code:Any city or county which requires a permit to construct,alter, , Q ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. ,LIC.NO. $LEC. a. O u requires the applicant for such permit 10 file a signed xtatemenl that - TOTAL -w PERMIT TO ro w he is licensed pursuant to the provisions of the Contractor's License L' A HZ > Law(Chapter 9(commencing with Sect ion 7000)of Division 3 of the (�G` 4 o Business and Professions Code)or that he is exempt therefrom and QTY. _ PLUMBING PERMIT FEE the basis for the alleged exemplion.Any violation of Section 7031.5 STORIES k TYPE CONSTR. n ; by any applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more titan five hundred dollars($5007.): ❑ I,as owner of the properly,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 I Tort re is not intended or offered I'or 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 properly who builds or improves thereon,and who docs such work FIXTURES,PER TRAP 5.00 So.FT FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsare Got imendedoroffered for safe.If,however,the building GAS-EA.SYSTEM-.l1NC.40UTLETS 6.00 or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving Thal be did not build or im- BUILDING USE prove for purpose ofsaleJ. RES IND CON PB Omer I,as owner of the property,am exclusively contracting will, INDUSTRIAL WASTE INTER. 30.00 ED El ❑ C1Ile n N contractors to construct the poanct(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon.and who LAWNSPR IN KLERS-OV ER 5(EA.) 1.00 contracts for such projects with a contmetor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ Iunl Exempt It Sec, ',B.&P.0orthis WATER HEATER W/VENT - 6.00 eason Owns Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORK CRS'COMPENSATION DECLARATION WATER TREATING EQUIP. - 5.00 I hereby affirm Ihm 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.C.). Policy No. Company 0 ❑ Cerlifiedcopyisherehyl'unliSlICd' FIRE SPRINK ENERGY z Z ❑ Certified.copy is'filed with Ilse oily inspection division. T2A V N� v N� FO Applicant MISC.- REFERTOORD. N CERTIFICATE OF EXEMPTION 17ROM WORKERS' PERMIT ISSUANCE ;10.00 FLOOD ZONE A.L.u.C. L'> COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG, ' Z This section need not he coinpleleA if the permit is for ane TOTAL Y❑� N❑ V N hundred dollars IS 100)or less.I U O 1 certity 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 many manner so as to 0 w become subject to the Workers'Compensation Laws of California. zt Dmc Appll°°m ALTER OR ADD TO MECH. 5.00 BUILDING - } to NOTICI7'1'0 APPLICANT: If,after making this Certificate of Ex- r 2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK _ provisions of the Labor Code, you most forthwith comply with FEE U such provisions or this permit Shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F,M.) 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER FOXIC.F.M.) 6.00 SEISMIC FEE I hereby,affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the Performunce of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). 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 I certify thatll,ave read❑lis upplica0oa and state thatthe Ulove VENTILATION FAN (SINGLE) 4.00 information is correct.1 agree to comply with all city and county PLUMBING hereby authorize representatives • ordinances and some laws refiling to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 othis purposes.s clty-to soler upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above mentioned property forinspectionthe (We) agree to save, indemnify and keep hiun less the City of 'MISC.- REFER TO ORD. upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX in any way accrue against ,'I City in consequenceof theJay an ofthis permitMECH.CONT. LIC.NO. MECH. TOTAL TOTAL ore of Applicant/ ntracto-d,­ Dafe OFFICE COPY